The common childhood illnesses series - Rubella
Sonia Hall of the Practice Nurse Association discusses the viral infection which can be highly dangerous if contracted by pregnant women.
Rubella is caused by a togavirus, which spreads by droplet infection. One attack confers a high degree of immunity. It tends to affect older children, adolescents and young adults and spreads less readily than measles. The incubation period is usually about 18 days1. The disease in children is trivial although in adults the illness maybe more severe, but of short duration and of little importance, except where it develops in a woman during the first four months of pregnancy. Maternal rubella infection in pregnancy may result in foetal loss or in Congenital Rubella Syndrome (CRS).
CRS is an important cause of severe birth defects. When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her foetus. This can cause the death of the foetus, or it may cause CRS. Even though it is a mild childhood illness CRS is widely known to cause many birth defects. Deafness is the most common, but CRS can also cause defects in the eyes, heart, and brain. Rubella is spread in airborne droplets when infected people sneeze or cough. Once a person is infected, the virus spreads throughout the body in about five to seven days. During this time, pregnant women may pass the virus on to their foetuses2.
The risk of damage declines to about 10-20% with infection occurring between 11 and 16 weeks gestation. Foetal damage is rare when the mother is infected after 16 weeks of pregnancy.
Clinical Features
In children the symptoms can be so slight that the illness is rarely suspected until the rash is seen. The spots are pink macules, which appear first behind the ears and then to the limbs. Tender enlargement of the suboccipital lymph nodes is usual. In adolescents and adults the onset maybe acute with fever and generalised aches but even then the illness lasts for only 2-3 days. Poly arthritis is the commonest complication. Encephalomyelitis and thrombocytopenic purpura are very rare. However, complete recovery from all of them is to be anticipated.
Figure 1: Shows a child with Rubella
Diagnosis
Serological tests are necessary for definitive diagnosis of rubella as the rash maybe fleeting and not specific to rubella.
Management
No treatment is available. If infection is known to have occurred during the first 16 weeks of pregnancy there is a high chance of foetal abnormality, the implications of which need to be discussed with the mother.
Prevention
Universal immunisation against rubella, using the measles, mumps and rubella (MMR) vaccine3, was introduced in the UK in October 1988. The aim of this policy was to interrupt circulation of rubella among young children, thereby protecting susceptible adult women from exposure. At the same time rubella was made a notifiable disease. A considerable decline in rubella in young children followed the introduction of MMR, with a concomitant fall in rubella infections in pregnant women – from 167 in 1987 to one in 2003.
Over 500 million doses of MMR have been used in over 90 countries around the world since the early 1970s. The World Health Organization states that MMR is a highly effective vaccine with an outstanding safety record4.
If women present for family planning checks and mention they are thinking of starting their families shortly, then a rubella blood test could be offered to check for immunity, and if not immune vaccination can be offered.
References
1. http://www.nhs.uk/Conditions/Rubella/Pages/Symptoms.aspx
2. http://www.who.int/topics/rubella/en/
3. www.nhs.uk/MMR
4. World Health Organisation, 2001
This article is the sole work of the author and does not necessarily reflect the views of Johnson & Johnson Medical Limited or any of its affiliated business or companies, nor does the publication of this article on the CareMail website comprise an endorsement of its contents, for which Johnson & Johnson Medical Limited and its affiliated businesses and companies accept no responsibility. In particular no such Johnson & Johnson entity shall be liable for any damages or injury resulting from any reliance placed on any information provided in this article or for any possible inaccurate or misleading data or statements contained therein.
Published in partnership with the Royal College of Nursing's Practice Nurse Association
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