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Rubella virus
Virus classification
Group: Group IV ((+)ssRNA) Family: Togaviridae Genus: Rubivirus Species: Rubella virus

Rubella, commonly known as German measles, is a disease caused by the rubella virus. It is often mild and an attack can pass unnoticed. However, this can make the virus difficult to diagnose. The virus usually enters the body through the nose or throat. The disease can last 1-5 days. Children recover more quickly than adults. Like most viruses living along the respiratory tract, it is passed from person to person by tiny droplets in the air that are breathed out. Rubella can pose a serious risk as it can also be transmitted from a mother to her developing baby through the bloodstream via the placenta. If the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome, which includes a range of birth defects. The virus has an incubation period of 2 to 3 weeks during which it becomes established.

Contents 1 Symptoms 2 Risks 3 Prevention and treatment 4 History 5 References 6 External links

Symptoms of rubella in children include low grade fever, swollen glands, joint pain, headache, conjunctivitis, and a rash.

Adults & children:

• swollen glands or lymph nodes (may persist for up to a week)
• fever (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])
• rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears between the first and third days of the illness but it disappears after a few days with no staining or peeling of the skin)
• Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate
• flaking, dry skin
• nerves become weak and numb (very rare)

The older the infected person is the more severe the symptoms are likely to be. Up to one-third of older girls or women experience joint pain or arthritic type symptoms with rubella. The diagnosis is typically based on symptoms alone because they are not life threatening unless the infected person is pregnant. A definite diagnosis can be made by measuring levels of IgM antibodies to the rubella virus in the blood.

Rubella can affect anyone of any age and is generally a mild disease, rare in infants or those over the age of 40. The older the person is the more severe the symptoms are likely to be. Up to one-third of older girls or women experience joint pain or arthritic type symptoms with rubella. The virus is contracted through the respiratory tract and has an incubation period of 2 to 3 weeks. During this incubation period, the carrier is contagious but may show no symptoms. However, rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman. CRS is the main reason a vaccine for rubella was developed. If infection occurs 0-28 days before conception, there is a 43% chance the infant will be affected. If the infection occurs 0-12 weeks after conception, there is a 51% chance the infant will be affected. If the infection occurs 13-26 weeks after conception there is a 23% chance the infant will be affected. Infants are not generally affected if rubella is contracted during the third trimester, or 26-40 weeks after conception. Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders, blindness, deafness, or other life threatening organ disorders.

Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6-9 years in the United States and 3-5 years in Europe, mostly affecting children in the 5-9 year old age group. Since the vaccine, occurrences have become rare but do still arise, usually in underprivileged countries where the vaccine is not as accessible or in schools or daycares where contact is close and frequent. During the last epidemic in the United States between 1964-1965, at least 11,000 fetuses died and 20,000 children were born impaired or disabled as a result of CRS.

Symptoms are usually treated with paracetamol until the disease has run its course. There is no treatment available for congenital rubella.

Fewer cases of rubella have occurred ever since a vaccine became available in 1969, although decreased uptake of the MMR vaccine (e.g. in the UK) is expected to lead to a rise in incidence. In most Western countries, the vast majority of people are vaccinated against rubella as children at 12 to 15 months of age. A second dose is required before age 11. The vaccine may give lifelong protection against rubella. A side-effect of the vaccine can be transient arthritis.

The immunization program has been quite successful with Cuba declaring the disease eliminated in the 1990s. In 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of rubella had been eliminated from the United States.^[1][2]

The overwhelming number of children born with lifelong defects sparked a hunt for a cure or vaccine for rubella in the mid 1960s. Dr. Harry Meyer and Dr. Paul Parkman led the search for the vaccine. The first form of the vaccine they created was released in 1966 and assured to be safe, lasting, and cost effective. They also devised a test to measure a person's immunity to rubella. That original vaccine has since been revised and is now most commonly administered in the form of a M.M.R. vaccination at the age of 12-15 months. A second dose is usually given at 4-6 years of age. 95% of those who receive the vaccine are immune after the first dose, immunity is lifelong. The vaccine can also be given with a varicella vaccinaion (M.M.R.V.) or as a rubella vaccination alone. Pregnant women or those with lowered immune systems due to HIV should not be given the vaccine.

Friedrich Hoffmann made a clinical description of rubella in 1740.^[3] Later descriptions by de Bergen in 1752 and Orlow in 1758 supported the belief that this was a derivative of measles. In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known medically as Rötheln (from the German name Röteln), hence the common name of "German measles".^{[3][4][5][6][7][8]}

English Royal Artillery surgeon, Henry Veale, observed an outbreak in India. He coined the euphonious name "rubella" (from the Latin, meaning "little red") in 1866.^[7] It was formally recognized as an individual entity in 1881, at the International Congress of Medicine in London.^[8] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.^[9] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.^[6]

In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.^[4][6] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now know as congenital rubella syndrome (CRS) and noticed that the earlier the mother was infected, the worse the damage was.^[8] The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.^[7][4]

There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.^[7] In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births.^[8]

In 1969 a live attenuated virus vaccine was licensed.^[6] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.^[7]

Batshaw, Mark L., and Yvonne M. Perret. Children with Disabilities: a Medical Primer. 3rd ed. Baltimore, MD: Paul H. Brookes Co., 1993. 45-46.

Beers, Mark H., ed. The Merck Manual of Medical Information. 2nd ed. New York: Pocket Books, 2003. 1581.

Clayman, Charles B., ed. The American Medical Association Family Medical Guide. 3rd ed. New York: Random House, 1994. 661.

Constable, George, ed. Childhood Medical Guide. Alexandria, VA: Time-Life Books, 1986. 61.

Edlich, Richard. "Rubella and Congenital Rubella (German Measles)." Journal of Long Term Effects of Medical Implants 15 (2005): 319-328. PubMed. 17 Oct. 2007.

"German Measles." Encarta. 2007. Microsoft Corporations. 17 Oct. 2007 <http://encarta.msn.com/encyclopedia_761567981/German_Measles.html>.

Plotkin, S A. "The History of Rubella and Rubella Vaccination Leading to Elimination." Clinical Infectious Diseases: a Official Publication of the Infectious Disease Society of America (2006): 164-168. PubMed. 17 Oct. 2007.

Sears, William. Safe & Healthy a Parents Guide to Children's Illnesses & Accidents. Franklin Park, IL: La Leche League International, 1989. 145-146.

Rubella
Classification & external resources

ICD-10	B06.
ICD-9	056
DiseasesDB	11719
MedlinePlus	001574
eMedicine	emerg/388  peds/2025 derm/259

• Rubella at Wong's Virology.
• Immunization Action Coalition: Rubella
• German Measles Video
• DermNet viral/rubella

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