Rubella: symptoms, treatment and vaccination side effects

Rubella symptoms are often so mild that they are difficult to notice, especially in children. German measles or rubella is a relatively mild, three-day childhood illness that rarely leads to complications in children. Occasionally, joint inflammation occurs in fingers, wrists and/or knees and in very rare cases, inflammation of the brain occurs. When pregnant women contract the disease during the first few months of pregnancy, it can have serious consequences for the unborn child. Rubella is a relatively harmless condition for which there is no treatment. If the sick person feels very bad, you can give him paracetamol. Children are vaccinated against rubella. Approximately 1 in 10 to 20 children becomes irritable, develops a fever and/or a rash after the first MMR injection. That usually takes several days.

  • What is rubella?
  • Incubation period
  • Cause and contamination
  • How often does it happen?
  • Rubella symptoms
  • Call in your GP
  • Examination and diagnosis
  • Blood tests
  • Differential diagnosis
  • Rubella treatment
  • MMR vaccination and possible side effects
  • Vaccine
  • Side effects
  • Complications
  • Prognosis
  • Recovery
  • Arthritis
  • Pregnant women

Rubella / Source: CDC, Wikimedia Commons (Public domain)

What is rubella?

Rubella or Rubella is a relatively mild, three-day illness that rarely leads to complications in children. When pregnant women contract the disease during the first few months of pregnancy, it can have serious consequences for the unborn child. The rubella virus can lead to babies being born with defects such as heart and eye defects; hearing loss and deafness; growth retardation; platelet deficiency; liver or spleen enlargement; disorders of the nervous system; bone abnormalities; abnormalities of the urinary tract. It is also possible that the pregnancy will end in a miscarriage. Infection with the virus later in pregnancy can cause damage to the unborn child.

Incubation period

According to the RIVM, the period between infection and the disease becoming visible is between 12 and 23 days.

Cause and contamination

Rubella is a contagious spot disease caused by the rubella virus, which only occurs in humans. Infection occurs via saliva droplets in the air, which are spread by coughing and sneezing, for example. It turns out that a person who has a rubella infection infects an average of seven to eight other people. An infected mother can infect her unborn child with the virus through the placenta. The average time between infection with rubella and the outbreak of the disease – called the incubation period – is 14 to 18 days. The disease is contagious from 10 days before the outbreak of the rash until approximately 1 week afterwards

How often does it happen?

According to the RIVM, rubella hardly occurs in the Netherlands with less than 5 infections per year. In 2004-2005, a rubella epidemic occurred among mainly unvaccinated, orthodox Protestant schoolchildren. During this epidemic, 32 pregnant women became infected with rubella, resulting in 2 spontaneous miscarriages and congenital abnormalities in 11 children.ยน

Rubella symptoms

The signs and symptoms of rubella are often so mild that they are difficult to notice, especially in children. There are then no more than cold symptoms. Half of the people hardly suffer from anything. If symptoms do occur, they usually last about two to three days. The symptoms of rubella can include:

  • mild fever;
  • headache;
  • stuffy or runny nose (cold);
  • inflamed, red eyes;
  • blotchy, pink-red rash that starts on the face and quickly spreads to the upper body, arms and legs;
  • In older children and adults, flu-like symptoms and swollen lymph nodes behind the ear and in the neck (swollen lymph nodes) may also occur.
  • joint pain, pain in the joints, especially in older girls and young women.

GP examines child / Source: Istock.com/michaeljung

Call in your GP

If you think your child has rubella, it is wise to call the doctor. If it turns out that it is indeed rubella, the school or daycare center can be informed. Also contact your doctor if you are in the first half of your pregnancy and you think you are infected or if you have not been vaccinated against rubella and you have never had the disease.

Examination and diagnosis

Blood tests

The rubella rash can resemble many other types of viral rashes. Blood tests for antibodies against rubella can therefore be used. The course of the antibodies can show whether there is an infection that has just been experienced, or whether it is an infection that was experienced some time ago.

Differential diagnosis

The rubella rash may resemble one of the following conditions:

  • a herpes virus infection
  • the measles
  • parvovirus B19 (causing agent of fifth disease)
  • scarlet fever
  • the West Nile virus
  • Kawasaki disease
  • juvenile rheumatoid arthritis
  • glandular fever or mononucleosis (disease with sore throat, swollen lymph nodes, fatigue and mild fever)
  • contact dermatitis
  • cytomegalovirus (CMV)
  • mycoplasma infections
  • pediatric syphilis
  • toxoplasmosis

Rubella treatment

There are no medicines for rubella. If the sick child feels very bad, you can possibly give him (children’s) paracetamol. Make sure the child gets enough to drink to prevent dehydration. In most cases, rubella is a harmless childhood disease that goes away on its own after a few days. There are a number of exceptions to this situation. Sometimes joint inflammation occurs in fingers, wrists and/or knees and in very rare cases, inflammation of the brain occurs. If your child feels well, he or she can go to school. It is advisable to report the infection at school or daycare, so that other parents can be warned about a possible infection.

MMR vaccination and possible side effects

Vaccine

There is an effective vaccine against rubella. In 1974, vaccination against rubella was included in the National Vaccination Program to protect pregnant women. Since then, the disease has rarely occurred. In 2004-2005, there was a rubella epidemic among unvaccinated people, causing at least 387 cases of illness, including 32 pregnant women.

Side effects

The MMR vaccination usually has no or few side effects. Any side effects are mild and short-lived. Side effects do not start until 5 to 12 days after vaccination. It appears that the first MMR vaccination causes a side effect in 5 to 10% of children. This concerns the following complaints: drooping, fever and/or rash. It usually lasts no longer than 1 to 2 days. A few children develop a high fever and a severe rash. Some children experience a febrile convulsion (1 in 5,000 to 10,000 children). After the second MMR injection, complaints only occur sporadically. There are also rare diseases for which it cannot always be ruled out that they are caused by the vaccine, such as a temporary shortage of platelets (in approximately 1 in 30,000 to 50,000 children) or transient joint complaints (even rarer). No side effect has been proven to cause permanent damage.

Complications

Rubella is a mild infection. Once you have had the disease, you are usually permanently immune. Some women with rubella experience arthritis in the fingers, wrists, and knees, which usually lasts about a month. In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain (encephalitis).

If you get rubella during your pregnancy, the consequences for the unborn child can be serious and in some cases even fatal. Up to 80 percent of babies born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome (CRS). This syndrome can cause one or more problems, including:

  • slowed growth
  • cataract
  • deafness
  • congenital heart defects
  • defects in other organs
  • mental disorder
  • behavioral problems
  • depression

The greatest risk to the fetus is during the first trimester, but exposure later in pregnancy is also dangerous. A pregnant woman can also spontaneously have a miscarriage as a result of rubella.

Prognosis

Recovery

Postnatal rubella is generally a mild disease that resolves spontaneously after a few days to 1 week. The most important consequence of a postnatal rubella infection is congenital rubella syndrome (see ‘complications’).

Arthritis

Arthralgia (moderate to severe pain in one or more joints or joint pain) and arthritis may persist or recur for weeks or months, especially in adult women. However, the general prognosis for joint function is good.

Pregnant women

Maternal infection in nonimmune women during pregnancy, especially early in pregnancy, can lead to spontaneous abortion or miscarriage, fetal death, or congenital rubella syndrome.

Notes:

  1. Lucas Mevius. America free from rubella, when will Europe follow? Ned Tijdschr Geneeskd. 2015;159:C2607

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