Rubella

Rubella is a viral illness that causes a skin rash and joint pain. A rubella infection is mild for most people, but it can have catastrophic consequences for an unborn baby. If a pregnant woman contracts rubella, her baby is at risk of severe and permanent birth defects or death. Rubella is sometimes called German measles, but rubella is a different viral disease to measles. Rubella is uncommon in Australia and other countries with widespread immunisation programs. The World Health Organization (WHO) announced in October 2018 that Australia has eliminated rubella. Elimination does not mean eradication. Outbreaks may still occur, so it is important to continue vaccinating children to prevent the spread of infection to pregnant women.

Symptoms of rubella

About half of rubella cases are so mild that there are no symptoms. If symptoms do occur, they usually appear between two and three weeks after infection. Some of the signs and symptoms of rubella may include:

• mild fever
• headache
• runny nose
• sore eyes
• skin rash
• swollen lymph nodes
• joint pain.

Complications of rubella

Rubella is a mild illness compared to measles and most people recover within about three days. Possible complications of rubella include:

• arthralgia – lingering joint pain that may take a month or more to get better
• otitis media – inflammation of the middle ear
• encephalitis – inflammation of the brain, which can be fatal in some cases.

Congenital rubella syndrome

A pregnant woman can spread the rubella infection to her unborn baby. This can have severe consequences such as miscarriage or birth defects known as congenital rubella syndrome (CRS), especially if the mother contracts the disease during the first trimester (first three months) of her pregnancy.

About nine in every 10 unborn babies exposed to rubella during the first 10 weeks of pregnancy will have a major congenital abnormality.

Birth defects associated with CRS include:

• deafness
• blindness
• heart defects
• intellectual disability
• impaired growth
• inflammation of various organs such as the brain, liver or lungs.

If you are pregnant and you suspect you may have been exposed to rubella, see your doctor.

Causes of rubella

Rubella is most commonly spread when someone ingests (swallows) or inhales the cough or sneeze droplets from an infected person. Infants with CRS shed the rubella virus in their nose and throat secretions and in their urine for months or even years.

Symptoms occur usually between 14 to 17 days (and up to 21 days). People infected with rubella are infectious for approximately one week before, and for at least four days after, the onset of the rash.

High-risk groups

As announced by the World Health Organization in October 2018, rubella has been eliminated in Australia, but cases may still occur. Anyone who hasn’t been vaccinated against rubella is at risk, in particular:

• travellers to (and visitors from) areas where rubella vaccination programs aren’t widespread
• childcare workers
• people who work in healthcare settings such as hospitals
• unborn babies whose mothers have low or non-existent rubella immunity.

Diagnosis of rubella

Rubella can be difficult to diagnose because the signs and symptoms are vague and non-specific. For example, many illnesses other than rubella cause fever and the rash looks similar to other types of rashes. Methods used to diagnose rubella may include:

• medical history including immunisation status and travel history
• physical examination
• blood tests.

Treatment for rubella

No specific medical treatment for rubella exists and the symptoms are usually mild. Antibiotics don’t work because the illness is viral. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:

• bed rest
• plenty of fluids
• paracetamol to reduce pain and fever.

It is important to isolate yourself for at least four days following the onset of the rash to reduce the risk of infecting others.

If you are pregnant and you contract rubella, discuss your treatment options with your doctor.

Immunisation against rubella

Immunisation is the best way to prevent rubella. A single rubella infection usually offers lifelong immunity for most people. Although unlikely, it is still possible to contract rubella even if you have had a vaccination or a previous rubella infection.

There are two types of rubella vaccine. In the first type, the rubella vaccine is combined with the measles and mumps vaccines and is commonly known as the measles, mumps, rubella (MMR) vaccine. In the second type, the rubella vaccine is combined with measles, mumps and varicella (chickenpox) vaccines and is commonly known as MMRV.

Protection against rubella is available under the National Immunisation Program Schedule. In Victoria, immunisation against rubella is free of charge for:

• children at 12 months – the first dose of rubella vaccine is given as the MMR combination vaccine
• children at 18 months of age – the second dose of rubella vaccine is given as the MMRV combination vaccine
• all children under 10 years of age can receive the free National Immunisation Program vaccines
• all young people 10 to 19 years of age
• women planning pregnancy or shortly after delivery – if their blood test shows they have no immunity to rubella
• children up to and including nine years – catch-up immunisations are available for children who have not been fully vaccinated
• women planning pregnancy or after the birth of their child – two doses of MMR are available for women who have low immunity or no immunity to rubella
• Aboriginal and Torres Strait Islander people, refugees, asylum seekers and vulnerable people – catch-up immunisations are available for people who have not been fully vaccinated
• people born during or since 1966, without evidence of receiving two documented doses of valid MMR vaccine or without a blood test showing evidence of immunity to measles, mumps and rubella, are eligible for one or two doses of MMR vaccine. (If two MMR doses are required they should be given a minimum of 28 days apart.)

If you have not received the vaccine, ask your doctor or immunisation provider about catch-up doses.

Note :The MMRV vaccine is not recommended for people aged 14 years and over. From 14 years of age people require the MMR vaccine and a separate chickenpox vaccine.

Pregnancy and immunisation against rubella

If you are intending to become pregnant, have a blood test to check your immunity against rubella and then have a vaccination if required. This blood test is necessary because even if you have previously been vaccinated against rubella, you may not be immune.

Women who are not immune require two doses of vaccine a minimum of 28 days apart and should avoid pregnancy for at least 28 days after immunisation.

If you are already pregnant, do not receive the MMR or MMRV vaccine. If you are pregnant and not immune, avoid contact with anyone who has rubella. Arrange for an immunisation soon after you have your baby and then avoid another pregnancy for at least 28 days.

People who work with children

If you work with children, remember that you are at an increased risk of catching and passing on infectious diseases. Stay up to date with all necessary vaccinations to protect yourself and the children (and their mothers) with whom you have regular contact. Some diseases cause only a mild illness in adults, but can be very serious for young children. For example, whooping cough (pertussis) can be deadly for young babies.

People who should not be immunised against rubella

Vaccination against rubella is not recommended for some people. A person with an impaired immune system should not be vaccinated.

Some of the possible causes of impaired immunity include:

• infection with human immunodeficiency virus (HIV) or the presence of acquired immunodeficiency syndrome (AIDS) from an HIV infection
• taking certain medications, such as high-dose corticosteroids
• having immunosuppressive treatment including chemotherapy and radiotherapy
• having some types of cancer, such as Hodgkin’s disease or leukaemia
• having an immune deficiency with extremely low levels of antibodies (hypogammaglobulinaemia, multiple myeloma or chronic lymphoblastic leukaemia).

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Local government immunisation service
• Maternal and Child Health Line (24 hours) Tel. 13 22 29
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Immunisation Unit, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• National Immunisation Hotline Tel. 1800 671 811
• Pharmacist