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 2 to 3 weeks after exposure. The most infective stage is typically 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, usually starting on the face and neck before progressing down the body and lasting 1–3 days. Lymphadenopathy may be noted during the second week after exposure and is often 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. Infected adults, primarily women, may develop arthritis and painful joints lasting 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 contracting rubella have a high risk of miscarriage, premature delivery, or fetal death. Additionally, 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 in children and adults is usually mild, self-limiting, and often asymptomatic. The prognosis for children born with congenital rubella syndrome (CRS) is poor.

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:

• 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 the virus to their babies during 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.

While rubella can affect anyone, certain risk factors increase the likelihood of contracting the disease. The key risk factors include:

• Being unvaccinated: Unvaccinated young children are particularly vulnerable to rubella and its complications, including death. Unvaccinated pregnant women and individuals who are non-immune are also at risk of infection.
• International traveling: Traveling to countries where rubella is endemic or less controlled significantly raises the risk of developing the disease.
• Countries experiencing a rubella outbreak: Regions affected by rubella outbreaks or recovering from natural disasters may have disrupted health infrastructures, which can interrupt routine immunization and greatly increase the risk of infection.
• Being in close contact with infected individuals: Rubella is a droplet infection, meaning the virus can spread easily from an infected person to someone who is not infected.

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 with 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. Although other diseases can complicate rubella, 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 completed 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 throat swabs are used for sample collection. RT-PCR can detect 3 to 10 copies of rubella virus RNA and is often 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.

• 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. Periodic boosters of the vaccine are necessary to maintain immunity. The following individuals should get vaccinated to protect themselves:

• Individuals who have never had rubella.
• The immunization for measles includes 2 doses: the first dose should be given between 12-15 months of age, followed by the second dose after an interval of 4 weeks, usually between 4-6 years.
• If you are unsure whether you have been vaccinated in the past.

• Special circumstances: A dose of MMR vaccine may also be administered to children over 6 months of age under certain conditions, such as:

• If there is an outbreak of rubella in your area.
• If there has been exposure to rubella.
• If you are planning to travel to areas where rubella is widespread.

• Isolation: To prevent rubella, maintain distance from individuals infected with the virus. An infected person should be isolated for a few days to a few weeks before returning to normal activities.

• Practice hygiene and cleanliness: To prevent rubella, maintain cleanliness and reduce the risk of infections. Recommended practices include:

• Avoid touching your nose and mouth as much as possible.
• Use tissue paper when coughing and sneezing.
• Always use hand sanitizer.

There is no specific treatment for rubella, and the condition usually improves by itself within 7 to 10 days. To avoid the spread of infection, it is important to avoid contact with vulnerable individuals such as pregnant women, immunocompromised individuals, and young children. It is also advisable to stay away from work or school for at least 4 days after the rubella rash first appears. The treatment focuses on relieving symptoms and supporting the body's ability to fight the infection. If symptoms cause discomfort, they should be treated while the body combats the virus. The treatment approach includes:

• Controlling fever and relieving pain: Paracetamol and ibuprofen can be used to control fever and alleviate pain. Liquid infant paracetamol is suitable for young children.
• Drinking plenty of fluids: If your child has a high temperature, encourage them to drink a lot of fluids to reduce the risk of dehydration.
• Treating sore eyes: Cleaning your child’s eyelids and keeping curtains closed or dimming lights can help soothe the eyes.
• Treating cold-like symptoms: If your child exhibits cold-like symptoms, have them sit in a hot bathroom or drink warm liquids containing honey to relax the airway and soothe a cough.
• Dealing with other illnesses: Medical care is necessary to avoid serious complications arising from the rubella virus. Some serious problems include:
  • Shortness of breath
  • Convulsions
  • Sharp chest pain
• Role of immunoglobulins: Immunoglobulins do not prevent rubella virus infection after exposure and are therefore not recommended as routine treatment. However, the administration of immunoglobulins may be considered for a pregnant woman who has been exposed to rubella and will not consider termination of pregnancy. In such cases, administering immunoglobulins within 72 hours of exposure may reduce, but not eliminate, the risk of rubella infection.

The following home remedies can help in recovery from rubella.

• Aloe vera: Applied on the inflamed area, it helps soothe inflamed skin.
• Neem leaves: Neem has antibacterial and anti-allergic properties. It is used to relieve the itching sensation caused by skin rashes. Take neem leaves, make a thin paste, apply it to the affected area, and let it dry.
• Licorice (mulethi) herb: An ancient herb used to cure rubella. Tea can be prepared by adding licorice herb, which helps reduce the cough caused by rubella.
• Baking soda: One cup of baking soda can be added to bathing water, providing quick relief from itching.
• Coconut water (nariyal paani): Rich in nutrients, it cleanses the body. Drinking plenty of coconut water helps flush toxins out of the body and keeps it hydrated.
• Turmeric (haldi): Known for its 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.
• Green tea: Consumed for its antioxidant, anti-inflammatory, and immune effects. It is advisable to choose caffeine-free green tea.

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 at risk of miscarriage or stillbirth, and her developing fetus is at risk of being born with severe birth defects known as congenital rubella syndrome (CRS). Passing on the virus to the developing baby can lead to serious birth defects such as:

• Heart problems
• Loss of hearing and eyesight
• Liver or spleen damage

3. Rare complications

Some rare complications include:

• Thrombocytopenia: A condition characterized by a low blood platelet count. Platelets are tiny blood cells made in the bone marrow that help in blood clotting.
• Hemolytic anemia: A blood condition that occurs when red blood cells are destroyed faster than they can be replaced.
• Myocarditis: Inflammation of the heart muscle (myocardium), which can reduce the heart's ability to pump and cause rapid or irregular heart rhythms.
• Pericarditis: Inflammation of the pericardium, a thin, two-layered sac that surrounds the heart, often causing sharp chest pain.
• Hepatitis: A condition involving inflammation of the liver, a vital organ that processes nutrients, filters blood, and fights infections.
• Orchitis: Inflammation of the testicles.
• Retinopathy: A disease that damages the retina, the part inside the eye that senses light.
• Uveitis: Swelling and irritation of the uvea, the middle layer of the eye, which can affect one or both eyes.
• Guillain-Barré syndrome: A rare and serious neurological disorder in which the body's immune system attacks the nerves.
• Post-infection encephalitis: A condition resulting from a faulty immune system reaction to an infection elsewhere in the body, where the immune system mistakenly attacks healthy cells in the brain.

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, and cakes.
• 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 to maintain gastrointestinal and immune health.

There is no specific home care treatment for rubella. The patient requires care, timely medications, and certain precautions since it is a contagious disease.

• Get plenty of rest.
• A sponge bath can reduce discomfort due to fever.
• Drink plenty of water.
• Use pain relievers and analgesics such as acetaminophen.
• To reduce itching from the rash, apply witch hazel to the affected areas or add oatmeal to a bath.
• Communicate openly with a doctor regarding any questions related to the disease.
• Lower stress levels.
• Ensure adequate sleep.