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Rubella

Also listed as: German measles

• What Causes It?
• Who's Most At Risk?
• Signs and Symptoms
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Special Considerations
• Supporting Research

Rubella, also known as German measles or three-day measles, is a contagious viral infection. Before a rubella vaccine became available in 1969, outbreaks of the disease occured every 6 - 9 years. Now rubella is rare in locations where vaccination is standard practice. In the United States, the measles-mumps-rubella vaccine, given to children twice before they reach school age, has led to the eradication of the disease. However, it is important for parents to make sure their children are vaccinated. If a pregnant woman contracts rubella, the virus can cause serious birth defects or even be fatal to the fetus.

What Causes It?

Rubella is caused by a virus. It can be spread in airborne droplets, such as from a cough or sneeze, from an infected person. Individuals can be contagious for as long as 1 week before a rash appears and up to 1 week after it disappears. Infants with congenital rubella syndrome (see section entitled Special Considerations for explanation) may spread rubella virus in respiratory secretions and urine for up to 2 years.

Who's Most At Risk?

These factors increase the risk for rubella:

• Not being vaccinated
• A person who has not been vaccinated coming in close contact with infants who have congenital rubella syndrome (such as in a hospital or day-care setting)
• A person who has not been vaccinated coming in close contact with large numbers of people from countries that don't routinely vaccinate against rubella

Signs and Symptoms

Symptoms are usually mild. In up to half of all cases, the disease is so mild that symptoms are hard to identify. The most distinctive sign of rubella is swollen lymph nodes behind the ear, in the neck, and at the back of the head. A pink rash is usually the first sign in younger children. In older children and adults, it is more common to have a low-grade fever, malaise (feeling unwell), loss of appetite, swollen glands, and upper respiratory infection for 1 - 5 days before the onset of full-blown disease.

Other signs and symptoms include:

• Joint pain. This is more common in older girls and women and may persist up to weeks or, rarely, months.
• Conjunctivitis (inflammation of the membrane around the eye)
• Pain and inflammation of the testes
• Mild itching

What to Expect at Your Provider's Office

Your health care provider will perform an exam to look for common signs and symptoms, and may perform blood tests or culture a sample of fluid from the nose or throat to check for the rubella virus.

Treatment Options

Prevention

The rubella vaccine causes immunity in 90 - 95% of those who receive it. Children should receive two doses [usually as part of the combination measles-mumps-rubella (MMR) vaccine] at least 4 weeks apart. Anyone born in or after 1957 should have at least one dose of MMR. Persons born before 1957 are considered immune. Women of childbearing age should still be vaccinated prior to becoming pregnant, or take a lab test to see if they are immune to the virus, even if they were born before 1957. (Having had rubella makes a person immune for life.)

In the past, some news reports have raised concerns about whether the MMR vaccine was linked to autism. However, a population-based study investigating a potential association between the incidence of autism and the introduction of the MMR vaccine in the United States and Britain found no link between the two, and reports from the Centers for Disease Control and Prevention and the American Academy of Pediatrics have found the vaccine to be safe. It is more likely that, since autism is usually diagnosed between the ages of 18 months and 3 years -- the same time children receive the MMR vaccine -- timing caused questions about whether the events were related.

Rubella vaccine should not be given to anyone who:

• Has a history of severe allergic reaction to a previous rubella or other vaccine
• Is pregnant or planning to become pregnant
• Has a deficient or suppressed immune system
• Has a moderate to severe illness
• Has received antibody-containing blood products within the previous 3 months

Treatment Plan

There is no specific therapy to fight the rubella virus. Treatment is supportive, and the infection generally resolves on its own. Complications are rare. Individual symptoms, such as fever, arthritis, and joint pain, may be treated.

Drug Therapies

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken to reduce fever.
• A nonsteroidal anti-inflammatory drug, such as ibuprofen, can be used for arthritis or joint pain.
• Aspirin or other medicines that contain salicylates should never be given to children because they increases the risk for developing Reye's syndrome -- a serious illness characterized by changes in the liver, vomiting, and seizures.

Complementary and Alternative Therapies

The MMR vaccine is the only effective prevention against rubella. No CAM method offers any immunity, but some alternative therapies may help alleviate symptoms of rubella.

Nutrition

No clinical trials have investigated the use of specific foods or nutrients to treat rubella. However, the following nutrients may be used to support the immune system in general. Check with your doctor to determine the proper dose for a child, and do not treat your child without medical supervision.

• Vitamin A
• Vitamin C
• Vitamin E
• Selenium
• Zinc
• Quercetin, a bioflavonoid that has antiviral effects

Herbs

No scientific studies have examined the use of herbal therapies to treat rubella. However, to treat viruses in general, remedies that stimulate the immune system and that have fever-reducing and anti-infectious properties may be used, along with herbs that reduce symptoms of rubella. These may include:

• Willow bark ( Salix alba, S. purpurea, S. fragilis ) to reduce fever. Make a tea by boiling 1 - 2 g of bark in a cup of water, strain, and cool; or use 2 - 3 tsps. powder in 1 cup of hot water. Drink three times a day. Do not use if you are allergic to aspirin or take blood-thinning medication. Although white willow bark has not been linked to Reye's syndrome, it is similar enough to aspirin to cause concern in children under 16. Consult your doctor before giving white willow bark to a child.
• Elderberry ( Sambucus nigra) has shown antiviral properties in several scientific studies. Doses vary depending on the formulation, so consult a qualified herbal prescriber to determine the right dose.
• Calendula flower ( Calendula officinalis ) for rash. Make a tea by steeping 1 - 2 g dried flowers in one cup boiling water, strain, and cool. Drink three cups per day.
• Hay flower ( Poa spp.) used externally for joint pain, in a preparation standardized to contain 3 - 5 mg per g coumarin
• Witch hazel ( Hamamelis virginiana) used externally to reduce itching
• For inflammation of the eyes: eyebright (Euphrasia officinalis) and bilberry (Vaccinium myrtillus) used as a compress. Use five drops of tincture in ¼ cup boiling water, or steep 1 tsp. herb in 1 cup boiling water for 5 - 10 minutes, strain, and cool. Soak cloth or gauze in solution and apply over the closed eyes for 10 minutes, three to four times a day.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for rubella based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum -- for individuals who experience a sudden fever, rash, and thirst
• Belladonna -- for rubella that appears suddenly, is associated with high fever, flushed face and red lips, and heat that radiates from the skin. This remedy is most appropriate for individuals who perspire minimally and may experience strange dreams.
• Ferrum phosphoricum -- this remedy is used early in the illness when symptoms are not specific and mild-to-moderate fever is present. Children for whom this remedy is appropriate tend to be tired with a mildly flushed face.
• Pulsatilla -- for individuals with fever and chills that are worse in warm rooms and better in fresh air. Symptoms tend to be less intense than for the other remedies listed.

Acupuncture

Electroacupuncture (in which acupuncture points are stimulated with electrodes) successfully treated two cases of visual and hearing impairments linked to congenital rubella syndrome (see section titled Special Considerations for explanation about this condition). Acupuncture may also help relieve joint pain.

Massage

Therapeutic massage may help relieve joint pain.

Prognosis/Possible Complications

Most people who have rubella recover completely without permanent side effects and are immune to rubella afterward. This is not the case for a fetus infected in the womb. Fetal infection can cause serious long-term effects (see section titled Special Considerations ).

Complications are more common in adults than children and may include:

• Arthritis or joint pain -- Occurs almost exclusively in women. Fingers, wrists, and knees tend to be affected. This develops along with rash and may take several weeks to resolve.
• Encephalitis (inflammation of the brain) -- More common in adults (especially in women) than in children. The severity can vary greatly. Up to 50% of people affected by this complication may die from it.
• Internal bleeding, including in the skin, gastrointestinal tract, brain, or kidneys -- More common in children than in adults. This may last for days or, rarely, months.
• Inflammation of the testicles, nerves, and brain
• Pregnancy complications -- Rubella infection during pregnancy can lead to miscarriage or stillbirth, as well as to congenital rubella syndrome in the child (see section titled Special Considerations ).

Special Considerations

If a fetus is infected with rubella in the womb, this can cause severe defects known as congenital rubella syndrome. The younger the fetus is at the time of infection, the more likely the syndrome is to occur and the more severe the effects are likely to be. Temporary effects of congenital rubella syndrome may include:

• Slow growth in the womb 
• Low birth weight 
• Bleeding disorder 
• Overgrowth of the liver and spleen 
• Anemia 
• Jaundice (yellowish coloration of the skin, tissues, and body fluids) 
• Pneumonia 

Permanent effects of congenital rubella syndrome may include:

• Deafness 
• Heart defects 
• Glaucoma and other vision problems 
• Mental retardation 
• Behavior disorder 
• Diabetes mellitus 
• Thyroid disease 
• Growth hormone deficiency 

Supporting Research

Advisory Committee on Immunization Practices (ACIP). Measles, mumps, and rubella -- vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. MMWR Morb Mortal Wkly Rep. 1998;47(RR-8):4.

Afzal MA, Minor PD, Schild GC. Clinical safety issues of measles, mumps and rubella vaccines. Bull World Hlth Org. 2000;78(2):199-204.

Behrman RE, ed. Nelson Textbook of Pediatrics . Philadelphia, Penn: W.B. Saunders; 2000.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Boston, Mass.: Integrative Medicine Communications; 1998:144.

Blumenthal M, Goldber A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass.: Integrative Medicine Communications; 2000:44-46; 408-412.

Chen RT, DeStefano F. Vaccine adverse events: causal or coincidental [letter]. Lancet. 1998;351:611-612.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. New York: Tarcher/Putman; 1997:112-114.

Ebrahimzadeh MA, Mahmoudi M, Salimi E. Antiinflammatory activity of Sambucus ebulus hexane extracts. Fitoterapia . 2006 Feb;77(2):146-8.

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Greene E. Massage therapy. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine . St. Louis, Mo: Mosby; 2000:338-348.

Hurwitz E, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther . 2000;23:81-90.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York: Warner Books; 1996:228-230, 166-169.

Jones A, Cork C, Chowdhury U. Autistic spectrum disorders 2: diagnosis and management. Community Pract . 2006 Apr;79(4):128-30. Review.

Kaul TN, Middleton E Jr, Ogra PL. Antiviral effect of flavonoids on human viruses. J Med Virol . 1985;15:71-9.

Maldonado Y. Rubella. In: Behrman RE, ed. Nelson Textbook of Pediatrics . Philadelphia, Penn: W.B. Saunders; 2000:951-953.

Ouhilal S. Viral diseases in pregnancy: a review of rubella, chickenpox, measles, mumps and 5th disease. Prim Care Update Ob/Gyn. 2000;7:31-34.

Peter G. Immunization practices. In: Behrman RE, ed. Nelson Textbook of Pediatrics . Philadelphia, Penn: W.B. Saunders; 2000:1081-1089.

Reef S, et al. Rubella. Chapter 11 in VPD Surveillance Manual . Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-11.

Reef S, et al. Congenital Rubella Syndrome. Chapter 12 in VPD Surveillance Manual . Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-12.

Starr M. A rash of exanthems: how they affect children and pregnant women. Aus Fam Phys. 2000;29(7):631-637.

Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353:2026-2029.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 86.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 176.

Uncini Manganelli RE, Zaccaro L, Tomei PE. Antiviral activity in vitro of Urtica dioica L., Parietaria diffusa M. et K. and Sambucus nigra L. J Ethnopharmacol. 2005 Apr 26;98(3):323-7.

West R, Roberts PM. Measles, mumps and rubella vaccine: current safety issues. BioDrugs. 1999;12(6):423-429.

• Review Date: 11/18/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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