Rubella Information from the March of Dimes( http://www.marchofdimes.com/complications_rubella.html)
Rubella (German measles) is a mild childhood illness that poses a serious threat to the
fetus, if the mother contracts the illness during pregnancy. More than 20,000 babies were
born with birth defects during an outbreak of rubella in 1964-65. The same outbreak also
resulted in at least 10,000 miscarriages and stillbirths.
Fortunately, major outbreaks of rubella no longer occur in this country. Since 1969,
when a vaccine for rubella became available, children have been routinely vaccinated,
helping to prevent the spread of the illness to susceptible pregnant women. Most women of
childbearing age are immune to rubella because they either were vaccinated or had the
illness during childhood. Because of widespread use of the vaccine, birth defects caused
by rubella have become rare.
However, since small outbreaks of rubella continue to occur, the potential for
susceptible pregnant women to become infected continues to exist. As many as 2 in 10 women
of childbearing age are susceptible to rubella. Women can protect their future children
from the effects of rubella by getting tested for immunity prior to pregnancy and being
vaccinated if they are not immune.
Rubella is a mild, highly contagious illness that is caused by a virus. It is
characterized by a rash, swollen glands and, especially in adults, joint pain. The rash
usually lasts about three days and may be accompanied by a low fever. Other symptoms such
as headache, loss of appetite and sore throat are more common in infected adults and
teenagers than in children. Sometimes there are no symptoms at all.
Rubella is caused by a different virus from the one that causes regular measles
(rubeola). Immunity to rubella does not protect a person from measles, or vice versa.
About 25 percent of babies whose mothers contract rubella during the first trimester of
pregnancy are born with one or more birth defects which, together, are referred to as
congenital rubella syndrome. These birth defects include eye defects (resulting in vision
loss or blindness), hearing loss, heart defects, mental retardation and, less frequently,
Many children with congenital rubella syndrome are slow in learning to walk and to do
simple tasks, though some eventually catch up and do well.
The infection frequently causes miscarriage and stillbirth. The risk of congenital
rubella syndrome drops to around one percent, after maternal infection in the early weeks
of the second trimester, and there is rarely any risk of birth defects when maternal
rubella occurs after 20 weeks of pregnancy.
Some infected babies have health problems that aren't lasting. They may be born with
low birthweight (less than 5.5 pounds), or have feeding problems, diarrhea, pneumonia,
meningitis (inflammation around the brain) or anemia. Red-purple spots may show up on
their faces and bodies because of temporary blood abnormalities that can result in a
tendency to bleed easily. The liver and spleen may be enlarged.
Some infected babies appear normal at birth and during infancy. However, all babies
whose mothers had rubella during pregnancy should be monitored carefully because problems
with vision, hearing, learning and behavior may first become noticeable during childhood.
Children with congenital rubella syndrome also are at increased risk of diabetes, which
may develop during childhood or adulthood.
There is no specific treatment for congenital rubella syndrome. Certain problems that
are common in the newborn period-such as blood and liver abnormalities-usually go away
without treatment. Other individual birth defects-such as eye or heart defects-can
sometimes be corrected or at least improved with early surgery. Babies with hearing or
vision loss benefit from special education programs that provide early stimulation and
build communication and learning skills. Children with mental retardation also benefit
from early special education. Children with multiple handicaps may require early
intervention from a team of experts.
There is a simple blood test that can determine whether a person is immune to rubella.
The blood test shows whether or not a person has virus-fighting substances called
antibodies in the blood. Rubella antibodies are produced by people who have had the
illness or were vaccinated against it.
The March of Dimes recommends that all women be tested for immunity to rubella before
they become pregnant, and that they consider being vaccinated at that time if they are not
Vaccination will prevent rubella in susceptible women, so that their future children
will be protected from the congenital rubella syndrome.
Women who missed being tested prior to pregnancy are routinely tested during an early
prenatal visit. If a pregnant woman is not immune, she should avoid anyone who has this
illness. There is no effective treatment for rubella during pregnancy, nor is there an
effective way to prevent rubella in a susceptible woman who was exposed to the illness.
Pregnant women who are not immune also should consider being vaccinated after delivery, so
that they will be immune during any future pregnancies.
A woman who is breastfeeding her baby can safely be vaccinated.
The vaccine is not recommended during pregnancy, and a woman should wait
after vaccination before she attempts to conceive.
Babies of women who were inadvertently vaccinated around the time of
conception are very unlikely to be harmed by the vaccine. Between 1971 and
1989 the government's Centers for Disease Control and Prevention (CDC)
studied hundreds of women who were vaccinated from three months before to
three months after they conceived. At the time they were vaccinated, the
women did not know they were pregnant or would conceive in the near future.
None of these women's babies had birth defects that resembled the ones that
rubella causes. However, the CDC continues to recommend postponing
conception for four weeks after vaccination because there is theoretically a very small risk of fetal harm.
All children should be vaccinated against rubella, unless there is a medical reason why
they should not. Widespread vaccination of children helps prevent the spread of this
illness to others, especially pregnant women.
The first vaccine dose is routinely given at 12 to 15 months of age, usually in
combination with the measles and mumps vaccines. The combined vaccination is referred to
as MMR. The child should not receive the first dose of MMR before 12 months of age. Before
that, the baby still has some of its mother's antibodies, which can interfere with the
vaccine and keep it from working. A second dose of MMR is given at either age 4 to 6 years
or 11 to 12 years. At least 12 states now require administration of the second MMR dose
before children enter kindergarten.
Vaccination of teenage or adult groups in colleges, workplaces, hospitals (staff and
volunteers) or military bases helps prevent outbreaks in those areas. People working in
newborn nurseries should be vaccinated, since infants born with rubella can spread it to
those around them for a while after birth. Susceptible women of childbearing age also
should consider being vaccinated before traveling abroad, as rubella is widespread in many
CDC. Recommended Childhood Immunization Schedule -- United States, 1995. Morbidity and
Mortality Weekly Report, volume 44, number RR-5, June 16, 1995.
Committee on Infectious Diseases, American Academy of Pediatrics. 1994 Red Book: Report
of the Committee on Infectious Diseases Twenty-third edition, Elk Grove Village, IL,
American Academy of Pediatrics, 1994, p. 406-412.
Cooper, Louis Z. Fetal rubella syndrome, in Buyse, Mary Louise (ed.): Birth Defects
Encyclopedia, Dover, MA, Center for Birth Defects Information Services, 1990, p. 723-725.
Cooper, Louis Z. Rubella, in Rudolph, M.M., Hoffman, J.l.E., Rudolph, C.D. (eds.):
Rudolph's Pediatrics 20th edition, Stamford, CT, Appleton & Lange, 1996, p. 679-683.
Immunization Practices Advisory Committee. Rubella prevention. Morbidity and Mortality
Weekly Report, volume 39, number RR-15, November 23, 1990.
© 1997 The March Of Dimes Birth Defects Foundation
for Disease Control - MMWR Weekly
Centers for Disease Control MMWR Weekly Revised Vaccination Recommendation
Centers for Disease Control Fact Sheet on Rubella