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German Measles: What You Should Know

How it spreads, why it’s deadly for expectant moms, and how to protect your family.


By Gwen Y. Reyes-Amurao, M.D.


What is German measles (rubella)?

German measles, or rubella, is an acute and contagious disease caused by the rubella virus. It can infect people of all ages. Signs and symptoms usually appear 14 to 21 days after exposure to the virus. Also known as the three-day measles, rubella is milder than the typical measles (rubeola). However, it does have a destructive streak: German measles can cause severe congenital defects in the fetus of a woman who contracts the disease in her first three months of pregnancy.


What are its signs and symptoms?

The symptoms appear very mild, with 20 to 50 percent of patients showing no symptoms at all (asymptomatic), according to Dr. Tomas Saiton, a pediatric infectious disease fellow who holds clinic at the Saiton Kiddie clinic in Guimaras. “Children appear well and are very active, unlike in [typical] measles, where the child appears ill and may have severe respiratory symptoms like cough and cold, even conjunctivitis.”

  • Enlarged and tender lymph nodes. The most characteristic sign of rubella, this becomes evident 24 hours before the rash appears and may last for one week or more. No other disease causes tender enlargement of the nodes as rubella.
  • Distinct rose spots on the palate. This may show before the rash, later merging into colored patches.
  • Rash. This usually starts on the face. By the time the rash shows on the upper body, the rash on the face may already be fading. Large areas of redness will spread rapidly over the entire body, usually within 24 hours. On the second day, the rash may look like pinpoints, especially on the upper body, accompanied by mild itching.


Other symptoms common in teenagers and adults are:

  • Headache
  • Loss of appetite
  • Mild conjunctivitis
  • Stuffy or runny nose
  • Swollen lymph nodes in other parts
  • of the body
  • Pain and swelling in the joints, especially in young women


How is it spread?

The rubella virus is spread by droplets from the nose or throat. It is known to be present seven days before the rash appears and seven to eight days after it disappears.


How is it diagnosed?

A doctor may suspect rubella based on clinical symptoms and physicalexamination, but to confirm a diagnosis, virus culture is taken from the nose, throat, or blood for laboratory testing.


How can infection be prevented?

Vaccination is key to preventing infection. Initial rubella immunization is part of the measles-mumps-rubella (MMR) schedule recommended for children at 12 to 15 months of age. The second immunization is given routinely at 4 to 6 years of age but may be administered at any time during childhood, as long as at least 4 weeks have passed since the first dose. Children who have not received the second dose should be immunized by 11 to 12 years of age. Girls must have immunity to rubella before they reach childbearing age.

Women should avoid becoming pregnant three months after being vaccinated, and   pregnant women should not be given live rubella virus vaccine. Side effects of immunization may include fever, rash, painful lymph nodes, painful and swollen joints (common in teenage girls), and pain in the arms and legs. “Vaccines have a success rate of 80 to 85 percent, and [so a person] may [still get] rubella despite being given the vaccine,” says Dr. Saiton.


How is it treated?

“There are ... no antiviral medications appropriate for rubella, since it is a relatively mild infection,” says Dr. Saiton. He advises increasing fluid intake and taking antipyretic (feverreducing) medications and pain relievers, if needed. Infection with German measles confers permanent immunity, although reinfection may occur in 3 to 10 percent of those who had it before, and in 14 to 18 percent of those immunized with the vaccine.


What are the complications of rubella?

Encephalitis (inflammation of the brain) similar to that in typical measles can occur in one out of 5,000 cases. It usually resolves within one to three weeks without any damaging effect on the nerves. A skin rash from bleeding into the skin due to a decrease in the number of platelets may occur in one out of 3,000 cases.

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