Risk factors and complications of German measles (rubella)

Risk factors and complications of German measles (rubella)

German measles risk factors

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.

German measles complications

Since the introduction of the MMR vaccine, serious complications associated with German measles have been rare. However,  with the recent trend towards not vaccinating in various countries, complications are once again a very real reality for those who do not retain immunity after vaccination, especially during pregnancy

One very serious complication is congenital rubella syndrome (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)
  • Deafness
  • 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.

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