- symptoms: first cold-like symptoms, followed by the typical rubella rash: small, bright red spots that first appear behind the ears and then spread over the face to the whole body;
- Caused by: Viruses (so-called rubella viruses)
- contamination: via droplet contamination; between infection and the appearance of the first symptoms lasts two to three weeks (incubation period)
- treatment: often not necessary; possibly measures to relieve the symptoms (for example painkillers and antipyretics)
- danger: Rubella during pregnancy can be transmitted to the unborn baby. Especially in early pregnancy, it threatens serious damage to the child.
- prevention: rubella vaccination
Rubella’s symptoms can vary slightly from person to person. In addition, many of them are not specific to the disease. This means that similar complaints can also occur with other diseases.
Up to 50 percent of all people who become infected with rubella show no symptoms. Then doctors speak of an asymptomatic course.
First rubella simptome
The first symptoms, which usually occur with a rubella disease, are reminiscent of a common cold. This includes, for example, cough, cold, and light to moderate headache, In some cases, conjunctivitis is added. The eyes appear red and may itch. Often these remain the only symptoms of rubella. They are then mostly not recognized as rubella.
Classic rubella simptome
In addition to the signs of a cold, about half of all patients experience additional symptoms. These include swollen, often painful lymph nodes in the neck and neck area (in adolescents and adults, often in other parts of the body). This swelling occurs because the pathogens initially multiply in the lymph nodes before spreading through the blood in the body. The lymph nodes behind the ears and neck may also hurt or itch.
In some patients, the rubella infection is one of the increased body temperature (below 38 degrees Celsius).
Typical of rubella is a rash (Exanthem) of small, pale red, slightly raised spots. He doesn’t itch, or at all. The red spots do not merge, just like with measles. Often the rubella rash is only slightly visible. He first forms behind the ears. Over a few hours, it spreads to the face, neck, arms, and legs and eventually to the whole body. After one to three days, the rash disappears again.
In Germany, rubella is sometimes referred to as “Rubeola”. The term originally covered all skin diseases with a red rash. Therefore he is misleading. In England, for example, the term is used for measles. In addition, scarlet fever is called “Rubeola scarlatinosa” in the jargon. Because of the possible misinterpretation, Rubeola is therefore rarely used in German.
The rubella is usually mild and harmless. But it can also cause complications. The risk increases with age. This means that rubella in adults (and adolescents) is more prone to complications than in children.
Possible complications are:
- Arthritis: especially young women with rubella often get swollen joints
- Middle ear infection (otitis media)
- Brain inflammation (encephalitis)
- Myocarditis (myocarditis)
- Pericarditis (pericarditis)
The contagion of rubella comes through droplet contamination: If you cough, sneeze or kiss, small droplets of saliva infected with the rubella viruses can be transmitted to other people. The viruses enter the body through the mucous membranes of the upper respiratory tract (mouth, nose, throat). also about objects Contaminated with pathogens, an infection is possible: for example, if you use the same cutlery as a sick person, you can also become infected.
The following applies: People who have not been vaccinated against rubella or who have not yet had the disease can become infected. Despite vaccination or successful infection, rubella symptoms are as good as ever: only if the vaccination or the illness is very long ago, you may be reinfected with rubella. Such reinfection is very rare. The affected persons then mostly show no and only very mild symptoms (such as getting a cold).
Rubella: incubation period
The time between the infection with a pathogen and the onset of the first symptoms refers to by doctors as the incubation period. For rubella, it is between 14 and 21 days. Infected people are contagious from about a week before to about a week after the appearance of the typical rash.
Even those infected with rubella viruses, but showing no symptoms (don’t get sick), can transmit the pathogens to other people!
Rubella & pregnancy
There is much fear of rubella during pregnancy: the pathogen can be transmitted from the mother to the unborn child via the placenta. Such a childhood rubella infection in the womb is called congenital rubella syndrome. It can damage the organs of the child so badly that it is born with significant disabilities. A miscarriage is possible.
The decisive factor is the stage of pregnancy: the damage that rubella can cause to children in the womb is more frequent and more serious, the earlier the infection occurs. Any defects that can cause rubella infection in the unborn child, called ” Congenital rubella syndrome ” (CRS) have been summarized.
Rubella in the 1st to the 11th week of pregnancy
Rubella infection in the 1st to the 11th week of pregnancy can cause a lot of serious damage to the child in particular. The rubella embryopathy can occur in different forms:
- clinical triad (Gregg syndrome): Organ formation of the heart, eye, and inner ear (such as heart defects, cataracts, and hearing damage)
- extended rubella syndrome: Jaundice, skin rash, decreased platelet count (bleeding risk!), anemia, myocarditis, pneumonia, encephalitis, bone disease
- Late-onset rubella syndrome: It is only noticed in the 4th and 6th months of life: The babies stop growing, and get a chronic rash, and repeated pneumonia. The mortality is high (especially in pneumonia).
- Late effects in youth: Hearing impairment, diabetes (diabetes mellitus), reduced release of hormones, seizure disorders (epilepsy), progressive inflammation of the brain tissue (panencephalitis)
In addition to Gregg syndrome and enlarged rubella syndrome, some unborn babies also have developmental abnormalities: for example, the head is noticeably small (microcephalus) and mental development is delayed.
Rubella in the 12th to 17th week of pregnancy
Rubella infection of the unborn child in this part of the pregnancy usually damages the inner ear: The little ones are born with a hearing loss (hearing loss in the inner ear).
Rubella after the 18th week of pregnancy
In this phase, a rubella infection is less critical. Perhaps the unborn child may develop a little more slowly than it would without infection. As a rule, however, long-term consequences cannot be expected.
If a pregnant woman becomes infected with the rubella virus shortly before birth, the newborn baby may suffer from rubella.
The cause of rubella is a virus also known as rubella virus or rubella virus. The virus enters the body via the mucous membrane of the upper respiratory tract and spreads mainly in the lymph tissue (such as the lymph nodes). From there, the rubella viruses can enter the bloodstream (viremia) and in this way spread throughout the body.
Rubella: investigations and diagnosis
If rubella is suspected, a doctor should be consulted. Sometimes the disease can be associated with serious complications.
In a conversation, the doctor first collects all important information about the patient’s medical history (anamnesis). He asks the patient (e.g. parents):
- When is the result exact?
- Is this itching?
- Is the body temperature raised?
- Do you feel tired?
The anamnesis is followed by a physical examination. The doctor examines, among other things, the rash and scans the lymph nodes (such as the neck and neck).
Based on the medical history and the symptoms, rubella cannot be established beyond doubt. Rashes and swollen lymph nodes can also occur with many other diseases. If rubella is suspected, laboratory tests should always be carried out:
In the blood can be a rubella infection, the specific body formed by the Defensive substances (antibodies) prove against the rubella virus. It works best from five days after the onset of the symptom (fever and rash).
For pregnant women, such an antibody test is used as a precautionary measure, if according to your vaccination the woman has not been vaccinated against roundworms, or has only received one of the two recommended doses for the turnip. The same applies if the vaccination status is unclear, and you do not know whether the woman has ever been vaccinated against rubella.
The doctor can swab it up to five days after the rash starts or send one urine sample to the laboratory to detect rubella viruses based on their genome. This is a simple, reliable method, especially for children, to safely confirm suspected rubella and to give good advice to pregnant women (such as the pregnant mother).
Investigations of the unborn child
In pregnant women with suspected or proven rubella infection, the unborn child can also be examined. This happens in the context of prenatal diagnosis, so an experienced doctor can prepare a sample of the nut cake ( chorionic villus sampling ) or amniotic fluid ( amniosynthesis refers). In the laboratory, it is investigated whether the genotype of the rubella virus can be detected in the sample.
From the 22nd week of pregnancy, it is also possible to take a blood sample from the unborn child from the umbilical cord with a long, thin needle ( Umbilical cord blood sampling ). This fetal blood can be tested for antibodies against rubella viruses or the genome of the pathogens.
The suspected rubella as well as a proven infection must be reported by the attending physician to the responsible health department. He must also specify the name of the patient. Deaths due to rubella are also noted.
No treatment can combat the rubella virus directly – therefore no causal (causal) treatment, it is possible only a symptomatic treatment You can for example take antipyretic drugs (such as ibuprofen or paracetamol) or calf rolls to reduce the elevated temperature if necessary. By itself, fever is desirable – it shows that the immune system is fighting the pathogen. Therefore, you should reduce fever only when necessary. The best way to discuss this is with the attending physician.
The antipyretics ibuprofen and paracetamol also have an analgesic effect. Ibuprofen also helps fight inflammation. Both medicines are also suitable for rubella patients with headaches and painful, inflamed joints.
Acetylsalicylic acid (ASA) is also a popular analgesic and antipyretic. It should not be used in children and young adults with febrile illnesses! Otherwise, there is a risk of developing the rare but dangerous Reye syndrome.
In a rubella disease, adequate hydration and rest are helpful. It helps the body to heal.
Patients should also keep as far away from other people as possible. This reduces the risk of them transmitting the viruses. Contact with pregnant women should be especially avoided: if they are not sufficiently immune to the pathogen, there is a serious risk for the unborn child.
Pregnant women who are not immune to rubella and have had contact with a patient should go to the doctor quickly. Within the first three days after contact, he can inject the pregnant woman with ready-made antibodies against the pathogen. Later, this so-called prophylaxis after exposure no longer makes sense.
Rubella: disease course and prognosis
A rubella disease usually goes without problems. It poses no great threat to children born, as well as to adolescents and adults in general. However, age it increases the risk for complications such as pain, inflamed joints, otitis media, bronchitis, or myocarditis. Encephalitis (encephalitis) is especially feared. But this is one of the very rare rubella complications.
Rubella is also usually mild in pregnant women. The danger here is that even the unborn child becomes infected. Especially in the first weeks of pregnancy, the child can be seriously harmed.
Vaccination is the best protection against rubella. The standing vaccination commission (STIKO) at the Robert Koch Institute recommends the rubella vaccine for all children, which consists of two vaccination doses. It is given in combination with the measles and mumps vaccination (mumps-rubella vaccine, MMR vaccine).
The first vaccine dose is recommended for children between 11 and 14 months (the sooner the better). The second vaccine dose must be given between the ages of 15 and 23 months. There should be a gap of at least four weeks between the two doses.
The rubella vaccine is not only used to protect the vaccinated against infection. In particular, this should prevent the spread of rubella viruses in the population. It protects even pregnant women who are not immune to the pathogen, as well as their unborn child.
Read more about the rubella vaccination and its possible side effects in the rubella vaccine article.
- Guideline “Laboratory diagnosis of pregnancy-relevant viral infections” of the German Society for the Control of Viral Diseases (2014)