Rubella: Causes, Transmission and Risk Factors

What is Rubella?

• Rubella, often known as German measles or three-day measles, is an infectious viral infection characterized by a distinct red rash.
• While most people may only have minor or negligible symptoms, if contracted by pregnant women, it can pose serious threat to the fetus.
• During the first trimester of pregnancy, a maternal infection with rubella can result in congenital rubella syndrome which is a fetal malformation condition.
• A pregnant woman who develops rubella runs the risk of her unborn child developing serious, permanent birth abnormalities or perhaps death.
• This viral infection is brought on by an RNA virus and primarily affects the skin and lymph nodes.

Key Facts

• Rubella continues to be the most common vaccine-preventable cause of birth defects.
• After recovering from rubella, a person gains lifelong immunity to the rubella.
• A pregnant woman who contracts rubella in the first trimester of her pregnancy has a 90% chance of giving birth to a child who has congenital rubella syndrome (CRS).
• Birth defects linked to CRS include a variety of issues, such as heart problems, hearing loss, glaucoma, cataracts, and developmental delays.
• Rubella usually takes 18 days to get into full incubation, although it might take anything between 14 and 21 days.
• By 2020, 173 of 194 nations (89%) had successfully implemented RCVs, and 93 of those nations (48%) had been confirmed to have stopped the spread of rubella.
• Notably, the number of cases of rubella recorded decreased noticeably by 48%, from 94,277 in 2012 to 49,136 in 2019, and then further decreased to 10,194 in 2020.

Social and cultural aspects of rubella

1. Pregnancy and Motherhood

• If expectant mothers and their families are more aware of and concerned about rubella and may result in greater caution and adherence to vaccine advice.

2. Stigma and discrimination

• Due to misconceptions about the illness, people who catch rubella or have children born with congenital rubella syndrome (CRS) may experience discrimination and stigma in some societies.

3. Vaccination Practices and Beliefs

• Rubella vaccination rates may be impacted by cultural values and attitudes toward vaccinations.
• The uptake of rubella-containing vaccinations (RCVs) and other immunizations may be impacted by misinformation or vaccine reluctance based on cultural considerations.

4. Religious Beliefs

• Some religious organizations may hold particular views regarding vaccinations, medical procedures, and general health.
• These beliefs may have an impact on decisions about rubella vaccination and management, especially when the vaccine’s components contradict with certain religious beliefs.

5. Education and Awareness

• How information regarding rubella is communicated and received is influenced by cultural norms.
• Cultural sensitivity must be taken into account when designing health communication efforts and messages must be tailored to appeal to various populations.

6. Traditional Medicine

• Traditional healers have a substantial influence on medical decisions in various communities.
• The acceptance and engagement of rubella prevention and control measures can be improved by incorporating them with conventional medical procedures.

Symptoms

• 102 F (38.9 C) or lower mild fever
• Headache
• Runny or stuffed nose
• Itchy red eyes
• Large, painful lymph nodes behind the ears, at the base of the head, and in the back of the neck
• A little, pink rash that first emerges on the face, quickly spreads to the trunk, arms, and legs, and then disappears in the same way
• Joint pain, especially in young women

Causes

• The RuV virus is the root cause of rubella.

Transmission

• When someone ingests (swallows) or inhales droplets from an infected person’s cough or sneeze, rubella is most frequently transmitted.
• For months or even years after contracting CRS, infants continue to shed the rubella virus in their urine, nasal, and throat secretions.
• People with rubella are contagious for at least four days after the rash appears and for about a week prior to it.

Risk factors

1. Vaccination Status

• People who did not receive the rubella vaccine or who have received incomplete vaccination are more likely to be infected with the virus.

2. Age

• Children and young adults are more likely to contract rubella.
• These age groups are more vulnerable to the virus than other age groups.

3. Travel

• Visiting regions with low vaccination rates or regions where there are still active rubella outbreaks can increase the risk of contracting the virus.

4. Pregnancy

• Pregnant women who are not immune to rubella are at risk of passing the virus to their unborn child, which could result in congenital rubella syndrome (CRS) and the difficulties that go along with it.

5. Close Contact

• The risk of transmission is increased while in close proximity to an infected individual, particularly in crowded settings.

Complications

• While mostly not harmful, a rubella infection can occasionally result in complications.
• These are uncommon.
• Possible complications include:
  • Internal bleeds (thrombocytopenia)
  • (Encephalitis) Brain inflammation
  • Neurological issues brought on by a viral infection of the brain (progressive rubella panencephalitis)

• The two people most at risk for serious complications from rubella infection are a pregnant woman and her unborn child.
• An infected pregnant mother can transmit the disease to her unborn child.
• Congenital rubella syndrome (CRS) can result from infection, which can have an impact on all of the fetus’ organs.
• This is a dangerous illness that could result in:

1. Critical birth defects
2. Miscarriage
3. Stillbirth

• Babies with CRS might suffer from:

1. Deafness
2. Eye, heart and brain defects
3. Other lifelong mental and physical disabilities

Diagnosis

• Due to the ambiguous and non-specific nature of the symptoms, rubella can be challenging to diagnose.
• For instance, numerous disorders besides rubella induce fever, and the rash resembles other rashes in appearance.
• There are several ways to identify rubella, including:

1. Travel history and medical history, including immunization status
2. Physical assessment
3. Blood test

Prevention

• The vaccination provides individuals lifetime immunity and over 95% protection.
• Couples planning to have children should both get their vaccinations if they haven’t before.
• Travelers should check with their doctor six to eight weeks before travel to be sure they are up-to-date on their rubella immunization.
• By using educational campaigns and dialogues, raise awareness of the value of rubella immunization in your community.
• Ensure that all registered children’s immunization records are kept up to date and that school and childcare facilities promote vaccination.
• Healthcare providers should put their own immunization in first place and urge their patients to do the same.

Vaccination

• A single dosage of the live attenuated strain of the rubella vaccination provides more than 95% long-lasting protection, which is similar to that induced by natural infection.
• There are two types of rubella vaccines: monovalent (a vaccine targeted at only one disease) and increasingly frequently, combinations with additional vaccines such as those for measles (MR), measles, mumps, and varicella (MMRV).
• Following immunization, adverse effects are typically minimal.
• They could consist of rash, muscle aches, low-grade fever, soreness and redness at the injection site, and low-grade fever.

Treatment

• Like measles and the majority of other viral disorders, rubella has no known cure.
• All you can do is waiting for it to pass.
• Fever and headache can be managed with the help of analgesics like ibuprofen and acetaminophen.

References and For More Information