German Measles (Rubella)

Symptoms of German Measles

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1. Pink or red spotted rash. This is the hallmark symptom of rubella, typically starting on the face and spreading downward over the body. The rash may also cause intense itching.
2. Fever. Individuals with rubella often experience fever, which can reach up to 38.9 degrees Celsius (102 degrees Fahrenheit).
3. Conjunctivitis. Due to the rubella virus, the eyes can develop conjunctivitis, leading to swelling and a pinkish hue.
4. Headache. Patients may experience headaches as the virus causes inflammation in various blood vessels, including those around the head.
5. Cough and runny nose. Rubella symptoms can resemble the flu, and patients may have a persistent cough and runny nose.
6. Joint pain. Commonly seen in young women, rubella can lead to joint pain. Patients may also feel muscle aches in addition to joint discomfort.
7. Swollen lymph nodes. Swelling of lymph nodes, especially around the neck and behind the ears, is a typical sign of rubella.

A person infected with rubella may not immediately show symptoms because the incubation period can range from 2 days up to 3 weeks. Despite not showing symptoms, the infected person can still spread the virus.

Diagnostic Procedures for German Measles

Diagnosing German measles, or rubella, involves clinical examination, laboratory testing, and a review of the patient’s medical history. While a characteristic rash can suggest rubella, additional testing is often necessary to confirm the diagnosis, especially in high-risk cases such as during pregnancy.

1. Physical examination and symptom review. The healthcare provider assesses visible symptoms, including the distinctive rash that typically starts on the face and spreads downward. Swollen lymph nodes around the neck and ears are checked, and recent flu-like symptoms, such as mild fever, cough, or runny nose, are reviewed to evaluate the likelihood of rubella.
2. Blood test for rubella antibodies. A blood test detects specific rubella antibodies (IgM and IgG) to confirm the infection. IgM antibodies indicate recent infection, appearing soon after symptoms develop and lasting for several weeks, while IgG antibodies suggest immunity from either past infection or vaccination.
3. Polymerase chain reaction (PCR) test. The PCR test identifies rubella virus RNA in body fluids, such as blood, throat swabs, or urine, and is highly accurate for confirming rubella, particularly in early infection stages. It is commonly used in cases involving pregnant women or suspected congenital rubella syndrome (CRS) in infants.
4. Prenatal screening. Pregnant women are routinely screened for rubella immunity as part of prenatal care. If exposed or symptomatic, further tests determine the risk of CRS to the fetus, including maternal antibody testing and, in some cases, amniocentesis to detect the virus in amniotic fluid.
5. Newborn testing for congenital rubella syndrome (CRS). If a mother contracts rubella during pregnancy, newborns may be tested for CRS. Samples of blood, urine, and throat fluids from the newborn help detect the rubella virus or antibodies. Early diagnosis of CRS is essential for managing potential health complications.

Accurate diagnosis of rubella through these procedures is crucial, especially for pregnant women and infants, to ensure timely care and prevent complications. Early testing and confirmation help manage and contain the spread of rubella effectively.

Complications of Untreated German Measles

While German measles, or rubella, is generally a mild illness, it can lead to serious complications if left untreated, particularly in vulnerable populations such as pregnant women and infants. Below are some potential complications associated with untreated rubella.

1. Congenital rubella syndrome (CRS). If a pregnant woman contracts rubella, the virus can pass to the developing fetus, causing CRS. This condition can lead to severe birth defects, including heart abnormalities, deafness, vision impairments, intellectual disabilities, and developmental delays. CRS is particularly common when rubella is contracted during the first trimester.
2. Miscarriage or stillbirth. Rubella infection in early pregnancy can lead to miscarriage or stillbirth. This risk is heightened in the first trimester when fetal development is most vulnerable.
3. Encephalitis. Though rare, rubella can cause inflammation of the brain, or encephalitis, in some individuals, leading to symptoms such as headaches, seizures, and behavioral changes. Encephalitis can be life-threatening or lead to long-term neurological issues.
4. Thrombocytopenia. Rubella can cause a decrease in the number of platelets, known as thrombocytopenia, which can lead to abnormal bleeding and bruising. This condition is more common in children and can sometimes be severe.
5. Otitis media (ear infections). In children, untreated rubella may lead to secondary complications, such as ear infections, which can cause pain, fever, and temporary hearing loss.
6. Arthritis. Joint pain and swelling are common in adults with rubella, particularly in women. In some cases, rubella-induced arthritis may become chronic if untreated, leading to prolonged joint discomfort.

Recognizing the complications of untreated rubella highlights the importance of prevention and early medical intervention. Vaccination remains the most effective measure to prevent these potentially severe health outcomes, particularly for women of childbearing age. By preventing rubella through vaccination, we can reduce the risk of serious complications and improve public health outcomes for all.

Causes of German Measles

The primary cause of rubella, or German measles, is the rubella virus. This virus spreads in several ways:

1. Inhaling small saliva droplets. The virus can be contracted by inhaling tiny droplets expelled when an infected person coughs, sneezes, or talks.
2. Touching contaminated objects. The virus can also spread through contact with surfaces or objects that have been contaminated by the saliva of an infected person.
3. Transmission from an infected pregnant woman to her fetus. An infected mother can pass the virus to her unborn baby, leading to congenital rubella syndrome, which can cause severe birth defects.

Rubella is highly contagious. The belief that rubella can be “caught from the air” is not entirely incorrect, as the virus often spreads through airborne droplets released by infected individuals.

Prevention of German Measles

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1. Vaccinate infants. The most effective way to protect infants from rubella is vaccination. The MMR (measles, mumps, and rubella) vaccine is available for free at local health centers. If preferred, vaccination can also be done at private clinics or hospitals, typically costing around 1,500 pesos or more per dose. The MMR vaccine schedule includes two doses, administered at 9 months and again at 1 year of age.
2. Vaccination before pregnancy. Women planning to conceive should receive the MMR vaccine if they haven’t been vaccinated before. Adults who missed vaccination in childhood are also eligible for the MMR vaccine. Doctors advise women to get vaccinated at least one month before becoming pregnant, as the MMR vaccine contains live but weakened virus strains that help the body produce immunity but should not be administered during pregnancy.

If the infant or woman planning pregnancy is not yet vaccinated, consider the following precautions:

1. Avoid crowded places with infants. Try to keep unvaccinated infants away from crowded areas where they might encounter asymptomatic carriers of the virus.
2. Bathe infants regularly. Frequent bathing helps remove any potential pathogens on the skin.
3. Practice regular handwashing. Regularly washing hands reduces the risk of transferring germs from surfaces to the body.
4. Follow proper cough and sneeze etiquette. Cover the nose and mouth with a tissue when coughing or sneezing. If a tissue is unavailable, sneeze or cough into the sleeve to minimize airborne droplets.

Implementing these preventive practices, along with vaccination, significantly reduces the risk of rubella infection.

Risk Factors for German Measles

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People of any age, whether children or adults, can contract rubella. However, the following groups are at higher risk:

1. Individuals not vaccinated with the MMR vaccine. Those who have not received the MMR (measles, mumps, rubella) vaccine are more susceptible to rubella.
2. Infants and children without vaccination. Young children who have not been vaccinated are at high risk of contracting rubella.
3. Pregnant women without vaccination. Pregnant women who haven’t been vaccinated are at risk, and if they contract rubella, it poses significant risks to the fetus.

Generally, people who have received the MMR vaccine are protected from rubella and measles. In the Philippines, the first dose of the MMR vaccine is typically administered when an infant reaches 9 months, followed by a second dose at 1 year of age. In cases of measles outbreaks, the first dose may be given as early as 6 months, as occurred during the measles outbreak in 2019. Vaccination remains the most effective preventive measure against rubella and its potential complications.

German Measles FAQs

German measles, also known as rubella, is a contagious viral infection best known for its characteristic red or pink rash. Although rubella often has mild symptoms, it can lead to severe complications, especially in pregnant women. Vaccination is the most effective way to prevent rubella, but it’s helpful to be aware of its symptoms, transmission methods, and treatment. Below are some frequently asked questions about German measles.

1. What is German measles? German measles, or rubella, is a viral infection caused by the rubella virus. It primarily affects the skin and lymph nodes, causing a red or pink rash, mild fever, and other flu-like symptoms.
2. How does German measles spread? Rubella spreads through respiratory droplets when an infected person coughs, sneezes, or talks. It can also be contracted by touching contaminated surfaces or through contact with saliva. Pregnant women who contract rubella can pass it to their unborn child.
3. Who is most at risk for German measles? Unvaccinated individuals, including infants, young children, and adults who haven’t received the MMR vaccine, are at a higher risk. Pregnant women without immunity are particularly vulnerable, as rubella can cause birth defects.
4. What are the symptoms of German measles? Symptoms include a red or pink rash that starts on the face and spreads down the body, mild fever, conjunctivitis, headache, and joint pain. Swollen lymph nodes around the neck and behind the ears are also common.
5. How long do symptoms last? Symptoms typically last around three days, hence the nickname “three-day measles.” However, the illness can persist for up to a week in some cases.
6. Can German measles be prevented? Yes, vaccination with the MMR (measles, mumps, and rubella) vaccine is the most effective way to prevent rubella. The vaccine is typically administered in two doses during childhood but is also available for adults who missed it earlier.
7. Is there a treatment for German measles? There is no specific treatment for rubella. The illness generally resolves on its own with proper home care, such as fever-reducing medications, hydration, and rest.
8. What complications can arise from German measles? While rubella is usually mild, it can lead to congenital rubella syndrome (CRS) in unborn children if contracted by pregnant women. CRS can cause serious birth defects, including heart abnormalities, deafness, and intellectual disabilities.
9. Is it safe to get vaccinated for rubella during pregnancy? No, pregnant women should not receive the MMR vaccine. Women planning to conceive are advised to get vaccinated at least one month before pregnancy to ensure immunity.
10. Can I get rubella if I’ve already been vaccinated? The MMR vaccine is highly effective, but immunity can sometimes wane. Adults who are unsure of their vaccination status can consult their doctor to check immunity levels.