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Rubella is a viral illness that causes a skin rash and joint pains. A rubella infection is mild for most people, but it can have catastrophic consequences for an unborn baby. If a pregnant woman contracts rubella, her baby is at risk of congenital rubella syndrome (CRS), which can cause severe and permanent birth defects or death.
Rubella is sometimes called German measles but rubella is a different viral disease to measles.
Rubella is uncommon in developed countries, including Australia, because of the widespread use of the rubella vaccine. However, outbreaks still occur so it is important to continue vaccinating children to prevent the spread of infection to pregnant women.
Symptoms
About half of rubella cases are so mild that symptoms don’t occur. If symptoms do occur, they usually appear between two and three weeks after infection. Some of the signs and symptoms of rubella may include:
- Mild fever
- Headache
- Runny nose
- Sore eyes
- Skin rash
- Swollen lymph nodes
- Joint pains.
Complications
Rubella is a mild illness compared to measles. Most people recover within about three days. However, rubella can sometimes lead to complications including:
- Arthralgia – lingering joint pains may take a month or more to resolve
- Otitis media – inflammation of the middle ear
- Encephalitis – inflammation of the brain, which can be fatal in some cases.
How it is spread
Rubella is most commonly spread when someone ingests (swallows) or inhales the cough or sneeze droplets from an infected person.
High-risk groups
Rubella is uncommon in Australia thanks to vaccination but cases still occur. Anyone who hasn’t been vaccinated against rubella is at risk, in particular:
- Travellers to areas where rubella vaccination programs aren’t widespread and visitors from these areas
- Child care workers
- People who work in health care settings such as hospitals
- Unborn babies whose mothers have low or non-existent rubella immunity.
Congenital rubella syndrome (CRS)
A pregnant woman can spread the rubella infection to her unborn baby. This can have catastrophic consequences such as miscarriage or birth defects, particularly if the mother contracts the disease during the first trimester (first three months) of her pregnancy. About nine in every 10 foetuses exposed to rubella during the first trimester will develop congenital rubella syndrome (CRS).
Birth defects associated with CRS include:
- Deafness
- Blindness
- Heart defects
- Intellectual disability
- Impaired growth
- Inflammation of various organs such as the brain, liver or lungs.
A pregnant woman who suspects she may have been exposed to rubella should see her doctor.
Diagnosis
Rubella can be difficult to diagnose because the signs and symptoms are vague and non-specific. For example, many illnesses apart from rubella cause fever and the rash looks similar to other types of rashes. Tests used to diagnose rubella may include:
- Medical history including immunisation status and travel history
- Physical examination
- Blood test.
Treatment
No specific medical treatment for rubella exists. Antibiotics don’t work because the illness is viral. Treatment is often unnecessary anyway because the symptoms are usually mild. Options may include:
- Bed rest
- Plenty of fluids
- Paracetamol to reduce pain and fever
- Isolation for at least four days following the onset of rash to reduce the risk of transmission to others.
A pregnant woman who contracts rubella can discuss her options with the doctor. Medicine can help the woman’s immune system fight the infection but does not reduce the risk of harm to the unborn baby.
Prevention
Immunisation is the best way to prevent rubella. A single rubella infection usually also offers lifelong immunity for most people. Although unlikely, it is still possible to contract rubella despite vaccination or previous rubella infection.
Vaccination is available
The rubella vaccine in Australia is combined with measles and mumps vaccines. In Victoria, this vaccine is available free to:
- Young children – at 12 months of age
- Children – at four years of age
- School-age children – as a ‘catch-up’ immunisation, if they have not been fully vaccinated.
Immunisation is also recommended for adults born during or since 1966 – unless you have evidence of having received two doses of MMR or a blood test to show natural immunity to measles, mumps and rubella. If you have not received the vaccine, ask your doctor about catch-up doses.
Pregnancy
Women considering pregnancy should have a blood test to check their rubella status and then a booster shot if necessary. A pregnant woman should never receive the vaccine and pregnancy should be avoided for 28 days after the vaccination.
Vaccination is not for everyone
Vaccination is not recommended for some people. A person with an impaired immune system should not be vaccinated. Some of the possible causes of impaired immunity may include:
- Certain medications, such as corticosteroids
- Immunosuppressive treatment
- Some types of cancer, such as Hodgkin’s disease or leukaemia
- Hypogammaglobulinaemia, a congenital or acquired condition characterised by extremely low levels of antibodies.
Pre-immunisation checklist
Before immunisation, it is important that you tell your immunisation provider if you or your child:
- Is unwell (temperature over 38.5˚C)
- Has had a serious reaction to any vaccine
- Has had a ‘live’ vaccine in the last month
- Is pregnant.
Possible side effects of the vaccine
The vaccine is effective and safe. However, all medicines can have unwanted side effects. Side effects from the rubella vaccine are rare and usually mild but may include:
- High fever (over 39˚C)
- Faint red rash (not infectious)
- Drowsiness or tiredness
- Head cold and/or runny nose
- Cough
- Puffy eyes
- Swollen salivary glands
- Soreness and redness at the injection site.
Treating mild side effects
Some side effects may occur five to 12 days after immunisation but usually resolve in two or three days. There are a number of treatment options to reduce the side effects of the vaccination:
- Paracetamol to reduce any fever – check the label for the correct dose (especially for children)
- A cold, wet cloth held against the injection site
- Extra drinks
- Appropriate clothing – do not overdress.
Rare side effects
There is a very small risk of a serious allergic reaction to any vaccine. This is why you are advised stay at the clinic or medical surgery for at least 15 minutes following vaccination in case further treatment is required. Apart from anaphylaxis, other extremely rare side effects include encephalitis and thrombocytopenia (abnormal bleeding caused by insufficient blood platelets).
If reactions are severe and persistent, or if you are worried, contact your doctor for further information.
Where to get help
- Your doctor
- Always call an ambulance in an emergency Tel. 000
- Emergency department of your nearest hospital
- Your local council immunisation service
- Immunisation Program - Department of Health Victoria, Tel. 1300 882 008
- Nurse on Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
- The Maternal and Child Health Line is available 24 hours a day Tel. 132 229
- National Immunisation Infoline Tel. 1800 671 811
Things to remember
- Rubella is a viral illness that causes a skin rash and joint pains.
- A rubella infection is mild for most people, but can cause death or birth defects in an unborn baby.
- The rubella vaccine is available in a combined vaccine that also contains vaccines against other serious and potentially fatal diseases.
You might also be interested in:
Chickenpox.
Immune system.
Immunisation - childhood.
Immunisation - common misconceptions.
Infections - bacterial and viral.
Measles.
Mumps.
Vaccines.
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