Rubella, also known as “German Measles,” or “three-day measles,” is a viral disease that is usually mild, but can sometimes cause serious complications or even death. This disease is caused by a different virus than the one that causes standard measles. The most recognizable symptom of rubella is the rash, which begins on the face and spreads from head to toe. It is a fine rash containing both raised and flat areas and usually lasts about three days. Other symptoms of rubella include a mild fever (usually less than 39°C), enlarged lymph nodes in the neck and behind the ears, nausea, runny or stuffy nose, conjunctivitis (red, itchy eyes), headache, and joint pain (especially in adult women). Usually, the rash is the first symptom in young children, and other symptoms occur before the rash in older children and adults.
Rarely, rubella can cause ear infections or encephalitis (brain inflammation). Rubella is particularly dangerous in pregnant women, because it may cause miscarriage, stillbirth, or health problems/birth defects in the baby. It is estimated that as many as 90% of babies born to mothers who had rubella during pregnancy will develop Congenital Rubella Syndrome. Possible problems in the baby include defects in the heart, brain, or other organs, delayed growth, vision and/or hearing loss, type I diabetes, blood count abnormalities, autism, and developmental or learning delays. The risks associated with rubella in pregnancy are highest during the first three months (first trimester), but the virus can still cause problems in the baby if it is contracted later in pregnancy. There is no cure for Congenital Rubella Syndrome
There is no antiviral treatment for Rubella that relieves symptoms or shortens the duration of the illness. There are some medications available that can help with symptoms. Most of the time, medication treatment is not necessary, as the disease is usually mild and only lasts a few days. Rest and adequate fluid intake are important.
Pain Relieves/Fever Reducers, also called “analgesics” or “antipyretics,” are used to help make patients with rubella more comfortable, treating symptoms such as fever, headache, and joint pain. Examples include acetaminophen, aspirin, and ibuprofen. Acetaminophen works by stopping pain signals and working on the part of the brain that causes temperature regulation. Ibuprofen and aspirin are NSAIDs (non-steroidal anti-inflammatory drugs) that treat pain and fever by decreasing inflammation in the body. Aspirin should NOT be given to children under 16 years old due to a serious potential reaction called Reye’s Syndrome.
Corticosteroids are not used routinely in Rubella treatment. However, they may be used in severe cases to decrease inflammation in the body and relieve symptoms. They are often used in cases of Rubella-related encephalitis. Examples include prednisone, methylprednisolone, and dexamethasone, which are given orally or by injection. Hydrocortisone creams and ointments can help with rash symptoms.
Antihistamines can help soothe itching associated with the Rubella rash and may help ease symptoms of conjunctivitis and runny nose. They work by blocking receptors in the body that release histamine, a substance involved in reactions such as itching, rash, red, watery, eyes, and runny nose. Examples include diphenhydramine, chlorpheniramine, brompheniramine, loratadine, and cetirizine. These are usually given orally. Diphenhydramine is also available as a topical cream.
Common side effects associated with treatments for Rubella symptoms include nausea, vomiting, diarrhoea, drowsiness, dizziness, increased appetite, and irritability. Because Rubella is a short-term illness, dangerous side effects associated with a longer duration of use of these medications are rarely an issue. However, it is important to take medications exactly as prescribed, or as directed in the package instructions, and report any unexpected and/or troublesome symptoms to your healthcare provider.
A vaccine is available to provide protection against Rubella infection. However, it is not part of the routine childhood vaccination programme in South Africa. You should talk to your healthcare provider about whether receiving the rubella vaccine is right for you and/or your child. Usually, this is in the form of the MMR (measles, mumps, rubella) vaccine. Because of the dangers to the baby associated with rubella infection in pregnancy, it is recommended that women of childbearing age who intend to become pregnant receive the vaccine. However, it is NOT recommended during pregnancy because of a slight risk of infection with rubella, since it contains a live, weakened strain of the virus. It is also recommended that you use a form of birth control to prevent getting pregnant for one month after receiving the vaccine. Unlike standard measles, administering the rubella vaccine right after known exposure to the rubella virus is not proven effective in preventing infection.
Vaccine side effects include mild fever, tiredness, body aches, and pain/irritation at the injection site. These are signs that the vaccine has caused an immune response to help the body fight the virus. There have been reports of the MMR (measles, mumps, rubella) vaccine causing autism. However, scientific studies have found these reports to be false, and there is no known link between autism and vaccines.
Infection control is extremely important in areas where the rubella vaccine is not routinely administered. If you or your child develops symptoms of rubella, it is important that you stay away from others while experiencing symptoms and for at least a week after the rash appears, because it can still be contagious during that time. You should avoid sharing eating utensils, plates, and cups, and wash your hands frequently. Be sure to cover your cough or sneeze and consider masking to prevent transmission of rubella. The vaccine can help control outbreaks of rubella and protect pregnant women and their babies from rubella infection and health complications.