Schematic diagram of Rubella virus.
Rubella (German measles) is a viral infection
that's now rare in the UK. It's usually a mild condition that gets better
without treatment in 7 to 10 days. Symptoms of rubella include:
- a
red-pink skin rash made up of small spots
- swollen glands around the head
and neck
- a
high temperature (fever)
- cold-like symptoms such as a cough and runny nose
- aching
and painful joints – more common in adults.
The symptoms of rubella usually only last a few
days, but your glands may be swollen for several weeks.
When to
see your doctor/ GP
You should always contact your GP or NHS 111 if you suspect rubella. Don't visit your GP surgery without phoning first,
as arrangements may need to be made to reduce the risk of infecting others.
If you're pregnant and develop a rash or come
into contact with someone who has a rash, contact your GP or midwife
immediately.
Rubella
and pregnancy
Rubella usually only becomes a serious concern
if a pregnant woman catches the infection during the first 20 weeks of her
pregnancy. This is because the rubella virus can disrupt the
development of the baby and cause a wide range of health problems, including:
- eye
problems – such as cataracts (cloudy patches on the
lens of the eye)
- deafness
- heart abnormalities
- brain
damage.
The birth defects caused by the rubella virus are
known as congenital rubella syndrome (CRS). Since the introduction of the mumps, measles and rubella (MMR) vaccine,
CRS is now very rare in the UK.
How it
spreads
Rubella is caused by a type of virus called a
togavirus. It's spread in a similar way to a cold or flu, through droplets
of moisture from the nose or throat of someone who's infected. These droplets
are released into the air when someone coughs, sneezes or talks.
You can become infected if you come into contact
with the droplets from an infected person, although it can take two to three
weeks for symptoms to develop. If you have rubella, you'll be infectious to other
people from one week before symptoms develop, and for up to four days after the
rash first appeared.
You should stay away from school or work
for four days after the rash starts to avoid infecting others, and try to
avoid contact with pregnant women during this time.
Schematic diagram showing the classical triad of Rubella.
Who is
affected?
Rubella is rare in the UK nowadays. Most cases
occur in people who came to the UK from countries that don't offer routine
immunisation against rubella.
However, there can occasionally be large outbreaks
of rubella in the UK. One of these occurred in 1996, when there were almost
4,000 cases in England and Wales. There were 12 confirmed cases of
rubella in England and Wales in 2013.
Treating
rubella
There's no specific treatment for rubella, but
symptoms normally pass within 7 to 10 days. If you or your child are
finding the symptoms uncomfortable, you can treat some of these at home while
you wait for the infection to pass.
For example, paracetamol or ibuprofen can be used to reduce the
fever and treat any aches or pains. Liquid infant paracetamol can be used for
young children. Aspirin shouldn't be given to children under the age of 16
years.
Preventing
rubella
The best way to prevent rubella is to be
immunised with the MMR vaccine. Children are offered this
vaccine as part of the routine childhood immunisation programme. It's given in two doses – the first when the
child is one year old, followed by a second booster dose before they start
school, at three years and four months.
Routine vaccination is important because it
reduces the risk of large outbreaks and helps protect pregnant women and their
babies. The MMR vaccine can also be given to older
children and adults who haven't been fully immunised before.
Contact your GP if you're uncertain
whether you or your child are up-to-date with vaccinations.
If you are thinking of getting pregnant and
you're not sure whether you've had two doses of the MMR vaccine, it's a good
idea to check with your doctor/ GP practice. If your records show you haven't had two
doses of MMR or there's no record, ask for the vaccinations.
Information
about you
If you or your child has rubella, your clinical
team will pass information about you/your child on to the National
Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).
This helps scientists look for better ways to
prevent and treat this condition. You can opt out of the register at any time.
Symptoms of rubella
The symptoms of rubella usually take two to three
weeks to develop after infection. This time is called the incubation period. Some infected people won't develop any symptoms,
but in those who do, a rash and swelling around the neck and head are common
signs of the condition.
A
red-pink rash
The rubella rash is typically a red-pink colour. It
consists of a number of small spots, which may be slightly itchy. The rash usually starts behind the ears before
spreading around the head and neck. It may then spread to the chest and tummy
(the trunk), and legs and arms. In most cases the rash disappears by
itself within three to five days.
Swollen
lymph glands
Lymph nodes, or glands, are small lumps of tissue
found throughout the body. They contain white blood cells that help fight
bacteria, viruses and anything else that causes infection.
If you have rubella, the glands will usually swell
behind the ears, below your skull at the back of your head, and in your neck.
In some cases this swelling can be painful.
These lymph glands sometimes start to swell before
the rash appears, and the swelling can last for several weeks after the rash
has gone.
Other
symptoms
As well as a rash and swollen lymph glands, people
with rubella may also develop other symptoms, including:
- a
high temperature (fever) – it is usually mild (less than
39C or 102.2F) but can be more severe in adults
- cold-like symptoms – such as a
runny nose, watery eyes, sore throat and cough
- slightly
sore and red eyes (conjunctivitis)
- aching
and painful joints
- loss
of appetite
- tiredness.
These symptoms may develop shortly before the rash
and usually last for a few days.
Seeking
medical advice
You should always contact your doctor/ GP surgery
or NHS 111 straight away if you suspect
rubella. While the condition is usually mild, it's important for a doctor to
confirm the diagnosis as the symptoms could be caused by a more
serious illness.
If you're pregnant and develop a rash, or come into
contact with someone who has a rash, contact your GP or midwife immediately. It is also important that any cases of rubella are
reported to the relevant local health authorities so they can track the spread
of infection in case there's a sudden outbreak of cases.
Do not visit your GP surgery without phoning first,
as arrangements may need to be made to reduce the risk of infecting others. In
particular, contact with pregnant women should be avoided if possible –
rubella can cause serious problems in an unborn baby, although this is rare
nowadays.
Diagnosing rubella
If you suspect rubella, phone your GP surgery
or NHS 111 straight away for advice. Don't visit your GP surgery without phoning first,
as arrangements may need to be made to reduce the risk of spreading any
infection to other people.
Contact with pregnant women should be avoided as
rubella can cause serious problems in an unborn baby, although this is very
rare nowadays. Your GP should be able to arrange a time for you to
visit that won't put other people at risk.
You should keep your child away from school – or
yourself away from work – until you've seen your GP. Your GP may suspect rubella from the symptoms,
but as other viral infections often have similar symptoms, testing a sample of
saliva or blood is the only way to confirm a diagnosis.
Saliva
and blood tests
If rubella is suspected, a sample of saliva from
your mouth or blood taken from a vein in your arm can be taken
and tested for certain antibodies. Antibodies are proteins your body produces to
destroy disease-carrying organisms and toxins. If you have rubella or you've
had it in the past, your saliva or blood will test positive for certain
antibodies:
- IgM
antibody – this will be present if you have
a new rubella infection
- IgG
antibody – this will be present if you've
had the rubella infection in the past, or you've been vaccinated
against it.
If neither antibody is present, you don't have
rubella and you haven't been immunised against it.
Diagnosis
in pregnancy
If you're pregnant, you should contact your
GP or midwife as soon as possible if:
- you
come into contact with someone who has rubella
- you have
a rash or come into contact with anyone who has a rash
- you
have symptoms of rubella.
It's unlikely you have rubella in these
circumstances, but a blood test may be necessary to check for the
condition. In the rare cases where testing shows you do have
rubella, you'll be referred to a doctor who specialises in conditions that
can affect unborn babies (obstetrician). You may be offered further tests, such
as an ultrasound scan, to check for any
signs of problems in your baby.
You'll also be offered counselling so you can make
an informed decision about whether you wish to continue with the pregnancy
if serious problems are found.
Treating rubella
There's no specific treatment for rubella. The
condition is usually mild and improves without treatment within 7 to 10
days. Phone your GP surgery or NHS 111 for advice if you suspect
rubella. Do not visit your GP surgery unless you are advised to do so.
Treating
your symptoms
If the symptoms of rubella are causing
discomfort for you or your child, there are some things you can do while you
wait for the infection to pass.
Controlling
fever and relieving pain
If necessary, paracetamol or ibuprofen can be used to reduce a high
temperature (fever) and treat any aches or pains. Liquid infant paracetamol can be used for young
children. Aspirin shouldn't be given to children under 16 years old.
Speak to your pharmacist if you are not sure which
medications are suitable for your child. If your child's high temperature is causing
them distress, you can also try to reduce it by keeping them cool. A
cool, but not cold, compress – such as a damp flannel held to their
forehead – can help.
Drink
plenty of fluids
If your child has a high temperature, make sure
they drink plenty of fluid as they may be at risk of dehydration. Keeping hydrated will also
help reduce discomfort caused by coughing.
Treating
cold-like symptoms
If you have cold-like symptoms such as a runny
nose, sore throat or a cough, there are a number of things you can
do to feel more comfortable.
For example, steam inhalation may offer some
relief from a cough. This involves sitting with your head over a bowl of hot
water. Place a towel over your head, close your eyes and breathe deeply, while
trying not to get the hot steam in your eyes.
Steam inhalation isn't advised for children because
of the risk of scalding, but it might help your child if they sit in a
hot, steamy bathroom. Alternatively, putting a wet towel on a
warm radiator will release more water into the air.
Giving your child warm drinks,
particularly ones containing lemon or honey, may also help to
relax their airways, loosen mucus and soothe a cough. Honey shouldn't be given
to babies under 12 months.
Avoiding
the spread of infection
While you have rubella, it is important to reduce
the risk of spreading the infection to other people. If you or your child have the condition, you should
avoid work or school for four days from when you first developed the
rubella rash.
In rare cases, rubella can cause serious problems
in an unborn baby, so you should also try to avoid contact with pregnant women
for four days from the start of the rash.
Preventing rubella
The best way to avoid catching rubella is to be
immunised with the measles, mumps and rubella (MMR) vaccine. The MMR vaccine is part of the routine childhood immunisation programme. The
first dose is given to a child when they're one year old, with
a second booster dose given before the start of school, at 3 years
and 4 months.
Contact your GP if you are uncertain whether your
child's vaccinations are up-to-date. It's possible to have the MMR vaccination
at any age.
If you suspect your immunisation is not up-to-date
and you are at risk of catching mumps, measles or rubella, your GP may recommend
the MMR vaccine. For example, this may be necessary if there's an outbreak of
measles or you're a woman planning to get pregnant. If you're already immunised, having the MMR vaccine
again won't cause you any harm.
Planning
a pregnancy
It's a good idea to check that you are fully
protected against rubella if you are planning to have a baby. If you're not sure whether you have had two
doses of the MMR vaccine, you can get your GP practice to check your
vaccination history. If your records show you haven't had both doses or
there is no record, ask to have the vaccinations.
Because MMR vaccination could cause a risk to
your baby in pregnancy, you should avoid becoming pregnant for one month after
having it. This means you'll need a reliable method of
contraception.
During
pregnancy
You cannot have the MMR vaccine when you're
pregnant as it could pose a risk for your baby. If you're currently pregnant and have not had, or
do not know if you have had, two doses of MMR, ask your doctor/ GP practice to check your
records.
If you have not had two doses of the MMR vaccine or
there's no record available, you should ask for the vaccine when you go for
your six-week postnatal check-up after your baby is born.
Limiting
the spread of infection
Someone who has the rubella virus is infectious for
one week before symptoms appear and around four days after the rash first
develops. If you or your child have rubella,
you should limit the risk of infecting other
people by staying off work or school for four days after you
develop the rash.
You should also try to avoid contact with pregnant
women for at least four days from the start of the rash.
Vaccination before travelling
Although rubella is uncommon in the UK, the
condition is more widespread in some other parts of the world, such as
areas of Africa, Asia and South America.
You should contact your GP before
travelling to areas with high rates of rubella if you are unsure whether you have
been fully immunised against the condition. In some cases, having the MMR
vaccine before travelling may be recommended.
Complications of rubella
Serious complications of rubella are rare,
particularly since the measles, mumps and rubella (MMR) vaccine was
introduced.
However, in the small number of cases where an
infection develops in pregnancy, there's a serious risk to the unborn baby. If a pregnant woman catches rubella, the infection
can be passed to her baby. This can result in problems such as miscarriage and a range of birth
defects known as congenital rubella syndrome.
Congenital
rubella syndrome
Congenital rubella syndrome (CRS) occurs when the
virus that causes rubella disrupts the development of an unborn baby. It is very
rare in the UK nowadays, with only eight cases reported between 2002 and 2011.
The risk of CRS affecting the baby and the extent
of the birth defects it causes depends on how early in the pregnancy the mother
is infected. The earlier in the pregnancy, the greater the risk:
- infection
in first 10 weeks – the risk of CRS is as high
as 90% and the baby is likely to have multiple birth defects
- infection
in 11th to 16th weeks – the risk of CRS drops to
around 10 to 20% and it's likely affected babies will have fewer birth
defects
- infection
in 17th to 20th weeks – CRS is very rare, with
deafness the only problem reported.
There isn't thought to be any risk of CRS
developing if you're infected with rubella after the 20th week of pregnancy. If a pregnant woman does become infected with
rubella during the first 20 weeks of pregnancy, there's no treatment known to
be effective in preventing CRS.
Problems
caused by CRS
CRS can cause the following problems in babies:
- eye
defects such as cataracts (cloudy patches in the
lens of the eye)
- deafness
- congenital heart disease – where
the heart doesn't develop in the right way
- a
small head compared with the rest of the body, as the brain is not fully
developed
- a
slower than normal growth rate in the womb
- damage
to the brain, liver, lungs or bone marrow.
Children born with CRS can develop problems later
in their lives as well. These include:
- type 1 diabetes – a lifelong
condition that causes a person's blood sugar level to become too high
- overactive thyroid or underactive thyroid – the thyroid
gland produces hormones to control the body's growth and metabolism
- swelling
inside the brain – this causes a loss of mental and movement functions.
Occasionally, hearing problems are not obvious at
birth, but are detected as the child gets older.
