General Information on Rubella (German Measles)

Introduction

For most people rubella is a mild infectious disease, although it can have serious consequences for pregnant women. It was previously common among children aged four to nine years. It often occurred in epidemics every 6-9 years in populations where vaccination had not been in use. Rubella is a notifiable disease, which means that a doctor who sees a patient whom they suspect has rubella is required by law to report it. It is transmitted by direct contact or droplet spread. Humans are the only known hosts.

The illness

Rubella is very rarely a serious disease. It causes a transient red rash, swollen lymph glands around the ears (post-auricular) and back of head (sub-occipital), and occasionally in adults, arthritis (any abnormality of a joint caused by inflammation) and arthralgia (pain in a joint caused by inflammation). Rubella is serious for pregnant women, because if they are infected their unborn baby may develop abnormalities. Fetal defects include mental handicap, cataract, deafness, cardiac abnormalities, retardation of intra-uterine growth and inflammatory lesions of brain, liver, lungs and bone marrow.
 

Table 1: Risk of intrauterine transmission during different stages of pregnancy

The rash may be fleeting and may look like the rash caused by other viruses, therefore, clinical diagnosis by rash is unreliable. Clinical diagnosis should be confirmed using oral fluid testing. The incubation period is 14 - 21 days and the period of infectivity from one week before until four days after the onset of rash.

Epidemiology

Rubella immunisation was introduced in the UK in 1970 for pre-pubertal girls and non-immune women of childbearing age, to protect them from the risks of rubella in pregnancy. Before the introduction of rubella immunisation, there were as many as 70 cases of Congenital Rubella Syndrome (CRS) during epidemic years; the ratio of therapeutic abortions to cases of CRS was approximately 10:1. This means that of the 70 cases of CRS, a further 700 pregnancies would have been terminated.

Although the selective immunisation policy was effective in reducing the number of cases of CRS and terminations of pregnancy, cases of rubella in pregnancy continued to occur. This was mainly because the few women who remained susceptible to rubella could still acquire rubella infection from their own and/or their friends' children.
 

In 1988, the introduction of MMR as a universal immunisation programme augmented the previous selective immunisation policy. The aim was to eliminate circulating rubella. A considerable decline in rubella in young children followed but in 1993, there was a large increase in both notifications and laboratory confirmed cases of rubella. The majority of these cases occurred in males in colleges and universities, who had previously not been offered a rubella-containing vaccine. However, there was also an increase in the number of reports of rubella infections in pregnant women. These rose from 2 in 1992 to 23 in 1993; there were 8 cases in 1995. Outbreaks of rubella have continued predominantly in young males and there will continue to be a small number of infections in pregnant women, through contact with young men in this country or acquired abroad.

Treatment

There is no specific treatment for rubella. Treatment should be based on alleviating symptoms.

Prevention

Rubella vaccine is one of the components of MMR vaccine. The introduction of MMR has led to a fall in the number of cases of rubella in the community and in pregnancies complicated by maternal rubella.

Rubella vaccine is no longer available as a single antigen vaccine. From the beginning of October 2003, the Department of Health has recommended that sero-negative women of child-bearing age and health care workers who need to be protected against rubella should be offered the combined MMR vaccine. For further details of this immunisation policy, please see "Protecting women against rubella: Switch from rubella vaccine to MMR" and the rubella chapter of "Immunisation against Infectious Disease".

There are two licensed MMR vaccines: Priorix (GSK) and MMRVAXPRO (replacing MMR II) (Sanofi Pasteur); both of which contain the Wistar RA 27/3 strain.

Recommended immunisation schedule

MMR is given in the national immunisation programme at 12 to 15 months and at 3 and a half to 5 years of age. There is no upper age limit and where required, two doses can be given separated by a minimum of a one month interval (over ten years of age) or three months (under 10 years of age).

Frequently asked questions

Q: Why are they giving rubella vaccine to boys - they are not at risk of getting pregnant?

A: The decision to give rubella vaccine universally was based on evidence that more young men than women were susceptible to rubella and that continuing outbreaks among young men posed a risk of transmission of rubella to unimmunised pregnant women.

Q: I have heard that rubella is made from aborted human tissue?

A: Rubella vaccination is grown in a cell culture called MRC5. This was developed in the 1960s from a small number of cells taken from a single fetus that had been aborted on medical grounds. During manufacturing the rigorous purification process removes all traces of the cells that the vaccine has grown in. There is no fetal tissue or fetal cells in this, or any other vaccine.

Q: I am pregnant and my child has a rash. Is it rubella?

A: You are advised to consult your GP. It may be rubella, or it may be something else, such as parvovirus B19 or measles.

Guidelines on the management of, and exposure to, rash illness in pregnancy.

Useful links

Immunisation Information England MMR Pack 
Department of Health Rubella web page 
Press release from the Royal College of Paediatrics and Child Health 
Sense (a support organisation for deafblind awareness)

Last reviewed: 28 December 2011