Rubella

Symptoms Of Rubella 

The main symptom of rubella is a red or pink spotty rash. Once a person is infected, the virus spreads throughout the body in about 5-7 days. The symptoms of rubella usually appear after 2 to 3 weeks after exposure. The most infective stage is usually 1–5 days after the appearance of the rash.

In children, the symptoms of the disease include:

• Rashes 

• Mild fever 

• Nausea 

• Mild conjunctivitis 

• Lymphadenopathy (swollen lymph glands) behind the ears and in the neck 

• Runny nose 

• General discomfort

• Cough

The rashes occur in 50–80% of cases, and it usually starts on the face and neck before progressing down the body and lasts 1–3 days.

Lymphadenopathy (swollen lymph glands) may be noted during the second week after exposure. It is usually the earliest and characteristic symptom of rubella infection. It can be more severe if the rash is present but may also occur even in the absence of a rash.

The infected adults are majorly women who may develop arthritis and painful joints that usually last from 3 to 10 days.

Congenital rubella

When a woman is infected with the rubella virus early in pregnancy (especially in the first trimester), she has a 90% chance of passing the virus to her baby. Pregnant women getting rubella have a high chance of miscarriage, premature delivery or fetal death. Also, their babies can have birth defects such as:

• Heart problems 

• Intellectual disabilities 

• Loss of hearing or eyesight 

• Liver or spleen damage 

• Microcephaly (baby's head is much smaller than normal)

• Central nervous system sequelae like mental and motor delay, autism

• Thrombocytopenia with purpura/petechiae (blueberry muffin syndrome)

• Intrauterine growth retardation

• Meningoencephalitis  

The classic triad of congenital rubella syndrome -- cataracts, hearing impairment and heart defects is seen in 10% of infants with congenital rubella syndrome. Hearing impairment is the most common single defect.

Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor.

Causes Of Rubella 

Rubella is a ribonucleic acid (RNA) virus of the genus Rubivirus within the Togaviridae family. Humans are its only known reservoir. It is transmitted through droplets and contact with an infected person. An infected person can spread the infection 2 weeks prior to the symptoms of infection appearing. One can spread the rubella virus infection through various modes like:

• Contaminated droplets that are spread through the air while coughing, sneezing, talking, or coming in direct contact with infected nasal or throat secretions. The virus remains contagious in the air for up to two hours.

• Sharing food, drinks, and utensils with someone who has rubella.

• Kissing someone with rubella.

• Shaking hands or hugging someone having rubella.

• Pregnant women can pass on to their babies during the pregnancy, delivery, or while breastfeeding.

A person with rubella may spread the disease to others up to one week before the rash appears, and remain contagious up to 7 days thereafter.

Risk Factors For Rubella 

While rubella can affect anyone, some risk factors elevate the risk of contracting the disease. Some of the risk factors are:

1. Being unvaccinated

Unvaccinated young children are prone to rubella and its complications including death. Unvaccinated pregnant women and nonimmune people can become infected. 

2. International traveling 

Traveling to countries where rubella is common and less controlled puts you at a higher risk of developing the disease. 

3. Countries experiencing a rubella outbreak 

Countries experiencing or recovering from a natural disaster. Damage to health infrastructures interrupts routine immunization and greatly increases the risk of infection. 

4. Being in close contact with people suffering from rubella 

Since it is a droplet infection, the infection can spread from an infected person to a non- infected person.

Diagnosis Of Rubella 

It is important to detect rubella as soon as possible since it is a contagious disease. Establishing a diagnosis for rubella involves the following:

1. Clinical evaluation 

Healthcare providers should consider rubella in patients a pink or red-spotted rash which is often the first sign of infection. These spots are especially helpful because they appear early. If the child has recently traveled or is unvaccinated, rubella is even more likely. Sometimes, other diseases can be complicated with rubella, but rubella rashes are easy to differentiate from other rashes. The rash starts on the face and spreads to the rest of the body.

2. Lab tests 

Laboratory confirmation is important after the clinical evaluation is done by the doctor. 

• IgM antibody: Detection of rubella-specific IgM antibody in serum. The antibody is usually present soon after the rashes appear. The level of antibodies is highest during the 14th day and is not present after the 30th day. 

• IgG antibody: A four-fold or greater increase in measles virus-specific IgG antibody levels is seen between acute and convalescent-phase serum specimens.

• Cell culture: Rubella can also be diagnosed by isolation of the virus in cell culture from respiratory secretions, nasopharyngeal or conjunctival swabs, blood, or urine.

• Biopsy: Direct detection of giant cells in the respiratory secretions, urine, or tissue obtained by biopsy provides another method of diagnosis.

• Real-time polymerase chain reaction (RT-PCR): Rubella RNA by RT-PCR is a common method for confirming rubella. Serum samples as well as the throat swab are used for sample collection. RT-PCR is now a common assay that can detect 3 to 10 copies of rubella virus RNA. This test can sometimes be necessary since many specimens have small amounts of rubella RNA.

• Urine sample: A urine sample can also contain the virus. Collecting urine samples can increase the chances of detecting the rubella virus. 

Specialist To Visit

Patients exhibiting the signs and symptoms of rubella should visit a general physician. The doctor will be able to diagnose rubella from the combination of the symptoms, especially with the characteristics of rashes and if the condition worsens many complications can also be seen. If needed, your doctor may recommend you to go to a specialist such as:

• Infectious disease specialist: A doctor who is trained in internal medicine and specializes in diagnosing, treating, and managing infectious diseases.

• Pediatrician: A pediatrician is a children’s specialist who diagnoses and treats malignancies, infections, genetic defects, and organic diseases.

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Prevention Of Rubella 

1. Measles, mumps, and rubella (MMR) vaccine 

Getting vaccinated is the best way to prevent rubella. You can either take the measles, mumps, rubella, and varicella (MMRV) combination vaccine or opt for MMR. From time to time, boosters of the vaccine need to be taken to prevent ourself from getting the disease.

The following people should get themselves vaccinated to safeguard themselves.

• People who never had rubella.

• The immunization for measles includes 2 doses wherein the first dose should be given between 12-15 months of age followed by the second dose after an interval of 4 weeks, usually up to 4-6 years.

• If you are not sure if you are vaccinated in the past.

2. Special circumstances 

A dose of MMR vaccine can also be given to children over 6 months of age under certain circumstances. For example, in conditions like:

• If there is an outbreak of rubella in your area.

• Exposure to rubella.

• Planning to travel where rubella is widespread.

3. Isolation 

To prevent rubella, keep a distance from the person having the infection. An infected person should be isolated for a few days to a few weeks to return to normal activities.

4. Practice hygiene and cleanliness 

To prevent rubella keep yourself clean and free of infections. The steps to be taken care of:

• Avoid touching your nose and mouth as much as possible.

• Use tissue paper while coughing and sneezing.

• Always use a sanitizer.

Treatment Of Rubella 

There is no specific treatment for rubella and the condition usually improves by itself within 7 to 10 days. To avoid the spreading of infection, avoid contact with people who are vulnerable like pregnant women, immunocompromised people, and young children. Also, try to stay away from work or school for at least 4 days when the rubella rash first appears.

The treatment includes relieving the symptoms and fighting the infection. If symptoms are causing discomfort then the symptoms need to be treated first, while you wait for your body to fight off the virus. The treatment approach includes:

1. Controlling fever and relieving pain

Paracetamol and ibuprofen can be taken to control fever and the pain caused by the fever. Liquid infant paracetamol can be used for young children.

2. Drinking plenty of fluids 

If your child is having a high temperature drink a lot of fluids to eliminate the risk of dehydration. 

3. Treating sore eyes 

Cleaning your child’s eyelids and closing curtains or dimming lights can help in soothing the eyes.

4. Treating cold-like symptoms 

If your child has cold-like symptoms then make them sit in a hot bathroom or make them drink warm liquids containing honey to relax the airway and soothe a cough. 

5. Dealing with other illnesses

Medical care is necessary to avoid serious complications because of the rubella virus. Some serious problems are:

• Shortness of breath

• Convulsions 

• Sharp chest pain 

6. Role of immunoglobulins

Immunoglobulins do not prevent rubella virus infection after exposure and therefore are not recommended as a routine treatment. However, administration of immunoglobulins can be considered only when a pregnant woman who has had exposure to a person with rubella will not consider termination of pregnancy under any circumstances. In such cases, administration of immunoglobulins within 72 hours of rubella exposure may reduce, but not eliminate the risk of rubella infection.

Home-care For Rubella

The following home remedies can help in recovery from rubella.

1. Aloe vera: It is applied on the inflamed area and helps in soothing inflamed skin. 

2. Neem leaves: Neem has antibacterial and anti-allergic properties. It is used to relieve the itching sensation caused due to skin rashes. Take neem leaves and make a thin paste of them, apply them to the affected area and let them dry.

3. Licorice (mulethi) herb: It is an ancient herb to cure rubella. Tea can be prepared by adding licorice herb and it helps in reducing the cough caused by rubella.

4. Baking soda: One cup of baking soda can be added to bathing water and this will provide quick relief from itching. 

5. Coconut water (nariyal paani): It is rich in nutrients and cleanses the body. Drinking plenty of coconut water helps in flushing the toxins out of the body. It keeps the body hydrated.

6. Turmeric (haldi): It has both antioxidant and antiseptic properties. It is used as an ancient home remedy. Drinking hot water infused with turmeric and honey helps reduce symptoms associated with rubella. 

7. Green tea: Green tea can be consumed for antioxidant, anti-inflammatory, and immune effects. Try to consume caffeine-free green tea.

Complications Of Rubella 

Rubella can cause the following complications:

1. Common complications

The development of polyarthritis and polyarthralgia is the most common complication of rubella infection, affecting up to 70% of adolescents and adult women. 

2. Severe complications in children and adults 

The most serious complication of rubella infection is the harm it can cause to a pregnant woman’s developing baby.

When a pregnant woman is infected with rubella, she is in danger of miscarriage or stillbirth, and her developing fetus is in danger of being born with severe birth defects known as congenital rubella syndrome (CRS). Passing on the virus to the developing baby can develop serious birth defects such as heart problems, loss of hearing and eyesight, and liver or spleen damage. 

3. Rare complications 

Some rare complications include:

• Thrombocytopenia: It is a condition in which a person has a low blood platelet count. Platelets are tiny blood cells that are made in the bone marrow from larger cells. Platelets help in blood clotting (stopping bleeding). 

• Hemolytic anemia: It is a blood condition that occurs when your red blood cells are destroyed faster than they can be replaced.

• Myocarditis: Myocarditis is inflammation of the heart muscle (myocardium). The inflammation can reduce the heart's ability to pump and cause rapid or irregular heart rhythms.

• Pericarditis: It is the inflammation of the pericardium, a thin, two-layered sac that surrounds your heart. Pericarditis often causes sharp chest pain.

• Hepatitis: It is a condition in which inflammation of the liver takes place. The liver is a vital organ that processes nutrients, filters the blood, and fights infections.

• Orchitis: It is an inflammation of the testicles. 

• Retinopathy: It is a disease that damages the retina. The retina is the part inside the eye that senses light.

• Uveitis: It is the swelling and irritation of the uvea, the middle layer of the eye. Uveitis can affect one or both eyes with inflammation.

• Guillain-Barré syndrome: It is a rare and serious neurological disorder in which the body's immune system attacks your nerves.

• Post-infection encephalitis: This condition results from a faulty immune system reaction to an infection elsewhere in the body. Instead of attacking only the cells causing the infection, the immune system also mistakenly attacks healthy cells in the brain. 

Alternative Therapies For Rubella 

Dietary modifications

• Drink a minimum of 8 glasses of water daily.

• Avoid refined foods, such as white bread, pasta, and sugar.

• Use healthy oils in cooking, such as olive oil, coconut oil, or ghee.

• Reduce or eliminate trans fats found in processed and packaged foods like biscuits, namkeens, cakes, etc.

• Limit caffeine-containing beverages like coffee

• Avoid alcohol and tobacco.

Nutritional supplements 

• A multivitamin should be taken daily containing antioxidants, vitamins A, B, C, E, and minerals such as magnesium, calcium, zinc, and selenium.

• Omega-3- fatty acids such as fish oil and flaxseed oil can be taken to reduce inflammation and improve immunity.

• Probiotic supplements can be taken for maintaining gastrointestinal and immune health.

Living With Rubella

There is no specific home care treatment for rubella. The patient requires care and time to time medicines and few precautions since it is a contagious disease.

• Get plenty of rest.

• A sponge bath can reduce discomfort due to fever.

• Drink plenty of water.

• Pain relievers and analgesics such as acetaminophen.

• To reduce itching from the rash, one can use witch hazel on the rashes or add oatmeal to a bath.

• Talking with a doctor openly in case of any questions related to the disease. 

• Lowering the stress levels.

• Taking adequate sleep.