Resource Packages: German Measles (Rubella)

Historical Overview

Rubella (German Measles) has been recognised for over two centuries. Originally described in Germany by De Bregan in 1752 and by Orlow six years later, rubella was regarded as a cross between measles and scarlet fever and was often confused between these two conditions.  

In 1815, Maton differentiated German measles from measles, and further clarification came in 1866 when Veale introduced the term “rubella”.  Following these observations, interest in rubella dwindled as it was regarded as a mild, self limiting disease overshadowed by more dramatic diseases which were then prevalent. 

During the past 50 years three major advances have completely changed our understanding of the importance of the disease and its prevention. 

First, in 1941, Sir Norman Gregg, at the annual meeting of the Ophthalmological Society Of Australia, drew attention to the association between rubella contracted during the first trimester of pregnancy and congenital cataracts in the infants born to those mothers. Gregg recorded 78 infants with cataracts of whom 67 had a history of maternal rubella. 

Second, the isolation of the rubella virus in 1962 led to the precise laboratory diagnosis of the disease, and allowed for the next major advance, the development of rubella vaccines.   

Efforts to develop a vaccine were accelerated by the worldwide rubella epidemic from 1962 to 1965 which resulted in the USA in approximately 30,000 stillbirths and 20,000 malformed infants. Since that time rubella vaccination programs have been promoted in many countries, and the numbers of congenital malformations have been greatly diminished. 

Vaccines are prepared from strains of attenuated virus.  Mass vaccination of schoolgirls commenced in 1971, and non-pregnant seronegative adult women were also vaccinated. 

Recent Developments

Rubella is a mild febrile viral disease with a rash and lymphadenopathy, post auricular and sub-occipital glands, is characteristic and precedes the rash by 5-10 days. Up to half the infections occur without evident rash.

Rubella is important because of its ability to produce anomalies in the developing foetus.  Congenital rubella syndrome occurs in infants born to women who acquired rubella during the first trimester of pregnancy. The risk of a single congenital defect falls by the 16th week and defects are rare when the maternal infection occurs after the 20th week of gestation.

Clinical diagnosis of rubella is often inaccurate, so laboratory confirmation is important. Rubella, especially in pregnant women, can be confirmed by the use of serological tests for example, ELISA (Enzyme-Linked Immunosorbent Assay) testing or by the presence of rubella-specific IgM indicating a recent infection.

Most people have been infected by the time they reach adulthood.  Because most adult women are immune, newborn infants are usually protected at birth from postnatal infection for the first six months of life by maternal antibody. By the sixth month of life this has often disappeared and thereafter the proportion with antibody increases with age and exposure. Once acquired, immunity appears to last for many years, if not indefinitely.

Modes of transmission - by droplet spread or direct contact with patients and contact with nasopharyngeal secretions of infected persons.

Incubation period - 16 - 18 days with a range of 14 to 23 days.

Communicability - For about 1 week before and at least 4 days after onset of rash, highly communicable. Infants with congenital rubella may shed virus for months after birth.

Preventative Measures

Educate the general public on modes of transmission and the need for immunisation. Every effort must be made to identify and vaccinate seronegative women.

Vaccination of all children, both female and male, is recommended.

Women should be screened for rubella antibodies before every pregnancy, or early in the pregnancy. Women found to be seronegative on antenatal screening should be vaccinated after delivery and before discharge from the maternity unit.

All health care and child care staff, both male and female, including medical and nursing students, should be screened and those without vaccination records, or who are seronegative, should be immunised both for their own protection and to avoid the risk of transmitting rubella to pregnant patients.

Rubella vaccine should not be given to a woman known to be pregnant, and pregnancy should be avoided for 2 months after vaccination.

Children should be excluded from school and adults from work for 7 days after onset of rash.

Standard and droplet precautions should be practiced at all times.  The patient suspected of having rubella should be nursed in a single room and attempts should be made to prevent exposure of non-immune pregnant women.

Notification to the Public Health Unit - Rubella is a notifiable disease to the Public Health Unit.

References 

Benenson AS, ed, 15th ed. 1990.  Control Of Communicable Diseases In Man. American Public Health Association, Washington.

Bennett JV, Brachman PS, Sandford JP eds. 1992 3rd edition.  Hospital Infections. Little, Brown and Company, Boston.

National Health and Medical Research Council, 4th ed. 1991.  The Australian Immunisation Procedures Handbook.  Canberra.

National Health and Medical Research Council, 5th ed. 1994.  The Australian Immunisation Procedures Handbook.  Canberra.

NSW Health Department, 1999, Infection Control Policy, 99/87, AIDS/Infectious Diseases Branch, Sydney.

Reid D, Grist N R, Pinkerton IW, 1986.  Infections in Current Medical Practice. Butterworth, London.

Wenzel RP, 1993, 2nd ed.  Prevention and Control of Nosocomial Infections. Williams and Wilkins, Baltimore.

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