Rubella

Centers for Disease Control and Prevention

Boy with rubella rash

Symptoms and Causative Agent

Rubella is caused by a virus from the genusRubivirus. 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, and include 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 a wide range of 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 that 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

The virus is spread by airborne respiratory droplets. 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 not normally a serious illness in children, and, in fact, 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 mentally retarded. There were 2,100 neonatal deaths and more than 11,000 abortions – some a spontaneous result of 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 number of 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. It was developed by the prolific vaccine researcher Maurice Hilleman, 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, which was 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 had been 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 in order to advance rubella and CRS elimination.

U.S. Vaccination Recommendations

Vaccination against rubella is included on the U.S. childhood immunization schedule as part of the combined MMR vaccination. This vaccine is given in two doses, the first at 12-15 months of age and the second between 4-6 years of age. Alternatively, rubella vaccination is available as part of the newer MMRV (measles, mumps, rubella, and varicella) combination vaccine, which also protects against chickenpox.

Women in the United States who are considering becoming pregnant may be tested for rubella immunity, especially if they were born in countries where rubella vaccination is not routinely performed. For women who may become pregnant, only documentation of sufficient vaccination or a positive blood test for rubella antibodies is considered evidence of rubella immunity. If immunity cannot be established, vaccination may be recommended for women considering becoming pregnant. (Rubella vaccination is not indicated for women who are already pregnant, or who intend to become pregnant within four weeks’ time, although CRS has never been reported to be caused by the vaccine.)