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Baby and childhood infectious diseases: german measles (rubella) BABY AND CHILDHOOD INFECTIOUS DISEASES: GERMAN MEASLES (RUBELLA)
Rubella is a common, simple infectious disease which is widespread amongst children. It is produced by a virus, and the symptoms are a fine skin rash and swelling and tenderness of the glands around the neck. It spreads from person to person by droplet infection (the germs cling to microscopic drops coughed, breathed or sneezed into the air by an infected person).
The time from infection until the onset of symptoms (the incubation period) is usually between two and three weeks. There is a lapse of a few days (the prodromal period) from the start of symptoms until the typical rash sets in. During this time there are minor symptoms: the child may feel slightly off-colour and notice that the glands in the neck are a bit tender. Frequently, especially in younger children, these may be completely overlooked.
Finally the rash appears. This is usually a faint, very fine stippling that starts on the face and rapidly spreads on to the trunk and limbs. Within two to three days, and often sooner, it vanishes. Occasionally the temperature is raised, but generally this is only mild. In some instances, especially in epidemics, there may not even be a noticeable rash, just the glandular swelling. In some epidemics, as many as 40 per cent of cases may be rash-free. In some cases, a fine rash may be present but last only a few hours.
The chief concern of rubella is the amazing capacity of the virus to cross the maternal-placental barriers in pregnant women. This is vitally important during the first trimester (first three months); during this time, vital organs are developing in the foetus. The virus can interfere with their normal development, and cause serious and severe congenital abnormalities in the baby. These will vary according to the time of infection. But the heart, eyes, ears and brain may be adversely affected. This can cause blindness, deafness (in varying degrees up to total deafness), mental retardation and major heart defects. The liver and spleen may be affected, interfering with the blood system of the infant. Rubella infection occurring during the first month of pregnancy may incur a 50 per cent chance of serious defects. This falls to a 10 per cent risk by the third month.
So great are the potential hazards that rubella during early pregnancy is now a well-established indication for a legal termination of the pregnancy should the mother desire this. In fact, the majority of obstetricians would now specifically recommend it.
Treatment
Generally little or no treatment is necessary. If symptoms are present which cause discomfort, they may be treated symptomatically, along the same lines as for ordinary measles. Rest, fluids, simple adequate foods, analgesics and antipyretics (mixtures for relieving pain and reducing temperatures) are occasionally required, but these are usually minimal.
If there is rubella in the home, it is important that warning be given to any women known to be pregnant who have recently visited the family. It is important that pregnant women keep away from the infected person. Being highly infectious, the risks of contracting the disease are high, especially if the woman has not previously had rubella or has not been immunized. If contact has been made, she should contact her own obstetrician without delay. Special tests are available that will indicate her own degree of protection against rubella, and appropriate steps may then be taken.
Rubella vaccination is readily available at present in this and most Western countries. This is usually given to schoolgirls in the 12-14 age group. Every girl should be vaccinated. One single injection is all that is required.
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