Introduction:

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 occurred 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 Special Considerations section) 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
• Rash

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 - 99% of those who receive it. Children should receive 2 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 increase the risk for developing Reye 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. Anyone suspected of having contracted rubella should be seen immediately by a conventional medical practitioner.

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.

Following these nutritional tips may help reduce risks and symptoms:

• Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils for cooking, such as olive oil or vegetable oil.
• Reduce significantly or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoonfuls oil daily, to help decrease inflammation and improve immunity.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• Vitamin C, 1 - 6 gm daily, as an antioxidant. Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower the dose if diarrhea develops.
• Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support. People who have alcohol addiction and those who have nutritional deficiencies should be cautious when taking Alpha-lopic acid. Without enough Thiamine (B1) in the body, Alpha lipoic acid can cause serious negative effects.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, immune and anti-inflmmatory effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg 3 times daily, for antioxidant and immune support.
• Rhodiola (Rhodiola rosea) standardized extract, 150 - 300 mg 1 - 3 times daily, for immune support. Rhodiola is an "adaptogen" and helps the body adapt to various stresses.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and immune stimulation.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 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 Special Considerations section). 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 Special Considerations section).

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 Special Considerations section).

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 

Alternative Names:

German measles