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Rubella

Synonyms of Rubella

  • German Measles
  • Three-Day Measles

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Rubella is a viral infection characterized by fever, headache, swollen lymph nodes, aching joints, and a distinctive red rash. Although it is sometimes called German measles or three-day measles, it is not caused by the same virus that causes measles. Rubella is generally mild in children and more severe but not life-threatening in adults. However, if a pregnant woman is infected with rubella, it can cause serious problems for the unborn child. In the United States, most children receive the measles-mumps-rubella (MMR) vaccine, and therefore the disease has become uncommon. In March 2005, health officials announced that rubella has been eliminated from the United States. However, it is still important for Americans to vaccinate their children, and women who are pregnant or might get pregnant still need to be sure they are immune, because the disease exists elsewhere. According to the Centers for Disease Control and Prevention (CDC), nine rubella cases were reported in the United States in 2004, and all of them originated in other countries.

Symptoms

Rubella is predominantly a childhood disease, although it also occurs among adolescents and adults. It has a 14- to 21-day incubation period and a 1- to 5-day preliminary phase in children. The preliminary phase may be minimal or absent in adolescents and adults. Tender swelling of the glands in the back of the head, the neck and behind the ears is characteristic. The typical rash appears days after onset of these symptoms.

The rubella rash is similar to that of measles, but it is usually less extensive and disappears more quickly. It begins on the face and neck and quickly spreads to the trunk and the extremities. At the onset of the eruption, a flush similar to that of scarlet fever may appear, particularly on the face. The rash usually lasts about three days. It may disappear before this time, and rarely there is no rash at all. A slight fever usually occurs with the rash. Other symptoms such as headache, loss of appetite, sore throat and general malaise, are more common in adults and teenagers than in children.

After-effects of rubella are rare among children, although there have been cases of joint pain (arthralgia), sleeping sickness and blood clotting problems. Adult women who contract rubella are often left with chronic joint pains. Encephalitis is a rare complication that has occurred during extensive outbreaks of rubella among young adults serving in the armed services. Transient pain in the testes is also a frequent complaint in adult males with rubella.

Congenital rubella syndrome is the name applied to the disease that affects the unborn child when a pregnant woman becomes infected with rubella. This is most dangerous to the fetus during the first six months of pregnancy. Congenital rubella syndrome can lead to miscarriage, stillbirth, and birth defects that include cataracts, deafness, mental retardation, and cardiac anomalies.

Causes

Rubella is caused by a virus and is spread by airborne droplet clusters or by close contact with an infected person. A patient can transmit the disease from 1 week before onset of the rash until 1 week after it fades. Congenitally infected infants are potentially infectious for a few months after birth. Rubella is apparently less contagious than measles, and many persons are not infected during childhood. As a result, 10% to 15% of young adult women are susceptible if they have not been vaccinated against the disorder. Many cases are misdiagnosed or go unnoticed.

Before the rubella vaccine was developed, epidemics occurred at regular intervals during the spring. Major epidemics occur at about 6- to 9-year intervals. Once a person has been infected by rubella, immunity appears to be lifelong.

Affected Populations

Rubella affects males and females in equal numbers. During 1964 and 1965, according to the CDC, a rubella epidemic in the United States caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome, which led to more than 11,600 babies born deaf, 11,250 fetal deaths, 2,100 neonatal deaths, 3,580 babies born blind, and 1,800 babies born mentally retarded. Since 1969, the rubella virus has been included in the measles, mumps, and rubella (MMR) vaccine routinely given to babies and young children.

Related Disorders

Symptoms of the following disorders can be similar to those of rubella. Comparisons may be useful for a differential diagnosis:

Allergic contact dermatitis is an itchy skin condition caused by an allergic reaction to material in contact with the skin. It arises some hours after the skin has come into contact with the responsible substance, and gradually goes away over a period of days. Contact allergy usually is the result of the allergen on the skin rather than from internal sources or food. The first contact usually does not result in allergy; often the person has been able to touch the material for many years without adverse reaction.

Cytomegalovirus, or CMV, is found in all geographic regions and among all socioeconomic groups. By age 40, it infects between 50% and 85% of adults in the United States. CMV is also the virus most frequently transmitted to a developing fetus before birth. CMV infection is more widespread in poor countries and among poor people. Healthy individuals who acquire CMV after birth present with few symptoms and no long-term health consequences. Some people with symptoms experience a mononucleosis-like syndrome with prolonged fever and a mild hepatitis. Once a person becomes infected, the virus remains alive, but usually dormant within that person's body for life. Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease.

Herpesvirus 6 infection (HHV-6) is another very widespread disease that is thought to be present in 90-95% of the human population, and in virtually all geographic areas. Primary HHV-6 infection takes place by age 2 and usually presents as an unremarkable illness with fever. The peak age of infection is 6-9 months. Infection lasts for an average of 6 days.

Rubella is clinically differentiated from measles by the milder rash that disappears faster and by the absence of the small, irregular, bright red spots (Koplik's spots) on the mucous membranes inside the cheeks and on the tongue, as well as the aversion to light and a cough. A patient with measles appear to be sicker, and the illness lasts longer than is the case with rubella.

Standard Therapies

Diagnosis
Since the rubella rash is so much like rashes caused by other viruses, the definitive diagnosis is made on the basis of blood tests for the presence of the virus.

Treatment
There is no specific treatment for rubella, so prevention (through vaccination) is important. Women of childbearing age who are not immune should be immunized. Conception should be prevented afterward until the overseeing physician says that it is safe. Women who become pregnant and have not had rubella or been immunized, or are not certain whether they have, should contact their physicians promptly.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Rubella Resources

Organizations:

References

TEXTBOOKS
Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:2327-29; 2185-86.

Berkow R, ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1580-82.

Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. W.B. Saunders Co., Philadelphia, PA; 1996:1761-62.

Behrman RE, Kliegman RM, Arvin AM, eds. Nelson Textbook of Pediatrics. 15th ed. W.B. Saunder Company. Philadelphia, PA; 1996:871-73.

REVIEW ARTICLES
Chez MG, Chin K, Hung PC. Immunizations, immunology, and autism. Semin Pediatr Neurol. 2004;11:214-17.

Song BJ, Katial RK. Update on the side effects from common vaccines. Curr Allergy Asthma Rep. 2004;4:447-53.

Levitt C, Shaw E, Wong S, et al. Systematic review of the literature on postpartum care: selected contraception methods, postpartum Papanicolaou test, and rubella immunization. Birth. 2004;31:203-12.

Atreya CD, Mohan KV, Kulkarni S. Rubella virus and birth defects: molecular insights into the viral teratogenesis at the cellular level. Birth Defects Res A Clin Mol Teratol. 2004;70:431-37.

Fitzpatrick M. MMR: risk, choice, chance. Br Med Bull. 2004;69:143-53.

Banatvala JE, Brown DW. Rubella. Lancet. 2004;363:1127-37.

Bedford H. Measles, mumps and rubella - safety of the combined combined vaccine. Nurs Times. 2004;100:74-75.

FROM THE INTERNET
Ratner A. Medical Encyclopedia: Rubella. MedlinePlus. Update Date: 9/26/2003. 3pp.
www.nlm.nih.gov/medlineplus/ency/article/001574.htm

FAQs about MMR Vaccine & Autism. CDC. National Immunization Program. Last reviewed on May 19, 2004. 10pp.
www.cdc.gov/nip/vacsafe/concerns/autism/autism_mmr.htm

Rubella. CDC. nd. pp. 145-158
www.cdc.gov/nip/publications/pink/rubella.pdf

Rubella. MayoClinic.com. June 16, 2004. 5pp.
www.mayoclinic.com/invoke.cfm?id=DS00332

Rubella. JAMA Patient Page: Rubella. January 23/30, 2002. 3pp.
www.medem.com/MedLB/article_detaillb_for_printer.cfm?

Facts About Rubella For Adults. National Coalition for Adult Immunization. July, 2002. 2pp.
www.nfid.org/factsheets/rubellaadult.html

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2007/09/23 00:00:00 GMT+0

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