Rubella

Introduction

Rubella is a viral illness that causes a skin rash and joint pain. The World Health Organisation announced in October 2018 that Australia had eliminated rubella. Elimination does not mean eradication - outbreaks may still occur, so it is important to continue vaccinating children to prevent the spread of infection to pregnant women.

Rubella is most commonly spread when a child ingests/inhales the cough/sneeze droplets from an infected person. About half of rubella cases are so mild, there are no symptoms. If symptoms do occur, they usually appear between two to three weeks post-infection.

Rubella symptoms include:

• mild fever
• headache
• runny nose
• sore eyes
• skin rash
• swollen lymph nodes
• joint pain.

Possible complications of rubella include:

• lingering joint pain, which may take around a month to improve
• inflammation of the middle ear
• inflammation of the brain, which can be fatal in some cases.

Symptoms usually occur between 14 to 21 days. People infected with rubella are infectious for one week before, and at least four days after, the onset of a rash.

Rubella has been eliminated in Australia, but cases may still occur. Anyone who hasn’t been vaccinated against rubella is at risk, including:

• travellers to/from areas where rubella vaccination programs aren’t widespread
• childcare workers
• people who work in healthcare settings
• unborn babies whose mothers have low or non-existent rubella immunity.

Rubella can be difficult to diagnose as the symptoms are often vague and non-specific. Diagnosis may include:

• medical history, including immunisation status and travel history
• physical examination
• blood tests.

No specific treatment for rubella exists and the symptoms are usually mild. Treatment aims to ease symptoms and reduce the risk of complications. Options include:

• bed rest
• plenty of fluids
• paracetamol to reduce pain and fever.
• isolation for at least four days following the onset of a rash to reduce the risk of infecting others.

Immunisation is the best way to prevent rubella. There are two types of rubella vaccines. It can be given as a combined measles, mumps and rubella vaccine (commonly known as the MMR vaccine), or as a combined measles, mumps, rubella and varicella (chickenpox) vaccine (commonly known as the MMRV vaccine).

Rubella combination vaccines are free under the National Immunisation Program for children aged 12 months and 18 months.

• At 12 months of age, a MMR vaccine is recommended
• At 18 months of age, a MMRV vaccine is recommended

Catch-up immunisations are available for anyone who has not been fully vaccinated, including Aboriginal and Torres Strait Islander people, refugees and asylum seekers over the age of 10. Infants as young as six months can receive free MMR vaccine prior to travel overseas to countries where rubella vaccination programs aren’t widespread.

Not everyone is a suitable candidate for a rubella vaccine. A child with an impaired immune system should not be immunised. Similarly for children who have had anaphylaxis after a previous dose of any rubella containing vaccine or anaphylaxis after any component of a rubella containing vaccine.