German measles is a mild viral illness caused by the rubella virus. It causes a mild feverish illness associated with a rash, and aches in the joints when it affects adults. The major reason for any attention being devoted to the eradication of this condition is the nasty effect that it has on the unborn baby (known as a fetus), when a pregnant woman catches it in early pregnancy.
Children are not usually affected too badly and often the first manifestation is the rash. This is a fine, pink rash spreading from the forehead and face downwards. The rash may last for 1 to 5 days. There are often some of the glands (lymph nodes) enlarged, especially behind the ears and on the back of the head. Adults often feel more unwell before the rash appears, and may have pains in the joints rather like arthritis.
|Damage to unborn fetus (multiple defects common)||9 out of 10 pregnancies (in
the first 8 to 10 weeks)|
|Damage to unborn fetus||1 in 5 to 10 (between 10 and 16 weeks)|
After 16 weeks damage is rare
|Bleeding disorders||1 in 3000|
|Encephalitis||1 in 6000|
The cause is the rubella virus. The incubation period, from exposure to the appearance of the rash, is usually 14 to 21 days.
This is usually made on the basis of the story and the symptoms and signs. Laboratory tests are unlikely to be of practical value except in a pregnant woman. The widespread testing of women during pregnancy has shown how unreliable the diagnosis can be. Many women who have been told categorically that they have had it prove to be negative on the blood test, and vice versa.
Very little treatment is necessary, but it consists essentially of symptom relief for pain and fever.
If a pregnant woman thinks she has been exposed to German Measles, she should first of all check with her midwife or her doctor on her rubella status, that is whether the blood test taken early in pregnancy shows her to be immune to rubella. In that case, she need not worry. You will not catch German Measles if you are immune, and if you do not catch it, your fetus cannot be affected, even if you come into contact with someone who has German Measles.
If she has had previous children then it is likely that she will be known to have been immune at that time, or will have been inoculated after the last pregnancy. If in doubt ask. Your doctor will want to do blood tests to ascertain whether you have caught German Measles or not, or are already immune. Your baby is not at risk if you do not catch the virus.
There is an injection (immunoglobulin) which can reduce the likelihood of actually coming out with the obvious German Measles, but it does not prevent an infection in someone who is not immune who has come into contact with the disease, and is not recommended in the UK as a way of protecting susceptible pregnant women who have come into contact with rubella.
In these cases, where a non-immune woman in the early stages of pregnancy catches rubella, she would normally be counselled regarding termination of pregnancy. If this would not be considered, for medical or moral reasons, then she would be offered the immunoglobulin, as soon as possible after exposure to rubella. There is thought to be a logical argument that cutting down the severity of an attack will reduce the likelihood of fetal damage occurring.
Up until fairly recently girls were inoculated against rubella in their early teens. There is now a vaccine, which in the UK is given at at 12 to 15 months, along with vaccines for measles and mumps. A booster is given before starting school. This vaccine is known as MMR.
Actually having the disease confers lifelong immunity, and the vaccine is supposed to have a similar effect. If the worldwide uptake of any vaccine is high enough, the actual disease can be eradicated, as was achieved with smallpox.