$Unique_ID{BRK04199} $Pretitle{} $Title{Rubella} $Subject{Rubella German Measles Three-Day Measles } $Volume{} $Log{} Copyright (C) 1986, 1989 National Organization for Rare Disorders, Inc. 274: Rubella ** IMPORTANT ** It is possible the main title of the article (Rubella) is not the name you expected. Please check the SYNONYMS to find the alternate names and disorder subdivisions covered by this article. Synonyms German Measles Three-Day Measles General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Rubella is a contagious viral disease characterized by swelling of lymph glands and a rash. A pregnant woman infected with Rubella during the early months of pregnancy may develop an abortion, stillbirth or congenital defects in the infant. (For more information, see the article "Rubella" in the Prevalent Health Conditions/Concerns area of NORD Services.) Symptoms Rubella has a 14- to 21-day incubation period and a 1- to 5-day preliminary phase in children. The preliminary phase may be minimal or absent in adolescents and adults. Tender swelling of the glands in the back of the head, the neck and behind the ears is characteristic. The typical rash appears days after onset of these symptoms. The Rubella rash is similar to that of measles, but it is usually less extensive and disappears more quickly. It begins on the face and neck and quickly spreads to the trunk and the extremities. At the onset of the eruption, a flush similar to that of scarlet fever may appear, particularly on the face. The rash usually lasts about three days. It may disappear before this time, and rarely there is no rash at all. A slight fever usually occurs with the rash. Other symptoms such as headache, loss of appetite, sore throat and general malaise, are more common in adults and teenagers than in children. After-effects of Rubella are rare among children, although there have been cases of joint pain (arthralgia), sleeping sickness and blood clotting problems. Adult women who contract Rubella are often left with chronic joint pains. Encephalitis is a rare complication that has occurred during extensive outbreaks of Rubella among young adults serving in the armed services. Transient pain in the testes is also a frequent complaint in adult males with Rubella. Causes Rubella is caused by an RNA virus of uncertain classification (probably a toga-virus), and is spread by airborne droplet clusters or by close contact with an infected person. A patient can transmit the disease from 1 week before onset of the rash until 1 week after it fades. Congenitally infected infants are potentially infectious for a few months after birth. Rubella is apparently less contagious than measles, and many persons are not infected during childhood. As a result, 10% to 15% of young adult women are susceptible if they have not been vaccinated against the disorder. Many cases are misdiagnosed or go unnoticed. Before the Rubella vaccine was developed, epidemics occurred at regular intervals during the spring. Major epidemics occur at about 6- to 9-year intervals. Once infected by Rubella, immunity appears to be lifelong. Related Disorders Measles, scarlet fever (scarlatina), secondary syphilis, drug rashes, erythema infectiosum (fifth disease), infectious mononucleosis, and echo-, coxsackie- and adenovirus infections must be considered in the differential diagnosis. Rubella is clinically differentiated from measles by the milder rash that disappears faster, and by the absence of the small, irregular, bright red spots (Koplik's spots) on the mucous membranes inside of the cheeks and on the tongue, a running nose (coryza), the aversion to light and a cough. A patient with measles appears more sick and the illness lasts longer. With even mild scarlet fever (scarlatina) there are usually more constitutional symptoms than in Rubella, including a severely red, sore throat. The white blood cell count is elevated in scarlet fever, but is usually normal in Rubella. The rash and swollen lymph nodes (adenopathy) of Rubella can be simulated by secondary syphilis. However, the lymph nodes are not tender in syphilis and the rash appears bronze-like. If there is doubt, a quantitative serologic test for syphilis can be performed. Infectious mononucleosis may also cause a Rubella-like swelling of lymph nodes and a skin rash, but can be differentiated by the initial lack of white blood cells (leukopenia) followed by an increase in white blood cells (leukocytosis). Many typical mononuclear cells appear in the blood smear, with appearance of antibodies to the Epstein-Barr virus. In addition, the sore throat of infectious mononucleosis is usually prominent, and malaise is greater and lasts much longer than in Rubella. A clinical diagnosis of Rubella is subject to error without laboratory confirmation, especially since many viral rashes closely mimic Rubella. Acute and convalescent serum should be obtained, if possible, for serologic testing. A 4-fold or greater rise in specific hemagglutination inhibiting antibodies confirms the diagnosis of Rubella. Therapies: Standard Prevention: The purpose of Rubella immunization programs is to prevent some of the catastrophes associated with congenital Rubella. All children between the ages of 15 months and puberty should be routinely vaccinated against Rubella. Women of childbearing age whose blood tests negative for hemagglutination inhibiting antibodies should be immunized. Conception should be prevented for at least 3 months after immunization. Rubella requires little or no treatment. Middle ear infection (otitis media), a rare complication, is usually treated with penicillin G or V in patients over 8 years of age, and with ampicillin for those under 8. Therapies: Investigational This disease entry is based upon medical information available through September 1989. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Rubella, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control 1600 Clifton Road, N.E. Atlanta, GA 30333 (404) 639-3534 References Rubella: Public Health Education Information Sheet: March of Dimes Birth Defects Foundation (1984).