Child Disability and Health

Rubella - German Measles MMR Vaccine

Sometimes rubella is known as German measles. The name likely comes from the Latin term germanus meaning "similar".

Sometimes rubella is known as German measles. The name likely comes from the Latin term germanus meaning "similar." And indeed, rubella and measles (rubeola) share some characteristics, but they're caused by different viruses.

Rubella and measles are both contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either illness. However, rubella isn't as infectious as measles and is usually not as severe, which is why it's also called three-day measles. There is one important exception, though: If a pregnant woman contracts rubella, especially during her first trimester, the virus can cause miscarriage, stillbirth or serious birth defects in the developing fetus — a condition known as congenital rubella syndrome. These defects can include deafness, growth retardation and heart problems.

After an incubation period of 14 - 21 days, the primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face which spreads to the trunk and limbs and usually fades after three days. Other symptoms include low grade fever, swollen glands, joint pains, headache, conjunctivitis. The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 oC (100.4 oF). The rash disappears after a few days with no staining or peeling of the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate.

Rubella can affect anyone of any age and is generally a mild disease, rare in infants or those over the age of 40. The older the person is the more severe the symptoms are likely to be. Up to one-third of older girls or women experience joint pain or arthritic type symptoms with rubella. The virus is contracted through the respiratory tract and has an incubation period of 2 to 3 weeks. During this incubation period, the carrier is contagious but may show no symptoms.

Rubella infections are prevented by active immunisation programs using live, disabled virus vaccines.

The vaccine is now given as part of the MMR vaccine. The WHO recommends the first dose is given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus.

Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertile females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children.

The measles-mumps-rubella MMR vaccine, usually given to children in the United States twice before they reach school age, is highly effective in preventing the illness.

Before widespread use of the rubella vaccine, rubella outbreaks occurred every six to nine years, causing more than 57,000 cases of rubella in the United States in 1969. Today, only rarely does a child or an adult in the United States contract rubella.

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