Rubella (German measles) is an infection caused by the rubella virus. Although it most commonly occurs in young children, it can affect anyone. The illness is usually mild. However, rubella in a pregnant woman can cause serious damage to the unborn child. Immunisation has made rubella uncommon in the UK.
What is rubella?
Rubella (German measles) is usually a mild illness. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child or cause a miscarriage. Rubella can lead to damage to the heart, brain, hearing and sight. The baby is likely to be born with a very serious condition called the congenital rubella syndrome.
Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome. Rubella is now a very uncommon infection in the UK as a result of the vaccination programme. However, rubella is still common in many developing countries.
What are the symptoms of rubella?
The majority of people have no symptoms when they are infected with rubella. This is called a subclinical infection. If symptoms do develop, they include the following:
Bleeding disorders and brain inflammation (encephalitis) are rare complications.
Note: rubella rarely causes complications in healthy people. The main concern of rubella is that is can cause complications in pregnancy.
Is rubella infectious?
Yes. It is passed on by direct contact and by coughing and sneezing the virus into the air. It takes 2-3 weeks to develop symptoms after being infected. You are infectious from one week before symptoms begin until four days after the rash appears. Therefore, affected children should stay away from school and not mix with others for four days after the rash starts.
Rubella and pregnancy
If you are pregnant and have rubella in the first few months of pregnancy, there is a high chance that the virus will cause severe damage to your developing baby. The virus affects the developing organs and the baby may be born with serious disability - the congenital rubella syndrome.
Complications of congenital rubella syndrome include cataracts, deafness, heart, lung and brain abnormalities.
Having rubella infection in the first three months of pregnancy also increases your risk of having a miscarriage:
In the unlikely case that you are confirmed to have rubella, then you will be referred to an obstetrician to discuss the possibility of your baby having congenital rubella syndrome. The risk is greater if you are less than 20 weeks pregnant. If you are more than 20 weeks pregnant, then the risk of your unborn baby developing congenital rubella syndrome is very small. No treatment can prevent the development of congenital rubella syndrome.
How can you test for immunity to rubella?
Even if you have had a rubella immunisation, or have had rubella infection, there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunisation has worked is to have a blood test. This checks for rubella antibodies.
Because the congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time, you should have a blood test to check that you are protected.
This blood test is offered to all women in the UK who are pregnant and also it may be offered to younger women in routine health checks. However, if you have not had it, you should ask your practice nurse for the blood test. In particular, women who have come to the UK from overseas and have not been immunised are at greatest risk of having a baby with congenital rubella syndrome.
What is the treatment for rubella?
There is no treatment that will kill the virus. Most people with rubella are not very ill, do not need any treatment, and soon make a full recovery. The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one bout of rubella.
Immunisation is now offered to all children in the UK as part of the MMR vaccine. Two doses of the vaccine are needed to provide satisfactory protection against rubella.
The first dose is usually given between 12 and 13 months. A second dose is usually given at age 3 years and four months to 5 years, at the same time as the preschool booster of DTaP/IPV(polio) (given as a separate injection). (DTaP stands for diphtheria (D), tetanus (T) and acellular pertussis (aP) (whooping cough). IPV stands for inactivated polio vaccine. Polio is short for poliomyelitis.)
Immunisation gives very good protection and so rubella is now uncommon in the UK. The number of babies born with congenital rubella syndrome has greatly reduced since routine immunisation was introduced.
It is extremely important that all children be immunised against the rubella virus to prevent any complications of rubella occurring.
If you are a woman and are planning to get pregnant, if you are unsure if you are immune then see your practice nurse. A blood test will confirm if you are immune. If you are not immune then you can be immunised before you become pregnant.