Rubella, commonly referred to as German measles or three-day measles, is usually a mild disease characterized by an red, flat to somewhat raised rash, lymph node swelling (most commonly in the neck area and especially behind the ears), and slight fever. Joint pains or even arthritis occasionally occur in children and are common in adolescents and adults, especially in girls; these joint symptoms are usually of short duration. Encephalitis and low platelet count with possible increased bleeding tendency are rare complications.

Ordinarily, rubella is a pretty trivial affair in childhood. Unfortunately, if a mother contracts rubella in the first trimester of pregnancy, her fetus may potentially be severely affected. This syndrome is called congenital rubella. It was once the leading cause of birth defects. The most commonly described birth defects associated with the congenital rubella syndrome involve the eye (cataracts and retinopathy), the heart (patent ductus arteriosus, pulmonic stenosis), the inner ear (nerve deafness), and the nervous system (behavioral disorders, meningoencephalitis, and mental retardation). Infants with congenital rubella are frequently growth-retarded and may have bone disease, enlargement of the liver and spleen, bleeding disorders, and purple skin lesions (the "blueberry muffin" baby).

For this reason - the protection of the unborn - rubella immunization is required of young children. Rubella immunity often wears off by adulthood; thus pregnant women are tested for immunity to assess the risk of congenital rubella, and they are immunized after delivery (when they can't be pregant) if their immunity has waned1. But the most important control measure is to make sure that any child the mother to be comes in contact with is immune to rubella and thus cannot infect the mother. This is called herd immunity.

1. This has been the prudent standard for many years, but a recent study during a nationwide vaccination campaign in Costa Rica found no cases of congenital rubella syndrome and no increased risk of miscarriage, stillbirth, or prematurity in the children born to 3800 women who received the vaccine during early pregnancy.

Badilla X, Morice A, et al. Fetal Risk Associated with Rubella Vaccination During Pregnancy. Pediatric Infectious Disease Journal 2007;26:830-835.

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