Rubella (German Measles)

Symptoms and Causative Agent

Rubella is caused by a virus from the genus Rubivirus. Its symptoms include low-grade fever, respiratory problems, and most notably a rash of pink or light red spots that typically begins on the face and spreads downward. The rash occurs about two to three weeks after exposure to the virus.

In children, illness from rubella infection is usually mild. Complications from rubella are more common in adults than children, including arthritis, encephalitis, and neuritis.

A woman who contracts rubella infection during pregnancy can pass the infection to the developing fetus. Such pregnancies are at risk of spontaneous abortion or premature birth. If the fetus survives, the child may suffer from many birth defects, including deafness, eye defects, cardiac defects, mental retardation, bone lesions, and other abnormalities. Together, the defects are known as Congenital Rubella Syndrome (CRS). Of children whose mothers are infected during their first trimester of pregnancy, studies suggest between 50% and 90% will suffer from CRS.

Although rubella is sometimes called “German measles,” the rubella virus is not related to the measles virus.

Transmission

Airborne respiratory droplets spread the virus. Infected individuals may be contagious as early as a week before the appearance of the rubella rash, and for up to a week after it first appears. (It is most contagious at the time the rash first appears.) Children born with CRS may transmit the virus to others for more than a year.

Rubella cases typically peak in late winter or early spring.

Treatment and Care

There is no direct treatment for rubella. Supportive care may be provided, including efforts to lower fever.

Complications

Rubella is normally not a serious illness in children, and its symptoms are often mild. The chief danger of the disease is Congenital Rubella Syndrome.

From 1964-1965, before the development of a vaccine against the disease, a rubella epidemic swept the United States. During that short period, there were 12.5 million cases of rubella. Twenty thousand children were born with CRS: 11,000 were deaf, 3,500 blind, and 1,800 intellectually disabled. There were 2,100 neonatal deaths and more than 11,000 abortions – some spontaneously due to rubella infection in the mother, and others performed surgically after women were informed of the serious risks of rubella exposure during their pregnancy.

As of 2004, rubella was declared eliminated in the United States, and transmission of the rubella virus in the World Health Organization’s Region of the Americas was halted in 2009. Globally, about 100,000 rubella cases were reported for 2012 in the member states to the World Health Organization, though it is probable that the number of actual cases is much higher. The countries with the largest cases in 2012 were Timor-Leste, Macedonia, Thailand, Tajikistan, and Syria.  The number of estimated CRS cases each year is more than 100,000.

Available Vaccines and Vaccination Campaigns

The first rubella vaccine—a live, attenuated vaccine—was licensed in 1969. Prolific vaccine researcher Maurice Hilleman developed it, using rubella virus obtained from Division of Biologics Standards scientists Paul Parkman and Harry Meyer. Other companies in both the United States and Europe licensed their own rubella vaccines. Hilleman’s rubella vaccine was used in the combination measles-mumps-rubella (MMR) vaccine, licensed in 1971.

In 1979, an improved live rubella vaccine superseded Hilleman’s in the United States. Developed by Stanley A. Plotkin, MD, the RA27/3 vaccine was used in Europe for years and offered superior protection against the disease. It also replaced the original rubella vaccine in the MMR combined shot, and is still used today.

Rubella-containing vaccine (RCV) is part of the national immunization program in the Russian Federation, most of Europe, China and a few other countries in Asia, Australia, all of North and South America, and a few countries in Africa. As of 2010, 131 countries, representing 42% of the global birth cohort, use rubella-containing vaccines in their national immunization programs. The World Health Organization encourages countries not currently using rubella vaccination to take advantage of widespread measles vaccination initiatives to introduce RCVs to advance rubella and CRS elimination.

Sources

• Centers for Disease Control and Prevention. . Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson, W., Wolfe, S., Hamborsky,J. eds. 13th ed. Washington DC: Public Health Foundation, 2015. Accessed 04/12/2017.
• Centers for Disease Control and Prevention. . MMWR 59(40);1307-1310. Accessed 04/12/2017.
• Centers for Disease Control and Prevention. . Accessed 04/12/2017.
• Jyoti, M., Shirke, S., Matliai, H. Congenital rubella syndrome: global issue. Journal of Cataract and Refractive Surgery. 2015;41(5)1127.
• Plotkin, S.A., Orenstein, W.A., Offit, P.A. eds. Vaccines, 5th ed. Philadelphia: Saunders, 2008.
• World Health Organization. . 2012. Accessed 04/12/2017.
• World Health Organization. . Updated 03/03/2017. Accessed 2/9/2016.
• World Health Organization. . Weekly Epidemiological Record. 2011, 86, 301-316. (405 KB). Accessed 04/12/2017.