RUBELLA (GERMAN MEASLES)

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Rubella, commonly known as German measles or the 3-day measles, is a viral infection caused by the rubella virus. While often mild in nature, german measles can pose significant risks, particularly to pregnant women and their unborn babies.

Unlike rubeola, which is another term for measles, rubella typically presents with milder symptoms. However, it can pose serious risks, especially to unborn babies if contracted during pregnancy. The primary defense against german measles is vaccination with the measles, mumps, and rubella (MMR) vaccine.

Causes

German measles is caused by the rubella virus. Transmission occurs when an infected individual releases tiny droplets laden with the virus into the air or onto surfaces through coughing or sneezing. Additionally, pregnant individuals can pass german measles to their unborn babies through the bloodstream.

Those infected with the virus are contagious a week before and after the appearance of the rash. Some carriers may not exhibit symptoms but can still transmit the virus to others. If diagnosed with rubella, it’s crucial to inform those who have been in close contact, especially pregnant individuals.

Symptoms

Symptoms of German measles are generally mild, particularly in children, and sometimes may not manifest at all. The most common indicator is a pink or red-spotted rash, which usually begins on the face and then spreads across the body, lasting around 3 days. However, in individuals with darker skin tones, the rash may appear darker and rougher in affected areas. Alongside the rash, other symptoms may include:

• Mild fever (ranging from 99°F to 100°F)
• Swollen and pink-colored eyes (conjunctivitis)
• Headache
• Swollen glands behind the ears and on the neck
• Stuffy, runny nose
• Cough
• Sore joints (more common in young women)
• mild conjunctivitis.
• General discomfort
• Swollen and enlarged lymph nodes

Long term effects of rubella

The long-term effects of German measles can vary, but some individuals, particularly women or those assigned female at birth, may experience arthritis as a complication. Arthritis associated with german measles typically manifests as sore joints and may last for an extended period, although it usually resolves within two weeks for most affected individuals. However, in a small percentage of cases, arthritis may persist as a long-term condition. It’s important to note that while arthritis is a potential long-term effect of german measles , it is relatively uncommon compared to other complications.

Risk Factors

1. Unvaccinated Individuals: People who have not received the rubella vaccine are at increased risk of contracting the virus.
2. Pregnant Women: Rubella infection during pregnancy can lead to serious complications, including miscarriage, stillbirth, or congenital rubella syndrome (CRS) in the unborn baby.

Prevalence of Rubella

The prevalence of German measles varies globally, with outbreaks occurring more frequently in areas with low vaccination rates. The widespread use of the measles, mumps, and rubella (MMR) vaccine has led to a significant decline in rubella cases in many countries.

Pregnancy and Rubella

Rubella poses significant risks during pregnancy, particularly if infection occurs in the first trimester, potentially leading to severe complications or even fetal death. Congenital deafness is a common consequence of German measles infection during pregnancy.

Some pregnant individuals infected with German measles may experience miscarriage, while others may face the tragic loss of their baby soon after birth.

To safeguard against rubella-related complications, it’s crucial to ensure immunity before pregnancy. Checking vaccination records to confirm MMR vaccine administration is recommended, with the second dose typically given between ages 4 and 6. If planning pregnancy, wait at least 4 weeks after vaccination. However, if already pregnant, vaccination is not advised.

During pregnancy, routine screening is conducted to assess German measles immunity. If unsure about prior MMR vaccination, inform your doctor promptly for immunity testing via a blood test.

Congenital Rubella Syndrome

Congenital Rubella Syndrome (CRS) results from fetal exposure to the rubella virus during pregnancy. Infections in early pregnancy can lead to miscarriage, stillbirth, birth defects, or hearing impairment in newborns. The risk of CRS is highest during the first trimester and decreases thereafter, becoming rare after the 20th week.

Children affected by CRS often exhibit multiple serious conditions, including developmental delay, cataracts, congenital heart disease, and hearing impairment. In some cases, only one condition may manifest, with hearing impairment being the most common.

Diagnosis of German measles

If german measles is suspected, your doctor may conduct blood tests and a virus culture to confirm the infection. The virus culture involves collecting samples from the throat, nose, or urine. Blood tests reveal different antibodies in your bloodstream, aiding diagnosis.

Two types of rubella-specific antibodies emerge post-infection:

• Rubella IgM: This antibody surfaces shortly after German measles infection or vaccination, lasting for about 3 months.
• Rubella IgG: Appearing roughly four days after the rash onset, this antibody peaks within one to two weeks. It can persist in the body for a lifetime.

Testing for antibodies is most effective within five days of fever or rash onset, with over 90% of rubella cases showing positive results for rubella IgM.

Differentiating rubella from measles involves similar diagnostic procedures. German measles diagnosis relies on detecting rubella-specific antibodies through blood tests or virus cultures, whereas measles diagnosis entails blood tests and throat or nose swabs.

Treatments for Rubella

There is no specific antiviral treatment for German measles. Antibiotics are ineffective against German measles since it’s a viral infection. Typically, German measles in children is mild and may not require treatment. Fever and discomfort can be managed with children’s acetaminophen or ibuprofen, while aspirin should be avoided due to the risk of Reye’s syndrome, a rare but severe condition causing brain and liver swelling.

Pregnant individuals suspected of German measles infection should promptly consult their doctor. Hyperimmune globulin, a type of antibody, may be administered to bolster the body’s defense against the virus.

Home Care Remedies

1. Rest: Get plenty of rest to help your body recover from the infection.
2. Hydration: Drink plenty of fluids, such as water, herbal tea, or clear broth, to stay hydrated.
3. Comfort Measures: Use cool compresses or oatmeal baths to soothe itching and discomfort from the rash.

Prevention

1. Vaccination: Children require two doses of the MMR vaccine, with the first typically administered between 12 and 15 months of age, and the second between 4 and 6 years of age.
   • For infants traveling to regions where rubella is prevalent, vaccination can begin as early as 6 months old.
   • For individuals of childbearing age who haven’t received vaccination, it’s recommended to get the MMR vaccine at least one month before pregnancy, particularly if planning to travel to rubella-prone areas.
   • The MMR vaccine, which combines protection against measles, mumps, and rubella, is commonly administered. It may also incorporate the varicella vaccine for chickenpox, known as the MMRV vaccine. Vaccination typically occurs between 12 and 15 months of age, with a booster shot between 4 and 6 years.
   • Receiving the vaccine provides lifelong immunity against rubella. Additionally, if vaccinated individuals have babies, the newborns are protected against rubella for approximately 6 to 8 months. Vaccination not only prevents rubella during subsequent pregnancies but also safeguards against the transmission of rubella to newborns.
2. Avoidance of Exposure: Avoid close contact with individuals who are infected with rubella, especially if you are pregnant or planning to become pregnant.

Complications of Rubella

German measles complications are most concerning during pregnancy, where the virus can transfer from the mother to the unborn baby in the womb, posing the highest risk within the initial three months of pregnancy.

Infected babies are susceptible to serious conditions like Congenital Rubella Syndrome (CRS), although this occurrence is very rare in the U.S. However, if a baby travels to a region where the virus is prevalent, they may contract CRS.

CRS-related health issues in infants can encompass:

• Heart defects
• Cataracts
• Deafness
• Delayed learning
• Liver and spleen damage
• Diabetes
• Thyroid problems

German measles can also lead to complications in non-pregnant women and men. Affected young girls and women may experience sore joints (arthritis), typically resolving within two weeks, although a small percentage may endure it long term. This condition rarely affects men and children.

In rare instances, german measles can provoke more severe health problems such as brain infections or swelling and bleeding issues.

When to See a Doctor

Seek medical attention if you develop symptoms of German measles , especially if you are pregnant or have been exposed to someone with german measles . Prompt diagnosis and appropriate medical care are essential, particularly for pregnant women and their unborn babies.

Outlook/Prognosis

In most cases, German measles is a mild and self-limiting illness. However, complications can occur, particularly in pregnant women and their babies. Adhering to vaccination recommendations and seeking prompt medical care can help mitigate the risks associated with german measles infection.

Sources

1. Centers for Disease Control and Prevention. (2021). Rubella (German Measles) – About Rubella.
2. World Health Organization. (2021). Rubella.
3. Mayo Clinic. (2021). Rubella (German Measles).
4. United Kingdom National Health Service: “Rubella (german measles).”
5. Nemours Foundation: “About Rubella.”