DISEASE NAME:
Rubella
CATEGORY:
Vaccine Preventable
Rubella
Rubella is a contagious disease caused by the rubella virus. Rubella is a notifiable disease. It is usually a mild acute viral disease accompanied by a low grade fever and a red rash usually starting on the face and progressing from head to foot. It may be fleeting but typically lasts about 3 days. It can be itchy. The rash is fainter than the measles rash and may be more obvious after a hot shower or bath. The most serious consequences of rubella infection occur when a pregnant woman is infected in the early stages of pregnancy. Damage to foetus is common in early pregnancy. The best protection against rubella is MMR (measles-mumps-rubella) vaccine.
At the meetings of WHO European Regional Verification Committee (RVC) for measles and rubella elimination, in 2015, 2016, 2017, and 2018 the WHO European RVC concluded that Ireland provided evidence for the elimination of rubella.1,2,3,4,5
References
- WHO. Regional Verification Commission for Measles and Rubella Elimination (RVC). Available at http://www.euro.who.int/en/health-topics/communicable-diseases/measles-and-rubella/activities/regional-verification-commission-for-measles-and-rubella-elimination-rvc
- WHO. 4th Meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Available at http://www.euro.who.int/__data/assets/pdf_file/0011/304958/4th-RVC-meeting-report.pdf?ua=1
- WHO. 5th Meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Available at http://www.euro.who.int/__data/assets/pdf_file/0005/330917/5th-RVC-meeting-report.pdf?ua=1
- WHO. 6th Meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Available at http://www.euro.who.int/__data/assets/pdf_file/0019/348013/6th-RVC-final-for-web-posting.pdf?ua=1
- WHO. 7th Meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC). http://www.euro.who.int/en/health-topics/communicable-diseases/measles-and-rubella/publications/2018/7th-meeting-of-the-european-regional-verification-commission-for-measles-and-rubella-elimination-rvc.-report
Last updated: 13 August 2019
Rubella was first described in German medical literature in 1814. The most serious consequences of rubella infection occur when a pregnant woman is infected in the early stages of pregnancy. Damage to foetus is common in early pregnancy.
What is rubella?
Usually a mild acute viral disease accompanied by a low grade fever and a red rash usually starting on the face and progressing from head to foot. It may be fleeting but typically lasts about 3 days. It can be itchy. The rash is fainter than the measles rash and may be more obvious after a hot shower or bath.
What are the symptoms?
Symptoms are often mild. Up to 50% of infections may be subclinical, particularly in children.
Swelling of the lymph glands behind the ear and around the neck usually precede the rash by 5-10 days and may last several weeks.
Older children and adults are more likely to experience a low grade fever headache, fatigue, mild runny nose and conjunctivitis for 1-5 days before the rash develops.
How is it spread?
Rubella is spread through direct airborne transmission or droplet spread (usually by coughing or sneezing) from someone who is infected person with rubella.
The incubation of rubella is 14 days (range 12-23 days). The rash typically appears 14-17 days after exposure.
How infectious is rubella?
Rubella is moderately infectious. Individuals with rubella are most infectious one week before rash onset to 5-7 days after rash onset. Infants with congenital rubella may shed large amounts of virus from their nasal or throat secretions or urine for as long as one year after birth.
Are there any complications with rubella?
Apart from pregnancy related complications (see next section), complications of rubella are not common but are more likely to occur in adults than children.
| Complications | Risk of complication | Comment |
|---|---|---|
| Arthralgia (pains in joints) | 70% women | Rare in children and men Typically affects fingers, wrists and knees Symptoms may last up to one month |
| Encephalitis | 1 in 6,000 cases | More frequent in women |
| Bleeding disorder | 1 in 3,000 cases | More common in children |
Rubella in pregnancy – risk of congenital rubella
Infection with rubella in early pregnancy can cause serious birth defects in the developing foetus, may lead to foetal death, spontaneous abortion, or premature delivery.
The risk of foetal damage depends on the stage of pregnancy when the mother is infected with rubella. The risk of congenital rubella syndrome developing when infection occurs during the first trimester is about 85% and during the second trimester about 10%-20%. Congenital defects are rare after 20 weeks.
Protect unborn babies from rubella - Infographic (ECDC)
What is Congenital Rubella Syndrome (CRS)?
CRS comprises either one, or a number, of the following defects: deafness, eye defects (cataracts, underdeveloped eyes, glaucoma, pigmented retina), heart defects, neurologic abnormalities (small head, mental retardation behavioural problems), bone abnormalities, splenomegaly (big spleen), hepatitis, bleeding problems (due to low platelets and vascular damage).
Other diseases associated with CRS
Diabetes mellitus, progressive encephalopathy, autism are more common in children with CRS.
Congenital rubella elimination
The European Office of the World Health Organization has set a strategy to eliminate congenital rubella in Europe. The target date is 2015. WHO provides information on next steps towards eliminating measles and rubella in Europe.
How is rubella diagnosed?
It may be indistinguishable from other viral rash illnesses such as measles, dengue, parvovirus B19, human herpesvirus 6, Coxsackie virus, Echovirus, adenovirus, scarlet fever. Laboratory diagnosis is therefore always recommended. Diagnosis may be made with oral fluid swab sample or serum.
How is rubella prevented?
Rubella infection is prevented by vaccination. Rubella vaccine was first introduced into Ireland in 1971. Since 1988 the combined measles-mumps-rubella (MMR) vaccine has been routinely used in the childhood immunisation programme. Two doses are recommended, the first dose at 12 months and the second at 4-5 years of age. Over 98% of vaccine recipients develop immunity to rubella after vaccination with two doses of MMR.
- MMR vaccine - information from Immunisation.ie
- Prevention of Rubella - Information for women planning a pregnancy or after giving birth
Notification
Rubella, both acute infection in children and adults as well as congenital rubella infection is notifiable. All cases should be reported to the Medical Officer of Health in the local HSE Department of Public Health.
Last reviewed: 15 February 2016
Case definition
Clinical criteria
Any person with sudden onset of generalised maculo-papular rash
AND
At least one of the following five:
- Cervical adenopathy
- Sub-occipital adenopathy
- Post-auricular adenopathy
- Arthralgia
- Arthritis
Laboratory criteria
- Laboratory criteria for case confirmation, at least one of the following three:
- Isolation of rubella virus from a clinical specimen
- Detection of rubella virus nucleic acid in a clinical specimen
- Rubella virus specific antibody response (IgG) in serum or saliva
- Laboratory criteria for probable case
- Rubella virus specific antibody response (IgM)*
Laboratory results need to be interpreted according to the vaccination status
Epidemiological criteria
An epidemiological link by human to human transmission
Case classification
A. Possible case
Any person meeting the clinical criteria
B. Probable case
Any person meeting the clinical criteria and with at least one of the following two:
- An epidemiological link
- Meeting the laboratory criteria for a probable case
C. Confirmed case
Any person not recently vaccinated and meeting the laboratory criteria for case confirmation.
In case of recent vaccination, a person with detection of wild-type rubella virus strain.
Note:
* When rubella in pregnancy is suspected, further confirmation of a positive rubella IgM results is required (e.g. a rubella specific IgG avidity test showing a low avidity). In certain situations, such as confirmed rubella outbreaks detection of rubella virus IgM can be considered confirmatory in non-pregnant cases.
Current as of: 24 January 2019
Rubella (Congenital) (Including congenital rubella syndrome)
Clinical criteria
Congenital rubella infection (CRI)
No clinical criteria can be defined for CRI
Congenital rubella syndrome (CRS)
Any infant <1 year of age or any stillborn with:
- At least two of the conditions listed in (A) OR
- One in category (A) and one in category (B)
Category A
- Cataract(s)
- Congenital glaucoma
- Congenital heart disease
- Loss of hearing
- Pigmentary retinopathy
Category B
- Purpura
- Splenomegaly
- Microcephaly
- Developmental delay
- Meningo-encephalitis
- Radiolucent bone disease
- Jaundice that begins within 24 hours after birth
Laboratory criteria
At least one of the following four:
- Isolation of rubella virus from a clinical specimen
- Detection of Rubella virus nucleic acid
- Rubella virus specific antibody response (IgM)
- Persistence of rubella IgG between 6 and 12 months of age (at least two samples with similar concentration of rubella IgG)
Laboratory results need to be interpreted according to the vaccination status
Epidemiological criteria
Any infant or any stillborn born to a woman with a laboratory confirmed rubella infection during pregnancy by human to human transmission vertical transmission)
Case classification
A. Possible case
NA
B. Probable case
Any stillborn or infant either not tested OR with negative laboratory results with at least one of the following two:
- An epidemiological link AND at least one category ‘A’ CRS clinical criteria
- Meeting the clinical criteria for CRS
C. Confirmed case
Any stillborn meeting the laboratory criteria OR any infant meeting the laboratory criteria
AND
at least one of the following two:
- An epidemiological link
- At least one category ‘A’ CRS clinical criteria
An infant with positive laboratory criteria only without a history of rubella in the mother during the pregnancy and without ‘A’ clinical criteria will therefore not be notified as rubella case.
Current as of: 24 January 2019
Information, Data and Reports for Rubella
Ireland’s specialist service for the surveillance of communicable diseases.