Rubella

What causes rubella?

Rubella is caused by a virus, called a rubivirus. It can be spread from a pregnant mother to her unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization with the rubella vaccine, which is one of the planned vaccinations that your child should receive during annual check ups

Are there any serious consequences?

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant can have severe birth defects and other consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it may also cause a miscarriage.

Warning: Pregnant women who have been exposed to rubella need to seek medical attention immediately.

The disease itself does not have any long-term consequences. The biggest concern is to prevent an infected child from transmitting it to a pregnant woman.

What are the symptoms of rubella?

It may take between 14 to 21 days for a child to develop signs of rubella after coming into contact with the disease, but it is important to know that a child is most contagious when the rash is erupting. The child still may be contagious, however, beginning 7 days before the onset of the rash and from 7 to 14 days after the rash has appeared. Your child may be contagious before you even know he or she has the disease.

Each child may experience symptoms differently, but the most common signs of childhood rubella:

• A period of not feeling well, a low-grade fever and diarrhea. This may last one to five days.
• A rash then appears as a pink rash with areas of small, raised lesions.
• A rash that begins on the face and then spreads down to the trunk, arms and legs.
• The rash on the face usually improves as the rash spreads to the arms and legs.
• The rash usually fades by the third to fifth day.
• Lymph nodes in the neck may also become enlarged.
• Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella – rubella that is present at birth because the child contracted it from his mother while in utero – can also result in the following problems:

• cataracts in the eyes
• heart problems
• mental retardation
• retardation growth
• enlarged liver and spleen
• skin lesions
• bleeding problems

Prevention of rubella

"We are seeing these new "pockets" or clusters of decreased vaccination, which are fueling outbreaks," says Ronald Samuels, MD, MPH. "Measles is very contagious, it just takes a few people and then it spreads like wildfire."

Since the introduction of the 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 and is called the MMR vaccine. It is typically given when your child is 12 to 15 months old and then again between the ages of 4 to 6. If your child has not received the second dose by the time he or she is 6 years old, he or she should receive it by the time he or she is 11 or 12. In addition, girls should complete rubella vaccinations before they reach childbearing age.

"When people opt out [of the vaccine], they substantially raise the chance that measles will be transmitted around the community, not only to their child, but to children who can't be vaccinated, or to the small number of children for whom the vaccine just doesn't work," says Ronald Samuels, MD, MPH. "The kids at most risk are those under 1 year of age who are not yet routinely vaccinated yet."

"Parents are always right to worry about their child. If you're not worried about your child, you're not being a good parent. But people underestimate the risks of the disease," says Ronald Samuels, MD, MPH. "They say it's 10 days of fever; well it's 10 days of fever unless your child dies. If I told you it's a one in a 1,000 chance that your child's going to die, what would you do? What you're betting is not that the disease is mild, but that your child is not going to get the disease. If your child gets the disease, it's a real risk, and if people don't vaccinate their kids, the risk goes way up."

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.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of your child. Because the lesions of rubella are unique, your child's physician can typically make a diagnosis based on a simple physical examination. Your child's doctor may also order blood or urine tests to confirm the diagnosis.

Since rubella is a viral infection, there is no cure. The goal of treatment is to help prevent the disease in the first place, or decrease the severity of the symptoms.

Treatment may include:

• increased fluid intake
• rest
• isolation to prevent spread of the virus