Rubella: everything you need to know about German measles

The symptoms, risk factors and treatment options for rubella, a contagious viral infection characterised by a spotty rash.

Rubella symptoms, signs and treatment
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Rubella, also known as German measles, is a contagious viral infection characterised by a spotty rash. It doe not require any special treatment and usually gets better in about a week, but it can be serious if you get it when you're pregnant.

Dr Roger Henderson looks at the symptoms, risk factors and treatment options for rubella:

What is rubella/German measles?

Rubella is an illness caused by the rubella virus. Epidemics tend to break out every three to four years, although the illness is less contagious than measles and chickenpox.

Rubella can affect anyone but most commonly occurs in young children and is usually a mild infection. However, if a pregnant woman develops rubella, this can cause serious damage to their unborn child, as it is a completely different condition to measles.

Very few children get rubella since most of them are vaccinated with the MMR vaccine.

While most children have measles in their early childhood, a lot do not get rubella until they are quite a bit older: 10 to 20 per cent of 20 to 25-year-olds have never had the disease. In fact, a lot of people have rubella in such a mild form that it's never diagnosed - this is referred to as a ‘subclinical’ infection.

Today, only very few children get rubella since most of them are vaccinated with the measles-mumps-rubella (MMR) vaccine, which protects against mumps, measles and rubella. It's very important to maintain a high level of vaccination in the population as a whole to ensure herd immunity.



How do you get rubella?

Rubella is caught by droplet spread, where microscopic drops from the breath of an infected person are carried through the air to a healthy person. The droplets carrying the virus reach the mouth, throat and nose, from where they spread to the rest of the body.

When should you visit the doctor for rubella?

If you suspect that you or your child has rubella, call your GP as soon as possible. It is best to phone initially rather than turning up at the surgery, so that arrangements for reducing the risk of infection to others can be made.



What are the signs of rubella?

Common rubella symptoms include the following:

✔️ The patient develops a rash, typically starting around the ears, from where it spreads all over the body in tiny pink spots.

✔️ The rash changes almost from hour to hour, and will disappear again after about two to five days, requiring no treatment.

✔️ Up to one week before the rash appears, the patient can suffer a light cold, consisting of a cough and sore throat and/or swelling in the neck and base of the skull (due to the enlargement of the lymph nodes). There may also be a mildly raised temperature at this time too.

✔️ Sore red eyes (conjunctivitis) can occur and last for several days.

✔️ Joint pains can occur, primarily affecting adults, and last for around one week.

✔️ The period between the time of infection and the actual outbreak of rubella (the incubation period) is usually quite long - between two and three weeks.



How is rubella treated?

German measles does not require any special treatment - except perhaps for a few days' rest in bed. But you'll have to consider the fact that the disease is infectious and can easily spread to other members of the household. Fever and muscular or joint pains can be symptomatically treated with paracetamol (eg Calpol) and ibuprofen (eg Nurofen for children).

The infection period usually lasts from a week before the rash starts to one week after it has disappeared, but is at its worst when the rash is at its peak. Because of the risks to pregnant women associated with the disease, it is an advantage for girls to acquire immunity before puberty.

Once you have had rubella, your body will have made antibodies to the condition that will provide immunity throughout your life. It is very rare to have more than one episode.



What risks are associated with rubella?

If a pregnant woman is infected with rubella there is a risk of damage to the unborn child. In some cases, this danger is so high that a termination of pregnancy is recommended but fortunately this is very rare today as most young women have been vaccinated against rubella with the MMR vaccine.

Brain inflammation (encephalitis) is a very rare complication, and bleeding disorders may very rarely occur as a result of this infection.



Who should be vaccinated against rubella?

The MMR vaccine is highly effective in preventing rubella. All girls should be vaccinated against rubella to prevent problems during any future pregnancy.

Today, all children are offered the MMR vaccine in two doses which protects them from rubella:

  • Initially between 12 and 15 months.
  • Again at the age of 3 years and 4 months prior to starting school.

    Both doses are given at the same time as other vaccinations as part of the national immunisation programme.

    It is impossible to know for sure if you have had rubella because many people do not even notice the disease. Girls who are vaccinated against rubella are advised not to start a pregnancy until three months after the vaccination.

    If you are in any doubt as to whether or not you have had the illness, an examination of antibodies in the blood will provide the answer. If required, your doctor can give you a vaccination.



    What's the difference between measles and German measles?

    Measles and German measles (rubella) are completely different conditions, caused by different viruses although they do have similar features such as a rash, temperature and cold-like symptoms.

    They are both protected against by the MMR vaccine and so remain uncommon although in recent years there has been a slight increase in the number of measles cases due to falling levels of MMR immunisation.

    If caught in pregnancy, measles is more likely to cause a miscarriage or premature delivery whereas rubella is more likely to cause birth defects in the baby.

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