Rubella: causes, symptoms and therapies

It is a typical disease of childhood, but if it affects a pregnant woman it can be very dangerous for the unborn child.

Rubella falls into the large group of childhood exanthematous diseases, ie those infectious diseases that mainly affect children (usually between 6 and 12 years), due in most cases to viral agents (among those that are exceptions we remember scarlet fever, caused by a bacterium) and united by the appearance of an exanthema , that is, a diffuse rash, which assumes, however, often very specific characteristics depending on the infection taken into consideration.

Unlike other exanthematous diseases, however, rubella is usually not problematic for children and indeed can also go unnoticed, while it becomes dangerous if it affects a pregnant woman, because it can be transmitted to the fetus. Fortunately, this “encounter” can be prevented. But before we talk about prevention, let’s get to know this disease better.

It is triggered by a virus

The agent responsible for rubella is Rubella virus, belonging to the genus rubivirus, of the Togavirus family (Togaviridae). According to current knowledge, it has only man as its host, so it is transmitted only from person to person.

The infection occurs mainly by air, through the droplets of infected saliva emitted by the respiratory tract coughing, sneezing or simply talking, or through direct contact with infected secretions coming from the nose and throat.

In general, the infection is contagious in the week preceding the appearance of the exanthema and for a few days following the manifestation of the outburst.

Usually after a first encounter with the virus, an almost definitive immunization against a possible new infection develops, so the possibility of getting sick a second time is very rare.

How it manifests itself

Rubella virus has an incubation period of about 2-3 weeks. After incubation in many cases the symptoms may be absent or so mild that the infection may go completely unnoticed.

Other times, however, you can manifest:

  • fever, although not particularly high
  • headache
  • joint pain
  • reddened eyes
  • exanthema characterized by small pinkish spots that appear first behind the ears, then on the forehead to then extend to the whole body; The hexathema usually persists for a few (2-3) days.

Lymphadenopathy is usually also associated, i.e. an enlargement and swelling of the lymph nodes of the neck, ears and at the base of the nape.

The disease generally has a benign course and complications (such as encephalitis) are rare, although, as with other childhood diseases, the risk is greater if it is contracted by an adult.

Rubella in pregnancy

If a pregnant woman falls ill with rubella, the infection can be transmitted, through the placenta, to the fetus: in this case the risks are all the greater the earlier during gestation the woman contracts the disease.

If, in fact, the mother falls ill in the first trimester of pregnancy, a miscarriage may occur, or the unborn child may develop congenital rubella syndrome (or congenital rubella syndrome) which includes a series of anomalies that can occur as a result of the infection, in particular:

  • slowed intrauterine growth
  • sensorineural deafness
  • eye defects (such as cataracts, glaucoma, etc.)
  • cardiac and cardiovascular malformations
  • neurological abnormalities
  • brain damage that can lead to mental retardation.

If rubella is contracted after the sixteenth week of pregnancy, however, it is much rarer that the infection can cause harm to the fetus.

Diagnosis

The diagnosis of rubella is based on the examination of the clinical picture and the rubeo-test, a blood test that looks for the presence of virus-specific antibodies in the serum:

  • immunoglobulins M (IgM), antibodies produced in the acute phase of the disease and active for about 2 months after infection
  • Immunoglobulins G (IgG), which are produced about 1-2 weeks after infection and then remain positive for life.

The test is therefore particularly useful not only to ascertain an ongoing or recent rubella virus infection, but also to evaluate immunization against the disease. It allows you to know if a person has already contracted the infection in the past (it may have gone unnoticed) and if he has therefore become immune or not. In the same way it can be used to assess whether a possible rubella vaccination has provided immunization.

The rubeo-test is therefore always strongly recommended for women who plan to become pregnant, even before conception, even if they are aware of having contracted the disease or know that they have been subjected to the vaccine. With this test, in fact, they can evaluate their degree of acquired immunity. If insufficient immunization emerges, the woman has time to undergo vaccination, after which one must generally wait at least a month before trying to conceive a child.

The rubeo-test, for the aforementioned reasons, is also among the routine tests that are prescribed to women in the very first weeks of gestation, so as to know if the future mother is at risk of contagion or not. In case of doubtful result, the avidity test (or IgG avidity test) is also performed, which allows to date the possible infection.

Pregnant women who are at risk because they are not immune cannot undergo vaccination because the vaccine contains live attenuated viruses, but they can only implement some hygienic measures to try to reduce the risk of possible contagion, although unfortunately the virus is transmitted very easily and it can be difficult to identify the disease in children.

Precautions, especially important if you have small children, often a vehicle for the virus, include washing your hands frequently, not drinking from the same glass or using common cutlery and plates. The child should then be washed and changed by the father or a relative. For those who work in a children’s community or kindergarten, these precautions become even more necessary. In case of non-immunity, moreover, the rubeo-test must be repeated during the nine months, until delivery, at regular intervals and in any case at any time a possible rubella infection is suspected.

If rubella infection is suspected or ascertained during pregnancy, careful ultrasound monitoring of the morphology of the fetus and fetal echocardiography are indicated.

There is no specific cure

There is no specific therapy against rubella, although you can possibly resort to the use of paracetamol to lower fever. Normally, however, the infection heals on its own in a few days.

If a pregnant woman falls ill, the management should be entrusted to a multidisciplinary team that includes, in addition to the gynecologist and the infectious disease specialist, also the pediatrician, the neonatologist and the teratologist (doctor who deals with congenital malformations).

A vaccine for prevention

Rubella can be prevented thanks to a vaccine, consisting of the live attenuated virus, that is, a virus treated so that it can maintain the ability to stimulate the immune defenses of the subject, but without triggering the infection.

Precisely because of the high risks in pregnancy, until 1999, in Italy, rubella vaccination was practiced to girls in pre-pubertal age (10-13 years), but then it was considered more valid as a strategy to limit the circulation of the virus to vaccinate all children in the second year of life with the trivalent MMR vaccine (which also includes the measles vaccine and the mumps vaccine) and to administer a second dose within 5-6 years of age.

Currently, the anti-rubella is among the vaccinations made mandatory by the vaccine decree of 2017 and, for those born from 2018, can be administered with tetravalent (the chickenpox vaccine is also added to the trivalent already described): the first dose is expected between the thirteenth and fifteenth month of life, while the second at six years.

Since it is a vaccine containing live attenuated viruses, it should not be administered to subjects with a deficit of the immune defenses (for example who take immunosuppressive drugs), as well as to pregnant women.

One of the objectives of the European Action Plan for Vaccination 2015-2020 is to eliminate rubella and congenital rubella syndrome. To monitor the effectiveness of vaccination programs and progress towards eliminating the virus, a national surveillance system for congenital rubella and rubella infections in pregnancy is active in Italy, which since 2005 have been included among the infectious diseases that must be mandatorily notified.

On the Epicentro portal of the Istituto Superiore di Sanità it is thus possible to view the periodic reports of the surveillance system. The latest currently available (relating to the period January 2005-February 2018) reports 88 cases of congenital rubella, of which 80 confirmed and 8 probable, and 173 cases of rubella in pregnancy, of which 160 confirmed, 9 probable and 4 possible.

In 2017, in particular, two confirmed cases of congenital rubella and one confirmed case of rubella in pregnancy were reported, while in the first two months of 2018 a confirmed case of congenital rubella was reported and there was no report of rubella in pregnancy. Since 2013, the incidence of congenital rubella has been less than one case per hundred thousand live births, but, as the aforementioned report points out, by virtue of the cyclical-epidemic trend of rubella, we cannot lower our guard.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

Leave a Reply

Your email address will not be published. Required fields are marked *