RUBELLA

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What Is It?

Rubella, also known as German measles, is caused by a virus. It is now uncommon in the US with fewer than 500 cases per year.

How can you get it?

Rubella spreads from person-to-person through respiratory droplets from coughs or sneezes. Patients with rubella are contagious for 7 days before and 7 days or longer after onset of rash. The incubation period averages 14 days and ranges from 12 to 23 days.

What are the symptoms?

The symptoms of rubella begin about 5-7 days after exposure to the virus. Symptoms are often mild and as many as 50% of infections may not have symptoms. When present, symptoms may include:

  • Fever
  • Rash - starts on the face and progresses down the body to the feet and lasts about 3 days
  • Lymphadenopathy (enlarged lymph nodes) in the head and neck may last several weeks

In older children and adults, symptoms may include a 1- 5 day prodrome (days preceding the rash) with low-grade fever, malaise, lymphadenopathy, and upper respiratory symptoms. Muscle and joint pain is common in adults.

Complications: If a pregnant woman is infected with rubella, birth defects, including deafness, cataracts, heart defects, microcephaly, and liver and spleen damage, may occur in the fetus. If the mother is infected in the first 3 months of pregnancy, the chance of a birth defect is at least 20% and the chance of some adverse effect on the offspring is as high as 85%. In contrast, risks are much lower if infection occurs in the last 3 months of the pregnancy. Infection during pregnancy may also result in fetal death or premature delivery. Arthritis, generally lasting less than a month, is common in adult women. Encephalitis occurs in 1 in 6000 cases and bleeding (hemorrhage) into the brain, kidneys or gastrointestinal tract occur in about 1 in 3000 cases.

How do you prevent it?

Rubella is prevented through vaccination. The vaccine (MMR) also prevents measles and mumps and is a routine childhood immunization. The MMR vaccine does not cause autism. Currently two doses are recommended in childhood.

Vaccination of healthcare personnel is recommended for workers born during or after 1957 unless they have:

  • documented administration of 2 doses of MMR or, up to age 13, MMRV (MMR + varicella) vaccine OR
  • laboratory confirmation of rubella disease or immunity

The CDC also recommends at least 1 dose of the MMR vaccine for unvaccinated workers born before 1957 who do not have laboratory evidence of rubella immunity (2 doses are generally given to ensure protection to the other viruses in this vaccine).

In a rubella outbreak, CDC recommends providing one dose of the MMR vaccine to unvaccinated healthcare personnel who do not have evidence of immunity.

Workers who get these vaccinations do not need to be excluded from work in the days immediately following vaccination.
In addition to vaccination, you can help prevent the spread of rubella by:

  • Preventing contamination and performing decontamination of surfaces
  • Using Universal Precautions
    • Assume patients with respiratory symptoms are contagious and provide masks for symptomatic patients
    • Limit the number of crew members having direct patient contact
    • Hand hygiene (wash with soap and water or using an alcohol based hand rub)
    • Personal protective equipment (PPE) (gloves, gowns, and respiratory protection). IAFF recommends P100 respirators for all patients with respiratory symptoms such as cough

What should you do if you believe you have been exposed to rubella?

The MMR vaccine should be given within three days of exposure to non-immune, non-pregnant individuals. Exposed susceptible personnel should be excluded from duty from day 5 after the first exposure to day 21 after last exposure, regardless of post-exposure vaccine.

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