Rubella: Causes, Symptoms, Transmission, Treatment and Prevention
Rubella, known as "German measles", is an acute, contagious viral infection caused by the rubella virus (Rubivirus).
While infection with the rubella virus usually causes a mild fever and a rash in children and adults, infection during pregnancy, especially in the first trimester, can lead to miscarriage, fetal death, stillbirth, or babies with congenital malformations, known as congenital rubella syndrome (CRS).
Transmission method
Rubella is a highly contagious virus that can spread through close contact or the air. It can be transmitted from person to person via aerosols produced when an infected person coughs or sneezes.
You can also contract the virus by touching an object contaminated with the secretions of an infected person. Rubella can also be transmitted from a pregnant woman to the fetus through the bloodstream.
People who have German measles are most contagious from the week before the rash appears until about two weeks after it disappears.
The virus can be transmitted even before symptoms appear.
Symptoms
Rubella is usually a mild infection that clears up within a week, even without treatment. However, severe complications can occur in pregnant women, as it can cause congenital rubella syndrome in the fetus.
Congenital rubella can disrupt the baby's development and cause serious congenital malformations, such as heart defects, deafness, and brain damage. It is important to receive immediate treatment if you suspect you have rubella during pregnancy.
Rubella in children
In children, rubella usually causes a mild fever and a rash that starts on the face and then spreads to the rest of the body. These symptoms can last for 2 to 3 days. Older children often experience a mild fever, swollen glands in the neck or behind the ears, and upper respiratory tract infections before developing a rash. Rubella is usually mild in children.
Rubella in adults
Rubella complications are rare but occur more often in adults. Adults (especially young women) may experience joint pain, headaches, and pink eye before the rash appears. Up to 70% of women who get rubella may also suffer from arthritis; this condition is rare in children and men.
Rubella during pregnancy
Rubella is very dangerous for both pregnant women and the fetus. If a pregnant woman is infected with rubella, she can transmit the virus to her baby, which can lead to miscarriage or the development of serious congenital malformations (heart problems, hearing and vision loss, intellectual disabilities, and liver or spleen disorders).
Rubella acquired in the first 11 weeks of pregnancy is associated with a high risk (up to 70-90%) of congenital rubella syndrome (CRS). In the case of infection between 11-17 weeks of pregnancy, there is a risk of hearing defects in the fetus.
Diagnosis
Rubella symptoms can be similar to other infections. Diagnosis is made after a medical evaluation of the symptoms. People who want to find out if they have had the disease in the past can take IgG antibody tests. At the same time, IgM antibody tests can be performed to detect the rubella virus, and the optimal time is 5 days after the skin rash appears.
For the reliable detection of the rubella virus, the following samples can be collected:
- pharyngeal exudate
- oral fluid
- urine
Due to severe complications in case of transmission to the fetus, it is essential to perform special tests under medical guidance. Confirmation of the diagnosis in pregnant women is made by detecting IgM antibodies. A positive IgM result with a low value in a pregnant woman without clinical signs or symptoms or contact with a confirmed case of rubella must be interpreted with caution, and IgG antibody detection testing is required. If the presence of specific IgG antibodies is confirmed, the IgG antibody avidity index must be determined. High avidity suggests the absence of a recent infection, and a low avidity index suggests the presence of an acute infection with wild or vaccine-strain rubella virus.
Newborns with CRS who survive the neonatal period may develop serious disabilities and an increased risk of developmental delays (autism, type I diabetes, thyroiditis). They need to be tested by detecting IgM antibodies. At least 85% of infants with congenital rubella infection will have positive IgM between the first 3-6 months of life, and some will remain IgM positive for 18 months.
Treatment
Most rubella cases are treated at home. Your doctor may recommend bed rest and paracetamol, which can help relieve the discomfort caused by fever and pain. They may also recommend that you isolate yourself to prevent the spread of the virus in the community.
Pregnant women can be treated with antibodies called hyperimmune globulin to reduce symptoms. However, there is a chance the fetus will develop congenital rubella syndrome. Babies born with congenital rubella will need specialized treatment.
Prevention
The measles, mumps, and rubella (MMR) vaccine can help prevent rubella. Two doses of the vaccine are recommended. The first dose of the MMR vaccine is usually given by 12 months of age, and the second dose is given between 5 and 7 years of age. In rooms where there have been people suspected or sick with rubella, it is recommended to use micro-aeroflora disinfectants and surface disinfectants.
Because the MMR vaccine is a live attenuated virus vaccine, pregnant women cannot be vaccinated during pregnancy. Women who plan to get pregnant should check their vaccination status, as they cannot be vaccinated against rubella during pregnancy.
References
https://www.who.int/news-room/fact-sheets/detail/rubella
https://www.healthline.com/health/rubella
https://www.reginamaria.ro/utile/dictionar-de-afectiuni/rubeola
https://www.catena.ro/rubeola-transmitere-simptome-tratament-si-preventie
https://www.medlife.ro/glosar-medical/analize-medicale/rubella-igg-indice-de-aviditate
https://vaccination-info.eu/ro/fisele-de-informare-despre-boli/rubeola
https://cnscbt.ro/index.php/ghiduri-si-protocoale/142-ghid-de-laborator-pentru-diagnosticul-rujeolei-rubeolei-si-parotiditei/file
