Rubella: symptoms and effects during pregnancy



What is Rubella?

Rubella (also called German measles) is an infectious disease caused by the rubella virus. The virus is highly contagious and is transmitted from person to person through direct contact or by airborne droplets from sneezing, coughing, or talking. Symptoms include mild fever and red rash, but in some cases it can be asymptomatic. Rubella is still contagious even when there are no noticeable symptoms. 
In Japan, a rubella outbreak occurred in 2013 with reports of over 14,000 people infected. Even though rubella is often thought of as a disease among children, 90% of the infected patients were adults.
Rubella is especially dangerous for pregnant women. Infection during the first trimester can cause serious lifelong consequences for the fetus.

Main symptoms: fever and red rash

Main symptoms: fever and red rash

When infected with the rubella virus, symptoms often develop after an incubation period of 16-18days. One of the main symptoms is a fine red rash which develops across the whole body. Other symptoms include fever(± 38 degrees Celsius), enlarged lymph nodes behind the ears and at the back of the neck, reddening of the eyes, light coughs, and joint pain. Not all symptoms occur at the same time. In adults, symptoms can become more severe, such as high fever and prolonged rash. 
15-30% of the people who are infected are asymptomatic and are often unaware of the infection. This is called subclinical infection, but they can still be carriers of the virus.

Infection during pregnancy affects the fetus

Contagious Rubella syndrome

Rubella is very dangerous for pregnant women. Infection with the rubella virus during the first 20 weeks of pregnancy causes the baby to be born with Congenital Rubella syndrome (CRS). CRS causes birth defects such as impaired hearing, heart problems, eye diseases such as cataract/ glaucoma/ and retinopathy, low birth weight, intellectual disabilities, delayed motor development, growth retardation, thrombocytopenic purpura, and splenohepatomegalia (swelling of the liver and spleen).

Rubella can be prevented by vaccination

Rubella can be prevented by vaccination and is very important for both women and men. During the 2013 rubella outbreak, the number of rubella cases in men were three times higher than in women. The most common place of infection was at the workplace and the most common transmission route to pregnant women was from husband to wife. To prevent CRS (congenital rubella syndrome), it is important that men get vaccinated as well as women.

You cannot be vaccinated during pregnancy. 
Women who are planning to become pregnant should make sure to get vaccinated beforehand. Rubella affects the fetus even from the very early days of pregnancy, which is often unnoticed. Women should be vaccinated twice including childhood vaccinations and should avoid being pregnant for two months after vaccination.

How to get vaccinated

Vaccines are usually given at the hospital at the internal medicine department or the pediatrics department. Two doses should be given because 1 in 20 people will not be able to produce antibodies with a single dose. The interval between doses should be one month or longer. The use of measles-rubella combination vaccine (MR vaccine) is recommended for rubella vaccination.

Make a reservation beforehand to make sure that the rubella vaccine stock is available at your hospital. In Japan, the cost of vaccination is fully borne by the local government for routine vaccination (1 year old and children entering elementary school). For people of other ages, vaccination is usually done with private expenses and the cost will vary depending on the institution. Some local governments have subsidy for the vaccination costs.

Antibody tests are also available

If you are not sure if you have had the rubella vaccine, antibody tests are also available at medical institutions. This is done with a simple blood test. It is not covered by health insurance, however, some local governments subsidize the cost of antibody testing.