Rubella (German Measles)

What are Torch infections?

TORCH is an acronym for a special group of infections. These may be acquired by a woman during pregnancy. "TORCH" stands for the following infections:

• Toxoplasma infection, also called toxoplasmosis
  
• Other infections, such as hepatitis B, syphilis, and herpes zoster, (the virus that causes chickenpox)
  
• Rubella, the virus that causes German measles
  
• Cytomegalovirus, or CMV
  
• Herpes simplex virus, the cause of genital herpes

What is rubella?

Rubella and measles are contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either of the illnesses. However, rubella isn't as infectious as measles and is usually not as severe, which is why it is also called the three-day measles. But if a pregnant woman contracts rubella, especially during her first trimester, the virus can cause miscarriage, stillbirth or serious birth defects in the developing fetus — a condition known as congenital rubella syndrome. These defects can include deafness, growth retardation and heart problems.

What are the causes?

Rubella is caused by a virus that passes from person to person hence spreading the disease. It can spread when an infected person coughs or sneezes, or by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. A person with rubella is contagious from one week before the onset of the rash until about one to two weeks after the rash disappears.

What are the symptoms?

The signs and symptoms of rubella are so mild that they're hard to notice, especially in children. The signs and symptoms generally appear between two and three weeks after the exposure to the virus. They last for about two to three days and may include:

• Mild fever
  
• Headache
  
• Stuffy or runny nose
  
• Inflamed, red eyes
  
• Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
  
• Pink rash that begins on the face and quickly spreads to the trunk and then to the arms and legs, before disappearing in the same sequence
  
• Aching joints, especially in young women

What is the diagnosis?

The rubella rash looks like many other viral rashes. Doctors usually confirm rubella with the help of laboratory tests.

If the doctor suspects that the patient has rubella, virus culture or a blood test can be done, which can detect the presence of different types of rubella antibodies in the blood. These antibodies indicate whether a person had a recent or past infection, or a rubella vaccine.

What is the treatment?

No treatment can shorten the course of rubella infection. Most of the time the symptoms are so mild that treatment usually isn't necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.

If a woman contracts rubella while she is pregnant, she should discuss the risks to the baby with the doctor. If the woman wishes to continue her pregnancy, she may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce the symptoms but does not eliminate the possibility of the baby developing congenital rubella syndrome.

Treatment for congenital rubella syndrome varies depending on the extent of the infant's problems. Children with multiple complications may require early treatment from specialists.

How can care be taken at home?

In rare instances when a child or adult is infected with rubella, simple self-care measures are required:

• Rest in bed as necessary
  
• Take acetaminophen to relieve discomfort from fever and aches
  
• Tell friends, family and co-workers — especially pregnant women — about the diagnosis if they may have been exposed to the disease
  
• Don't give aspirin to children who have a viral illness. Aspirin in children has been associated with Reye's syndrome — a rare, but serious illness that can affect the blood, liver and brain of children and teenagers after a viral infection.

Can rubella be prevented?

The rubella vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine, which contains the safest and most effective form of each vaccine. Children should receive the MMR vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — before entering school. It is particularly important that girls receive the vaccine to prevent rubella during future pregnancies.

Usually babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. But if a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.