German Measles (Rubella) Overview
Rubella (also known as German measles or 3-day measles) is a viral infection caused by the rubella virus, which is a member of the Rubivirus genus of the family Togaviridae. ‘Rubella’ is derived from a Latin term meaning “little red” and causes a red rash on the body.
Other symptoms associated with an infection usually include a high fever and swollen lymph nodes (suboccipital adenopathy). An infection can become complicated, particularly in older children and adults, where the infected person suffers arthralgia (pain in the joints), arthritis and thrombocytopenic purpura (ITP) – a disorder that can cause excessive bleeding or bruising.
The severity of the illness varies with age and commonly affects children between the ages of 5 and 9 years old, as well as adults. Some individuals who become infected with this illness are asymptomatic (producing or showing no symptoms).
German measles is typically mild, and an infection generally clears within a week. An infection is contagious and can be spread from person to person. Spreading occurs through contact with droplets of an infected individual’s cough or sneeze, sharing food or beverages or touching your mouth, nose or eyes after coming into direct contact with something that has droplets of bodily fluids from an infected person.
German measles is a very serious condition in expectant moms, particularly during the early weeks of pregnancy, due to its teratogenic effects (i.e. The ability to cause birth defects). The virus is easily transmitted to the foetus through the placenta and can cause serious congenital defects, miscarriage and even stillbirths if a woman is able to carry to term.
It is important to seek medical treatment if you suspect German measles, particularly if you are pregnant.
What to expect
Initially, symptoms of German measles may be so mild that you hardly notice you have an infection. Symptoms usually develop within a 2 to 3-week period (incubation period) after the initial exposure to the virus. Once you begin to feel ill, symptoms last between 3 and 7 days.
Symptoms you will experience are:
- A rash that is pink or red in colour. A rash initially develops on the face, typically behind the ears, spreading around the head and neck. The rash then spreads downwards towards the trunk (chest and stomach), arms, legs and the rest of the body. The rash consists of a number of small spots, which can become itchy. A rash typically clears by itself within 3 to 5 days (which is why it’s occasionally referred to as 3 day measles).
- Fever (usually under [celcius:38]): Symptoms of fever are generally mild, but can be more severe in adults.
- Tender or swollen lymph nodes. Glands or lymph nodes are small lumps of tissue found throughout the body. These glands contain white blood cells that help fight bacteria and viruses that cause infections. When infected with rubella, the glands tend to swell behind the ears (below the skull at the back of the head and neck). This swelling, which sometimes occurs even before a rash appears, can become painful. Swelling can also last for several weeks after the rash has cleared up.
- A runny or congested nose. Cold or flu-like symptoms can occur. Along with a runny or stuffy nose, you may also experience watery eyes, a sore throat and cough.
- Muscle and joint aches and pains
- Inflamed or red eyes (conjunctivitis)
In some cases, although rare, German measles can cause ear infections and swelling on the brain. Symptoms may not seem serious at first, but you should consult a medical professional, especially if you are pregnant or even suspect you may be pregnant.
If you experience any of the above symptoms as well as prolonged headaches, earache or a stiff neck, book an appointment with your doctor immediately.
Factors to consider
The rubella virus causes German measles and is highly contagious. The virus is easily spread through close contact from person to person or through the air. Tiny drops of fluid from the nose and throat while sneezing or coughing can easily spread the virus. You can also get the virus by touching an object contaminated with these droplets.
You are at your most contagious the week before a rash appears until approximately 2 weeks after it clears completely. As a result, an infected person can easily spread the virus before they are even aware they have it, especially if other symptoms aren’t yet noticeable.
Routine immunisations (measles, mumps and rubella vaccine - MMR) against rubella began in the late 1960s and typically provide lifelong immunity to the virus. German measles is most prevalent in countries that don’t offer routine vaccinations against the virus.
The vaccine is usually given to children between twelve and fifteen months old, and again between 4 and 6 years of age. Infants and young toddlers are thus at high risk of getting German measles if they haven’t been vaccinated. It is vital to contact your doctor if you suspect an infection, especially if you have never been vaccinated.
German measles and pregnancy
Expectant moms are also at high risk if they become infected with the virus. To reduce or avoid potential complications during pregnancy, many women are given a blood test to confirm immunity to rubella.
German measles is of high concern for a pregnant woman as the rubella virus is transmitted through the bloodstream to her developing baby. This is known as congenital rubella syndrome (CRS) and causes miscarriages, stillbirths and birth defects.
As a result, it is highly recommended that women of childbearing age intending to have children get their immunity to the rubella virus tested before falling pregnant. If it is found that a woman is not immune and needs a vaccination, it is important that she is vaccinated at least 28 days before trying to conceive.
Since the introduction of the MMR vaccine, serious complications associated with German measles are rare.
One very serious complication is CRS, but what happens and how does it affect a woman’s pregnancy and her unborn baby?
CRS disrupts the natural development of the foetus. The risk of CRS affecting the unborn baby, as well as the extent of birth defects is largely dependent on how soon in a woman is infected in the pregnancy. The risk is higher earlier in the pregnancy.
If a woman is infected during:
- The initial 10 weeks: The risk of CRS can be as high as 90%. As this stage of pregnancy is at the highest risk, and the foetus is in early stages of development, this is the period of gestation where the baby is most likely to develop birth defects.
- Or between weeks 11 to 16: The risk of CRS drops to between 10 and 20%. Fewer birth defects have been noted when infection has occurred at this stage of pregnancy.
- Or between weeks 17 to 20: During this stage of pregnancy CRS tends to be at the lowest risk, even rare. Deafness is, however, the most common complication when infection occurs at this stage of a woman’s pregnancy.
- After 20 weeks: Risk of CRS is believed to be virtually non-existent after this stage of pregnancy. The first twenty weeks are when an expectant mom and her unborn baby are at most risk of complications. If infection occurs before the twenty-week mark, there is no known treatment effective enough to prevent CRS.
If infection occurs and CRS develops, problems commonly seen in babies include:
- Cataracts (cloudy patches in the eye lens) and other eye defects
- Congenital heart disease (a range of birth defects affecting the development and normal functions or workings of the heart)
- A small head, disproportionate to the rest of the body (the brain hasn’t fully developed)
- Delayed growth rate in the womb
- Poorly functioning organs or damage to the brain, bone marrow, liver or lungs
- Intellectual disabilities
Health complications can develop later in life too. These include type 1 diabetes (a chronic condition where a person’s blood sugar level becomes too high), an overactive or underactive thyroid (this is the gland that produces hormones which control the body’s metabolism and growth rate), or brain in the brain (impaired mental and movement functionality).
Hearing problems can occur from birth, but may only be detected once the child gets older.
Diagnosis and Treatment
If you have any reason to suspect a rubella infection, book an appointment with your doctor as soon as possible. It is strongly advisable to inform your doctor of your suspicion when you make the appointment so that they can make any necessary arrangements ahead of time to reduce any potential risk to other people visiting their practice, especially those who may be pregnant.
In some countries around the world, doctors will also need to report any infections to all relevant local health authorities so that they can assess any sudden outbreak cases or the spread of infection, in other countries it is not a notifiable condition. However, your physician will likely arrange a time for your consultation that won’t put others at risk.
If you suspect a rubella infection (either in yourself or a child) based on your overall symptoms, it is recommended that you stay away from community areas, school or work until a diagnosis either confirms or rules out the illness.
Some symptoms of German measles, particularly a rash, are often similar to other viruses. The main means of diagnosis your doctor will use is a blood test. Your doctor may also test your saliva by taking a sample from your mouth.
The blood test (a sample usually taken from a vein in your arm) will determine if there are different types of rubella antibodies (proteins that recognise and destroy bacteria and viruses harmful to the body) present in the bloodstream. Results of the blood test enable your doctor to see straight away whether you currently have an infection or are immune to it.
Even if you have had rubella in the past, your sample could test positive for certain antibodies.
Antibodies that will be present in your result are:
- IgM antibody: If it is determined that you have a new infection, this antibody will be present.
- IgG antibody: If you have had a rubella infection in the past or you’ve been vaccinated against it, this antibody will be present.
- Neither: Where neither antibody is present, your result will indicate that you are not infected with the virus and / or haven’t been vaccinated against it. There is a small chance that a person can test negative for these tests and still clinically have the disease.
Pregnant women who suspect, for any reason, that they may have the infection must see their physician as soon as possible. An expectant mom may be aware that she has come into contact with an infected individual, develop a rash, come into contact with someone who has a rash, or experience other known symptoms of the virus.
As with any other suspected case, a blood, and / or saliva test will be done to determine the presence of an infection or not. If the rubella virus is present, a pregnant woman will likely be referred to her gynaecologist (obstetrician) who specialises in conditions that affect an unborn baby.
Further tests and an ultrasound scan will then be conducted as soon as possible to assess any developing problems with the growing foetus. If serious problems are determined, many will be offered counselling as well, enabling an infected mother to make an informed decision about whether she wishes to continue her pregnancy or not.
Once diagnosed, most cases of German measles can be treated at home. As the symptoms of the illness are usually mild, treatment recommendations help clear up the virus within 7 to ten days.
To treat your symptoms, you will be advised to:
- Stay home and rest. Staying away from others, especially while you are contagious, is strongly recommended. Rest also helps your body to heal and recover from the symptoms brought on by the infection.
- Control your fever and relieve any bodily aches and pains with paracetamol or ibuprofen. Liquid paracetamol may be recommended for young children. Children under the age of 16 should never be given aspirin to relieve pain as the risk for Reyes Syndrome is incredibly high. This is a potentially deadly disease affecting the brain and the liver. Other ways you can relieve a high temperature is with a cool (not cold – this will cause blood vessels to constrict) compress applied to the forehead.
- Drink plenty of fluids to reduce the risk of dehydration. Sufficient hydration will also help to alleviate any discomfort caused by coughing.
- Your doctor or pharmacist can recommend over-the-counter medication to help treat cold or flu-like symptoms. Other ways you can help treat these symptoms include steam inhalation (hold your head over a bowl of steamy water with a towel placed over your head and breathing in the warm steam). Warm drinks with lemon and honey can also provide some relief by relaxing the airways, loosening mucus and soothing a cough.
- Expectant moms may also be treated with antibodies called hyperimmune globulin to assist with fighting the virus in the body. These antibodies will also help to alleviate the severity of symptoms experienced. Hyperimmune globulin will not, however, prevent or reduce the risk of CRS.
What is the difference between German measles and measles?
Regular measles (rubeola) is not the same as German measles (rubella), although the two illnesses do share similar characteristics – namely a red rash on the skin. Rubella is caused by a different virus and is considered a milder illness (not as severe) that only lasts between 3 days and a week. Rubeola (measles) can become a serious illness lasting several days and cause other more serious and / permanent complications.
Is German measles itchy?
The rash that appears on the skin when infected with German measles it not usually itchy. As the rash begins to heal, however, skin may be shed (and resemble skin that peels after sunburn). In some instances, the rash can become itchy, but still clears up within 3 to 5 days.
Can German measles be prevented?
The MMR vaccination (measles, mumps and rubella vaccine) is the safest and most effective way of preventing German measles. Some countries offer the MMRV vaccine, which in addition to protecting against measles, mumps and rubella, can also help prevent varicella (the virus that causes chicken pox).
Each vaccine contains small doses of the virus, which can sometimes cause mild fevers and rashes. These are easily cleared on their own. Adverse or systemic reactions have been noted in some people. Severe allergic reactions are very rare.
A vaccination usually isn’t recommended for those with an impaired immune system (due to another illness or condition), are pregnant (there is a risk to the unborn baby during pregnancy) or are planning a pregnancy within a month of a vaccination (in this case a woman will be advised to wait at least 28 days before trying to conceive).
Typically given to children between twelve and fifteen months, booster shots are also given again when children reach the age of between 4 and 6. If a pregnant woman has no record available of 2 doses of the MMR vaccine, she may be advised to have the vaccine soon after her 6-week postnatal check-up following the birth of her baby.
It may not necessarily prevent an infection, but ensuring that you are immune to the virus before you travel to countries where the infection is widespread can help reduce the risk of getting or spreading the illness. Your physician can advise you on whether or not your destination currently has a high rate of rubella, and also confirm your immunity with blood or saliva tests.