rubella

M-M-R® II

MMR

M-M-R® II is used for primary vaccination and revaccination of children and adults to protect against measles, mumps and rubella.

Rubella

Common Name: 
German measles
Parents & Caregivers
Introduction: 

Rubella, also known as German measles, is caused by a virus. It is usually a mild disease, but when it occurs in pregnant women during pregnancy it can result in severe damage to the developing baby.

A brief history: 

The number of rubella cases has fallen dramatically since the vaccine became available in 1970. Prior to this, extensive outbreaks of rubella occurred every 6-9 years. The last such outbreak started in Europe in 1962/1963 and spread to the USA and other countries including New Zealand in 1964/1965 causing many cases of Congenital Rubella Syndrome.

The current New Zealand situation: 

Outbreaks of rubella continue to occur both in New Zealand and in nearby Pacific Island countries.

Symptoms: 

Rubella infection without symptoms is common. When symptoms are present they include a brief widespread rash, swollen lymph glands and painful joints, the latter mainly occurring in adults.

The rubella rash looks similar to other rashes and the only way to diagnose rubella is by a blood test.

How do you get it?: 

Rubella is spread from person to person by airborne respiratory secretions (coughing and sneezing). The incubation period varies from 14 to 23 days. Infants with Congenital Rubella Syndrome should be considered infectious until they are one year old.

What are the risks?: 

Rubella is usually a mild disease in children. Adults tend to have more complications, including temporary painful or swollen joints. Rubella may also occasionally present as a more severe illness, indistinguishable from measles.

  • About 5 in 10 cases of rubella develop a rash and painful swollen glands.
  • Nearly 5 in 10 adolescents and adults have painful joints (temporary).
  • Encephalitis (inflammation of the brain) occurs in 1 out of 6,000 cases.

Rubella is of serious concern if contracted in the early stages of pregnancy, as it is highly likely to cause severe abnormalities in the developing baby. These include cataracts, deafness, heart abnormalities, mental retardation and behavioural problems. These abnormalities are referred to as Congenital Rubella Syndrome.

Who is most at risk?: 
  • The unborn baby is most at risk.
  • Those without a prior history of rubella immunisation or confirmed rubella disease and women born in New Zealand between 1965 and 1967 are at an increased risk.
  • Immigrant women of child bearing age who have not received rubella or MMR (measles, mumps, rubella) vaccine are also at risk.
Treating the symptoms: 

There is no specific treatment for infection.

Preventing Disease Spread: 

Rubella vaccine, as part of the MMR (measles, mumps, rubella) vaccine is the best method of prevention.

Cases of rubella must be kept away from early childhood services or school for 7 days after the rash appears.

Health Professionals
Causative organism: 

The rubella virus is from the togavirus family. It is easily killed by heat and UV light.

Clinical signs, symptoms and complications: 

Symptoms may be absent or mild and in 30%-50% of cases.

Usually a mild disease in children. Adults tend to have more complications.

  • A discrete macular rash appears on the forehead about 7 days following infection and spreads down the trunk and limbs.
  • Mild conjunctivitis, cervical lymphadenopathy and arthralgia may occur.
  • Small petechial lesions (Focheimer spots) may be seen on the palate.
  • Splenomegaly may occur.

The most serious complication of rubella infection is Congenital Rubella Syndrome (CRS), which results when the rubella virus attacks a developing fetus. When infection occurs during the first trimester of pregnancy up to 85% of infants will be born with some type of birth defect, including deafness, eye defects, heart defects, mental retardation and more.

The risk of damage reduces to 10-20% by about 16 weeks gestation and has rarely been reported when infection occurred after 16 weeks gestation.

The rubella rash looks similar to other rashes. The only way to diagnose rubella is by a blood test.

Method of transmission: 

Spread is from person to person through the air (by coughing, sneezing) and is moderately contagious.
The incubation period varies from 14 to 23 days.
The disease is most contagious when the rash is erupting, but the virus can be spread from seven days before, to seven days after the rash appears.

Public health significance: 

German physicians first described rubella; hence, it is commonly known as German measles.

In 1941 an ophthalmologist reported a link between maternal rubella and congenital cataracts. A pandemic of rubella in 1964 led to recognition of an expanded congenital rubella syndrome (CRS), which includes hepatitis, splenomegaly, encephalitis, mental retardation as well as the more familiar association with deafness, cataracts and heart disease.

Rubella has a very similar pattern to measles, epidemiologically. It has respiratory spread that is greater in crowded societies, and periodically may disappear from a geographic area only to reappear in epidemic form.

The seriousness of CRS can be seen when reviewing the latest major American epidemic in 1964-65. There were 30,000 pregnancies affected out of 12.5 million rubella cases, including 2,000 cases of encephalitis. Of these pregnancies, 5000 women had surgical abortions, over 6000 women had spontaneous abortions and among the 20,000 infants who survived pregnancy, 11,600 were deaf, 3,580 were blind and 1,800 with mental retardation.

Not every country can offer free rubella immunisation and regional epidemics do occur periodically. In 2003 there were large epidemics in several Pacific Island nations.

New Zealand epidemiology: 

Outbreaks of rubella continue to occur in New Zealand. Although rubella immunisation was offered from 1979 to all girls in year 7 (form 1), it was not offered to boys until 1992, allowing spread in the community. There were 100 cases 232 reported between August 1989 and February 1990, some among pregnant women, and there were three cases of CRS reported. The outbreaks of rubella in 1993 and a larger one in 1995 have mostly involved young adult males, who would not have been offered immunisation. These outbreaks emphasise the need to immunise both boys and girls to reduce the risk of exposure in pregnant women, as well as to reduce illness in men. Rubella has been a notifiable disease since 1996. In 2003 there were 26 cases of rubella notified, of which three cases were laboratory confirmed; and in 2004 there were 25 cases notified, of which three were laboratory confirmed. It is important that suspected cases are notified and are laboratory confirmed so that public health control programmes can limit spread. No cases of CRS in New Zealand newborns reported to the New Zealand Paediatric Surveillance Unit between 1998 and 2010. 

Prevention: 

Respiratory diseases are difficult to control in large populations. People who are infectious with rubella should always avoid coming into contact with pregnant women.

Post-exposure prophylaxis with immunoglobulin and vaccination in pregnant women has not been established as effective and is not recommended.

The major prevention method is by national immunisation programmes.
MMR (measles, mumps, rubella) vaccines are widely available and recommended by the World Health Organization.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Rubella is a viral disease that causes a rash and swollen glands. It causes severe damage to unborn babies if acquired during pregnancy.

Effects of disease: 
About 5 in 10 cases of rubella develop a rash and painful swollen glands.
Nearly 5 in 10 adolescents and adults have painful joints (temporary).
About 1 in 6,000 develops inflammation of the brain.
For women in early pregnancy, 85% of babies infected during the first eight weeks after conception will have a major congenital abnormality such as deafness, blindness, brain damage, or a heart defect. This risk decreases to 10-20% by about 16 weeks gestation. After 16 weeks fetal abnormalities are rare.
Common side effects of vaccine: 
Measles component:
Fever over 39.5˚C and/or rash 6–12 days after immunisation.
Mumps component:
Parotid and/or submaxillary swelling 10–14 days after immunisation.
Rubella component:
Mild rash, fever and/or lymphadenopathy between two and four weeks after immunisation.
Joint symptoms may occur after the vaccine, the incidence of which is age related. More adult women than children get joint symptoms about two to four weeks after immunisation.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Temporary thrombocytopenia.
Encephalitis occurs once in one million doses. There may be some long-term effects from this.
Aseptic mumps meningitis.
Convulsion associated with fever.
Vaccines: 
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