Rubella (German Measles)

This viral disease is generally mild in small children. However, when it is acquired during pregnancy, rubella can be truly devestating. Rubella infection in a pregnant woman can cause a wide range of serious birth defects in up to 60 percent of infants exposed during the first month of gestation. Those defects may include heart and eye abnormalities, deafness, low birth rate, encephalitis (brain inflammation) and liver and kidney malfunction.

Fortunately, a rubella vaccine was licensed in 1969 and currently is given in conjunction with measles and mumps vaccines at age 15 months, followed in most areas by a booster at school entry. (For more information on this and other vaccines, see Immunizations). Thanks to rubella immunization, the number of cases of congenital rubella has fallen drastically in the past 20 years. Even so, small outbreaks of rubella occasionally occur, mainly among adults who neither had the disease nor received the immunization.

WHAT CAUSES RUBELLA?
Rubella is caused by a virus known as rubivirus. It is passed from person to person when an infected individual expels fluid droplets in coughing or sneezing and a noninfected person inhales them. When a pregnant woman is infected with the virus, it passes to the fetus through the placenta. Fetal infection lasts throughout pregnancy. In fact, a baby with congenital rubella infection may still harbor the virus at the age of one year.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS RUBELLA?
Children's risk of catching rubella is fairly low. A child may develop the disease, however, if he is exposed to the virus before being immunized. Such exposure may occur from an infected child or adult, particularly if the family travels to an area where an outbreak is occuring.

The illness begins two to three weeks after exposure to the virus. In some cases, the rash (which consists of small, reddish bumps that start on the face and spread down to the trunk, arms and legs) is the initial symptom, but in others, it is preceded by one to five days of mild fever, coughing, red eyes and swollen glands. The rash itself lasts about three days, although it may disappear sooner.

IS MEDICAL ATTENTION NECESSARY?
Yes. Any time a child develops a generalized rash, a doctor should be consulted.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS RUBELLA?
The main method of diagnosing rubella is by physical examination. It may be confirmed by measuring antibodies to the virus during the illness and after recovery. If the antibody levels go up dramatically between the two tests, rubella infection occurred.

WHAT TREATMENTS ARE AVAILABLE?
Rest and acetaminophen (to reduce fever) are the only treatments needed. It is extremely important, however, for anyone with rubella infection to avoid contact with women who could be pregnant.

EXPOSURE DURING PREGNANCY
All women entering the childbearing years should be immunized against rubella. If a pregnant woman who has not been immunized is exposed to rubella, she should go to a doctor immediately to obtain an antibody test. When antibodies are present right after exposure, it means the woman is already immune to the virus and has no need to worry. If antibodies are not present, the woman should have a second test in about three weeks. Continued negative findings mean infection probably did not occur, but one further test, in three more weeks, is needed for absolute certainty. An antibody test that becomes strongly positive indicates that infection has taken place and the fetus is at high risk of having congenital rubella.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.