Rubella is an infection caused by the rubella virus; it can cause severe harm to the unborn child. The number of german measles cases has fallen dramatically, thanks to vaccination programs, but the battle against this infection is not yet won.
Also known as German measles, it is an acute viral infection that usually affects children and young adults. It is a contagious condition that can be transmitted between humans via airborne droplets when infected individuals cough or sneeze.
The symptoms of the infection are usually mild in children but can have severe consequences in some population groups, such as pregnant women. It has the potential to cause fetal death or birth defects to the infant. On a global basis, more than 100,000 babies are born with congenital rubella syndrome each year.
The infection is usually self-limiting and there is no specific treatment. The disease can be prevented, however, by vaccination.
How rubella is spread
Rubella is spread:
- When an infected person talks, coughs or sneezes small droplets containing infectious agents into the air. The droplets in the air may be breathed in by those nearby.
- By indirect contact with hands, tissues or other articles soiled by nose and throat discharges.
Signs and symptoms
Rubella infection in a woman in the first 8 to 10 weeks of pregnancy results in death of or damage to the fetus in up to 90% of cases. Multiple defects are common (for example, deafness, blindness, brain and heart damage, and mental handicap) and recognition of late complications are increasing. The risk lowers to about 10 to 20% if the mother gets rubella at 16 weeks gestation and defects are rare after 20 weeks.
In other people, rubella is a mild disease. Symptoms, when present, may include:
- runny nose
- conjunctivitis (inflammation of the lining of the eyelids and eye)
- rash (see image)
- swollen glands (especially at the back of the neck)
- joint pain.
Symptoms, particularly joint pains, are more severe in adults.
Image courtesy Public Health Image Library (PHIL), Department of Health and Human Services, Centers for Disease Control and Prevention (CDC-USA)
German Measles is diagnosed by a blood test. Clinical diagnosis on the basis of rash appearance is unreliable as Rubella can often resemble other viral rash diseases.
(time between becoming infected and developing symptoms)
16 to 18 days with a range of 14 to 23 days.
(time during which an infected person can infect others)
Up to 7 days before and at least 4 days after appearance of the rash.
There is no effective antiviral treatment for german measles. Treatment of symptoms includes plenty of fluids and pain relief if required. Paracetamol may help reduce fever and pain. Unless with specific doctor’s recommendation, children under 12 years of age should not take Aspirin.
- Exclude people with german measles from childcare, preschool, school and work until fully recovered or for at least 4 days after the onset of the rash.
- Rubella is best prevented by the measles, mumps and rubella (MMR) combination vaccine or the measles, mumps, rubella and varicella (MMRV) combination vaccine, or the recently launched Indonesian measles and rubella (MR) combination vaccine; vaksin MR. Two doses of a rubella-containing vaccine will protect most people against rubella infection.
- Vaccination after exposure will not prevent infection.
- All health care and childcare workers (men and women) should test themselves for immunity against rubella. Consequently, those who are not immune requires a booster rubella vaccination.
- Anyone with suspected german measles should consult a doctor both to check that the diagnosis is correct and so that contacts (in particular, pregnant women) can be advised. A contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person.
Rubella Vaccine In Indonesia
Despite the scarcity of the MMR Vaccine and the still unavailable MMRV Vaccine in Indonesia over the past few years, Indonesia has launched a MR Vaccine (vaksin MR). Notably, this MR Vaccine (vaksin MR) protects against Mumps and Rubella only, without Measles and Varicella. In effort to eradicate Rubella in Indonesia, the Government of Indonesia launched a national measles-rubella immunisation campaign on 1st August 2017. This campaign targets all Indonesian children between the ages of nine months and 15 years. The campaign will aim to reach 95% immunisation coverage and thus eliminate measles and rubella in Indonesia by 2020.
Gavi – The Vaccine Alliance is supporting the Government of Indonesia by contributing 50% of the total cost of vaccines. WHO is assisting with the preparation of immunisation activities, particularly in high-risk areas and among vulnerable populations, to ensure all children receive the vaccine.
This MR Vaccine is however, still only limited for the campaign use. It is available at the public health centres (PusKesMas) and public hospitals. The general public, – e.g. adults who want to acquire a booster MR Vaccination – are still unable to get access to the aforementioned vaccine, and might need to wait until further notice and increasing availability of the product.
Pregnant women & German Measles
In addition to the above prevention points, all pregnant women:
- Should be tested for immunity to rubella prior to, or during early pregnancy. If found not to be immune, MMR vaccination is given after delivery of the baby but before discharge from the maternity unit. A woman, known to be pregnant should not get the rubella vaccination. It is best to avoid pregnancy for one month after vaccination.
- With suspected german measles or exposure to rubella virus should seek specialist obstetric advice, regardless of a history of german measles disease or rubella vaccination. Furthermore, German Measles re-infection, can often occur without symptoms in individuals who have had previous infection or vaccination. However, fetal damage is very rare in these cases.
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