Rubella (German Measles)

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Organism
Rubella is caused by a virus of the same name, which is in the family togaviridae.

Transmission
Rubella is spread from person to person via airborne transmission or droplets shed from the respiratory secretions of infected persons. Rubella may be transmitted by persons with subclinical infection or asymptomatic cases (up to 50% of all rubella virus infections).

Symptoms
Typical symptoms of rubella are a mild rash, swollen and tender glands (especially behind the ear, at the back of the neck, and under the skull), and a slight fever. Also, some adolescent girls and adult women get joint pain (arthritis), especially in the small joints of the hands.

• Swollen glands in the neck area are common with many viral infections. The glands that are most affected by rubella are those located behind the ear and at the back of the head. The degree to which they become swollen and tender is unique to rubella.
• Sometimes a rash is the only symptom of rubella that young children develop.
• Older children and teens may have fever, eye pain, sore throat, and body aches. They may or may not get a rash.
• Symptoms of rubella, especially pain and swelling at the joints, may be more severe in adults than in children. Joint pain (more commonly seen in women) may take as long as a month to go away.

The rubella rash is mild, starts on the face, and spreads to the neck, the chest, and the rest of the body. It may first appear as a mild blush before it develops into a more pinpoint rash with distinctive spots. Rubella infection without a rash is also common. Even if you do not have a rash, you are still contagious.

Complications, such as infection of the brain (encephalitis), can arise from rubella. Encephalitis from rubella is very rare but serious.

In adults and children, rubella is usually a mild disease with infrequent complications. For pregnant women, however, rubella can cause serious birth defects (known as CRS, Congenital Rubella Syndrome) in the fetus, including: 

• Deafness
• Cataracts
• Heart defects
• Mental deficiency
• Liver and spleen damage.

There is at least a 20 percent chance of damage to the fetus if a woman is infected early in her pregnancy.

Incubation Period
From 14-18 days with a range of 12-23 days.

Communicability
Rubella is only moderately contagious. The disease is most contagious when the rash first appears, but virus may be shed from 7 days before rash to 5–7 days or more after rash onset.  

Prevention and Vaccination
There is no treatment for rubella, however it can be prevented by the measles mumps rubella (MMR) vaccine. That vaccine is currently required for school entry in the state of Texas. Children may also get the MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox).

Women who are considering pregnancy should ensure they are up to date with the MMR vaccine to prevent Congenital Rubella Syndrome. Prenatal care usually includes testing to ensure the mother is immune to rubella. If a pregnant woman thinks she might have rubella or is exposed to someone with rubella, she should contact her physician immediately for follow up.

School Exclusion Policy
According to the Texas Administrative Code (TAC), specifically Rule 97.7 for schools and Rule 746.3603 for childcare, children in school and childcare settings shall be excluded for seven days after onset of rash. In an outbreak, unvaccinated children and pregnant women should be excluded for at least three weeks after the onset of the last rash.

Texas Trends
In 2015, two cases of rubella were reported in Texas, both imported from other countries. In 2017 there was one case of rubella indigenous to Texas. In 2018 there were two cases of rubella, both imported from other countries. Prior to 2015, Texas had not had any reported cases of rubella since 2004 and in 2019, Texas resumed its zero case status. Please see the congenital rubella syndrome (CRS) page for information specific to CRS.