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Rubella (German Measles)

Commonly called German measles, rubella is an acute, mildly contagious viral disease that produces a distinctive rash and lymphadenopathy.

Rubella and measles are both contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either illness. However, rubella is neither as infectious nor usually as severe as measles, which is why rubella is also called three-day measles. There is one important exception: If a pregnant woman contracts rubella, especially during her first trimester, the virus can cause death or serious birth defects in the developing fetus.

The incubation period is 18 days with a duration of 12 to 23 days. The disease is self-limiting and the prognosis is excellent, except for congenital rubella, which can have disastrous consequences.

Causes

The rubella virus, a toga virus, is transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected people. It's communicable from about 10 days before until 5 days after the rash appears. Rubella can also be transmitted transplacentally. Humans are the only known hosts for the virus.

Signs and symptoms

  • Low-grade fever (102 F or lower)
  • Headache
  • General discomfort or uneasiness (malaise)
  • Runny nose
  • Inflammation of the eyes (bloodshot eyes)
  • Rash with skin redness or inflammation
  • Muscle or joint pain
  • Encephalitis (rare)
  • Bruising (from low platelet count, rare)

Diagnostic tests 

Clinical signs and symptoms usually are sufficient to make a diagnosis, so laboratory tests seldom are done. Cell cultures of the throat, blood, urine, and cerebrospinal fluid, along with convalescent serum that shows a fourfold increase in antibody titers, confirm the diagnosis. Rubella-specific immunoglobulin M (IgM) antibody also can be determined by laboratory testing.

Treatment

Because the rubella rash is self-limiting and only mildly pruritic, it doesn't require topical or systemic medication. Treatment consists of antipyretics and analgesics for fever and joint pain. Bed rest isn't necessary, but the patient should be isolated until the rash disappears.

Immunization with the live rubella virus vaccine (RA 27/3), the only rubella vaccine available in the United States, is necessary for prevention. The vaccine should be given with measles and mumps vaccines at age 15 months and a second dose during childhood.

Home Treatment

Rubella is usually a mild illness, especially in children and typically requires little special care at home. Monitor your child's temperature, and call your child's doctor if the fever climbs too high.

To relieve minor discomfort, you can give your child acetaminophen or ibuprofen. Avoid giving aspirin to a child who has a viral illness because the use of aspirin in such cases has been associated with the development of Reye syndrome , which can lead to liver failure and death.

Prevention

Since the introduction of rubella vaccine, the incidence of rubella has decreased by more than 99 percent. Most cases today occur in adults who have not been vaccinated. The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine. It is usually given when the child is 12 to 15 months old, and then again between 4 to 6 years of age.

Other ways to prevent the spread of rubella:

  • Children should not attend school for seven days after the onset of the rash.
  • Children who are born with rubella are considered contagious for the first year of life.
  • Assure that all of your child's contacts have been properly immunized.


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