Rubella Virus infection

Rubella, which is also known by the names German Measles or three-day measles, is a contagious viral infection best known for its distinctive red rash. Rubella is not the same disease as measles which is also known as rubeola. Although the two illnesses do share some characteristics, including a red rash, the causative viruses are quite different and they are separate and distinctive illnesses altogether. It is also known that rubella is neither as infectious nor usually as severe as measles. It is yet another one of the usual childhood infectious illnesses that are often taken for granted. The disease is still common in many parts of the world, although in more than half of all countries it is now well controlled with the use of a specific vaccine.

Rubella is a disease that is caused by a virus that is passed from person to person. It can spread through droplets being released into the atmosphere when an infected person coughs or sneezes or, it can spread by direct contact with an infected person’s respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child via the bloodstream of the mother. A person with rubella is contagious from 10 days before the onset of the rash until about one or two weeks after the rash disappears.

The signs and symptoms of rubella are often so mild that they’re difficult to notice, especially in children. If signs and symptoms do occur, they generally appear between two and three weeks after exposure to the virus. They typically last about two to three days and may include fever of 102 F (38.9 C) or lower, headache, stuffy or runny nose, inflamed congested red eyes, enlarged and tender lymph nodes or glands at the back of the base of the skull, the back of the neck and behind the ears, a fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs, before disappearing in the same sequence and aching joints, especially in young women. Though it is a rare manifestation, some get arthritis in the fingers, wrists and knees, which generally lasts for about one month. Rubella usually does not cause many problems in children and resolve without any undue persistent or long-term problems. Once a person has had the disease, he or she is usually permanently immune. In rare cases, rubella can cause certain complications which involves an ear infection (otitis media) or inflammation of the brain (encephalitis).

In doubtful instances certain specific blood tests help to establish the diagnosis. The usual routine blood counts are unremarkable and at best would show some evidence of a viral infection. However, the tests that are most useful are those that could isolate the virus or assess the presence of specific antibodies in the blood. Not many laboratories are able to isolate the virus but the antibody tests are available in the government and private laboratories.

Rubella can also occur as a "sub-clinical infection". This means that a person could get the infection but show no outward sign of an illness. There is no fever, rash or enlargement of the glands of the neck. These patients can however transmit the infection to another person during the usual period of infectivity. It has been estimated that significant proportions of children and adults do get these sub-clinical infections. This means that one may get it and not even know that he or she has got it. The only way to detect such an occurrence is by performing blood antibody tests.

When there are clinical features of the infection straightforward measures are all that is required. Rest is generally recommended and fever may need simple fever-reducing medications. No treatment will shorten the course of rubella infection, and symptoms are usually so mild that treatment usually is not necessary. However, doctors often recommend isolation from others, especially pregnant women, during the infectious period.

The biggest danger of rubella is if a woman gets it during the first 20 weeks of pregnancy. She may lose the baby, or the virus could cause problems to her unborn baby. This latter scenario is known as Congenital Rubella Syndrome. It is perhaps the best studied of all the intrauterine infections and it involves many systems of the baby. It is particularly dangerous as the infection in the mother is so mild that it is often missed or she may have a sub-clinical infection. The degree of damage to the baby is not proportional to the severity of the illness in the mother. In infection before 8 weeks of gestation which is the critical period of organ formation, the classical cardiac defects such as septal defects or "holes-in-the-heart, ear problems such as nerve deafness, eye defects such as congenital cataract and brain involvement leading to mental retardation, could occur?? Between this and 12 weeks the defects are not severe and are generally not seen in infections occurring after 16 weeks. In addition fetuses affected early in gestation suffer intrauterine growth retardation with a high mortality They may suffer from thrombocytopaenic purpura which is a bleeding tendency due to a reduction in the levels of platelets in the blood, enlargement of the lymph glands, the liver and the spleen. Many organs and systems of the baby could be affected by the disease. There is unfortunately no treatment for this disease once it occurs at birth and the only types of help that could be offered are various forms of surgical treatment of cataracts and correction of heart defects, all of which may need to be carried out later. The congenital rubella syndrome could be a very severe incapacitating incurable problem. It has been firmly established that up to 85 percent of infants born to mothers who had rubella during their first 11 weeks of pregnancy develop congenital rubella syndrome. The highest risk to the fetus is during the first trimester, but exposure later in pregnancy also is dangerous. It is well known that even sub-clinical infections of the mother could cause the same devastating effects in the baby.

Rubella is a preventable disease and as such, the logical aftermath of such a preventive strategy would be that Congenital Rubella Syndrome too is also very much a preventable entity. There is an effective vaccine against rubella. In the public sector it is administered at 3 years of age as the MR vaccine which contains both measles and rubella vaccine components. In the private sector it is available as the MMR vaccine which contains measles, mumps and rubella vaccine components. Successful vaccination could be confirmed by an antibody test on the blood. A second dose of the vaccine is needed later on to boost immunity levels. It is particularly important that girls receive the vaccine to prevent rubella during future pregnancies. Most children experience no side effects from the vaccine. About 15 percent of them may develop mild fever between seven and 12 days after vaccination and about 5 percent of children may develop a mild rash. Some teens and adult women experience temporary joint pain or stiffness after receiving the vaccine. Less than one out of a million doses causes a serious allergic reaction.

In recent years, some news reports have raised concerns about a connection between the MMR vaccine and autism. However, extensive reports from many authoritative sources including the American Academy of Pediatrics, the Institute of Medicine, and the Centers for Disease Control and Prevention (CDC) in Atlanta and The Royal College of Paediatrics and Child Health in the United Kingdom conclude that there is no scientifically proven link between the MMR vaccine and autism. These organizations note that autism is often identified in toddlers between the ages of 18 months and 30 months, which just happen to be about the time children are given their first MMR vaccine in many Western countries. But this coincidence in timing should not be mistaken for a cause-and-effect relationship. Currently it is firmly established that there is no scientific evidence to link early childhood autism spectrum disorder to thee MMR vaccine.

Many young women of marriageable age today belong to the cohort who would have received the rubella vaccine in childhood. The expanded programme of immunization of the Ministry of Health with over 90 per cent coverage of all children should ensure that all children would receive the vaccine in the future. However, if there is any doubt at all about the vaccination status or the effectiveness of vaccination, it could be easily checked by doing the antibody test. It is hoped that the terrible clinical picture of the Congenital Rubella Syndrome would be a thing of the past in the very near future. g

The writer would appreciate some feedback from the readers. Please e-mail him at bjcp@sltnet.lk

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