Rubella, commonly known as German measles, is a contagious viral infection primarily affecting children and young adults. While generally mild in children, it can have severe consequences for pregnant women, potentially leading to congenital rubella syndrome (CRS) in the foetus, which can cause serious birth defects. By Tshepy Malope.
According to Dr. Kerrigan McCarthy, Pathologist, Division for Public Health Surveillance and Response at the National Institute of Communicable Diseases (NICD), South Africa has just had a major measles outbreak from 2022–2023. A national measles vaccination campaign took place in February–April 2023. Unfortunately, only 54% of children under the age of 15 received the measles vaccination. This article explores key aspects of rubella, including its symptoms, transmission, prevention, and the importance of vaccination.
What causes rubella?
Rubella is caused by the rubella virus, a member of the togavirus family. The infection is usually mild, presenting with symptoms such as a low-grade fever, rash, and swollen lymph nodes. The rash typically starts on the face and spreads to the rest of the body, lasting about three days. Other symptoms may include joint pain, headaches, and conjunctivitis.
How is Rubella transmitted?
Rubella is primarily spread through respiratory droplets when an infected person coughs or sneezes. It can also be transmitted from a pregnant woman to her foetus through the bloodstream. The incubation period for rubella is typically 14 to 21 days, and individuals are most contagious from one week before to one week after the appearance of the rash. Dr. McCarthy explains, “Rubella is transmitted from person to person by droplets. That means it requires close contact between people.”
What are the symptoms of rubella?
In infants, children, and adults, many rubella infections are asymptomatic, and a person will not know they have been infected. However, if symptoms do occur, rubella typically presents with a cough and fever, followed by a rash. The rash is blotchy, reddish-brown, and starts on the neck and face before progressing to the trunk, abdomen, and limbs, healing within 3-5 days. Some people, especially adolescents and young women, may develop painful joints. Very occasionally, people develop a severe headache that may progress to encephalitis, characterised by confusion. In all cases, rubella infection in infants, children, and adults resolves spontaneously without complications.
However, rubella poses a significant risk to pregnant women. “When a woman in her first trimester (first 14 weeks) of pregnancy develops rubella, she will have symptoms as above, or may have no symptoms at all. However, her foetus may develop ‘congenital rubella syndrome, or CRS’ as the virus infects the foetus and causes abnormal development of the heart, eyes, and ears. Many infected and damaged foetuses are spontaneously aborted or born dead (i.e., a stillbirth). If the infant survives, it may have any of the following features: cataracts, heart defects, deafness, a rash, developmental delays, and a and a large liver or spleen” says Dr. McCarthy.
How is rubella diagnosed?
Rubella is diagnosed through laboratory tests, including serological tests to detect rubella-specific antibodies. Prompt reporting and investigation of suspected rubella cases are vital for controlling outbreaks and preventing the spread of the virus. Health care providers play a key role in recognising the symptoms of rubella, especially in pregnant women, and ensuring timely diagnosis and reporting. Dr. McCarthy explains, “At the NICD, we test all these blood samples for measles and rubella. We first look for antibodies of the IgM class, as these antibodies are the body’s way of responding to measles or rubella within the first 2-4 weeks after infection. If these tests are negative, our lab does a PCR (molecular) test for measles/rubella genetic material (RNA). Together, both measles/rubella antibodies and measles-rubella PCR will detect all cases of rubella.”
What are the treatments for rubella?
There is no specific antiviral treatment for rubella. The management of rubella is mainly supportive, focusing on relieving symptoms such as fever, rash, and joint pain. Patients are advised to rest, stay hydrated, and use medications like acetaminophen or ibuprofen to reduce fever and discomfort. Most cases resolve spontaneously without complications, but monitoring is essential, especially for pregnant women, due to the risk of CRS.
How effective is the Rubella vaccine?
The most effective way to prevent rubella is through vaccination. The MMR vaccine, which protects against measles, mumps, and rubella, is highly effective and is included in routine childhood immunisation programmes in many countries. According to the NICD, two doses of the MMR vaccine are recommended for optimal protection. The first dose is usually given at 12–15 months of age, with a second dose at 4-6 years of age. Rubella elimination is a key public health goal due to its potential to cause severe birth defects through CRS. Many countries have made significant progress towards eliminating rubella by implementing widespread vaccination programmes.
Clinical and Public Health Steps
Dr. McCarthy emphasises that the MR vaccine is the only way to prevent rubella infection. However, women who have had rubella infections in the past are protected against repeat infections, and so they cannot develop rubella during pregnancy. “Our evidence shows that most women (up to 90%) of childbearing age already have antibodies to rubella, mostly from natural infection, as South Africa has not used the rubella vaccine in large numbers until this year,” says McCarthy. Any woman who wants to become pregnant should check that they have rubella antibodies, and if they don’t, they should find a vaccine. The measles-mumps-rubella vaccine may be purchased in private if the local primary health care clinic is still using the measles-alone vaccine and has not ordered the combined MR vaccine.
In conclusion, rubella, though mild in most cases, poses a significant risk to pregnant women and their unborn children. Vaccination remains the most effective strategy to prevent rubella and protect against its serious complications. High vaccination coverage is essential to achieve herd immunity and prevent outbreaks. Public health organisations, including the NICD, play a vital role in monitoring, controlling, and ultimately eliminating rubella. By staying informed and ensuring timely vaccination, individuals can contribute to efforts to eradicate rubella and protect public health.
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Rubella, commonly known as German measles, is a contagious viral infection primarily affecting children and young adults.
