Overview
Also known as German measles, Rubella (from Latin ‘rubellus’ meaning reddish) is a viral infection caused by the rubella virus. It is spread by direct contact with an infected person or via respiratory droplets and is preventable by immunisation.
Rubella is generally mild but can cause serious complications in pregnancy, including congenital rubella syndrome.
Once infected or immunised, most people develop lifelong immunity, however, reinfection can occur.
Pathophysiology
The rubella virus replicates in nasopharyngeal cells before spreading to nearby lymph nodes and then the bloodstream. It is teratogenic as it can cross the placenta and infect the foetus, leading to impaired cell development and destruction, which may result in congenital rubella syndrome.
Epidemiology
- Since the introduction of the measles, mumps, and rubella (MMR) vaccine, the incidence of rubella is uncommon
- In 2017, the total number of laboratory-confirmed cases of rubella was 3
Presentation
Rubella may be asymptomatic in up to 50% of people. It presents with:
- Rash – usually present for 3-5 days
- A maculopapular, pink or light red maculopapular rash that starts on the face and spreads to the rest of the body
- There may be a prodrome of non-specific features:
- Fever, malaise, anorexia, coryza
- Other features include:
- Lymphadenopathy (usually postauricular and/or suboccipital) – may precede the rash and last for 2 weeks after the rash resolves
- Arthralgia – more common in adults and occurs in up to 70% of people with rubella
Investigations
Overview
Rubella cannot accurately be diagnosed via history and clinical features alone. Discuss appropriate investigations urgently with a specialist.
Management
For non-pregnant people with rubella infection, treatment is supportive. This includes rest, adequate fluids, and paracetamol for fever and pain.
Rubella is a notifiable disease. Notify Public Health England.
For pregnant people, management is discussed in Rubella Exposure in Pregnancy.
Patient Advice
Patients should:
- Stay away from work or school/nursery for at least 5 days after the initial rash
- Avoid contact with pregnant people
- Seek urgent help if symptoms do not settle or features of complications develop
Complications
- Congenital rubella syndrome:
- This can lead to stillbirth and severe birth defects
- If an infection occurs early in pregnancy, there is a 90% chance of the virus being passed to the foetus
- Arthritis and arthralgia – most common in adult women
- Thrombocytopenia – in around 1 in 3000 cases
- Encephalitis – in around 1 in 6000 cases
Prognosis
- Most cases of rubella are mild with a transient rash and lymphadenopathy which resolves in around 1 week
- Maternal infection in non-immune people during pregnancy can cause serious congenital abnormalities (congenital rubella syndrome), lifelong disability, and stillbirth
