What Causes It?

Rubella is caused by a virus. It can be spread in airborne droplets, such as from a cough or sneeze, from an infected person. Individuals can be contagious for as long as 1 week before a rash appears and up to 1 week after it disappears. Infants with congenital rubella syndrome (see Special Considerations section) may spread rubella virus in respiratory secretions and urine for up to 2 years.

Who is Most At Risk?

These factors increase the risk for rubella:

• Not being vaccinated
• A person who has not been vaccinated coming in close contact with infants who have congenital rubella syndrome (such as in a hospital or day care setting)
• A person who has not been vaccinated coming in close contact with large numbers of people from countries that do not routinely vaccinate against rubella

Signs and Symptoms

Symptoms are usually mild. In up to half of all cases, the disease is so mild that symptoms are hard to identify. The most distinctive sign of rubella is swollen lymph nodes behind the ear, in the neck, and at the back of the head. A pink rash is usually the first sign in younger children. In older children and adults, it is more common to have a low-grade fever, malaise (feeling unwell), loss of appetite, swollen glands, and upper respiratory infection for 1 to 5 days before the onset of full blown disease.

Other signs and symptoms include:

• Joint pain. This is more common in older girls and women and may persist for weeks or, rarely, months.
• Conjunctivitis (inflammation of the membrane around the eye)
• Pain and inflammation of the testes
• Mild itching
• Rash
• Headache

What to Expect at Your Provider's Office

Your health care provider will perform an exam to look for common signs and symptoms, and may perform blood tests or culture a sample of fluid from the nose or throat to check for the rubella virus.

Treatment Options

Prevention

The rubella vaccine causes immunity in 90 to 99% of those who receive it. Children should receive 2 doses [usually as part of the combination measles-mumps-rubella (MMR) vaccine] at least 4 weeks apart. Anyone born in or after 1957 should have at least one dose of MMR. People born before 1957 are considered immune. Women of childbearing age should still be vaccinated prior to becoming pregnant, or take a lab test to see if they are immune to the virus, even if they were born before 1957. (Having had rubella makes a person immune for life.)

In the past, some news reports have raised concerns about whether the MMR vaccine was linked to autism. However, a population-based study investigating a potential association between the incidence of autism and the introduction of the MMR vaccine in the United States and Britain found no link between the two, and reports from the Centers for Disease Control and Prevention and the American Academy of Pediatrics have found the vaccine to be safe. It is more likely that, since autism is usually diagnosed between the ages of 18 months and 3 years, the same time children receive the MMR vaccine, the timing caused questions about whether the events were related. Nevertheless, some scientists maintain the possibility that the MMR vaccine is the triggering event in a small subset of people. One study found increased levels of measles antibody in immunized children with autism compared to those without the disorder. Scientists say the presence of the anitbody could indicate a hyper immune response to measles in children with autism.

Rubella vaccine should not be given to anyone who:

• Has a history of severe allergic reaction to a previous rubella or other vaccine
• Is pregnant or planning to become pregnant
• Has a deficient or suppressed immune system
• Has a moderate-to-severe illness
• Has received antibody-containing blood products within the previous 3 months

Treatment Plan

There is no specific therapy to fight the rubella virus. Treatment is supportive, and the infection generally resolves on its own. Complications are rare. Individual symptoms, such as fever, arthritis, and joint pain, may be treated.

Drug Therapies

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken to reduce fever.
• A nonsteroidal anti-inflammatory drug, such as ibuprofen, can be used for arthritis or joint pain.
• Aspirin or other medicines that contain salicylates should never be given to children because they increase the risk for developing Reye syndrome, a serious illness characterized by changes in the liver, vomiting, and seizures.

Complementary and Alternative Therapies

The MMR vaccine is the only effective prevention against rubella. No CAM method offers any immunity, but some alternative therapies may help alleviate symptoms of rubella. Anyone suspected of having contracted rubella should visit a conventional medical practitioner immediately.

No clinical trials have investigated the use of specific foods or nutrients to treat rubella. However, the following nutrients may be used to support the immune system in general. Check with your doctor to determine the proper dose for a child, and do not treat your child without medical supervision.

Following these nutritional tips may help reduce risks:

• Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils for cooking, such as olive oil.
• Reduce significantly or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise moderately for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 to 2 tbsp. of oil daily, to help reduce inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect, and may increase the risk of bleeding in patients who take blood-thinning medications, such as warfarin (Coumadin) and aspirin. Speak to your doctor.
• Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant and immune activity. CoQ10 can increase clotting and interfere with the action of blood-thinning medications, such as warfarin (Coumadin) and others.
• Vitamin C, 1 to 6 mg daily, as an antioxidant. Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower the dose if diarrhea develops.
• Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Some doctors are concerned about giving probiotics to people are severely immune-compromised.

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 to 2 heaping tsp/cup water steeped for 10 to 15 minutes (roots need longer).

• Rhodiola (Rhodiola rosea) standardized extract, 150 to 300 mg, 1 to 3 times daily, for immune support. Rhodiola is an "adaptogen" and helps the body adapt to various stresses.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg, 3 times a day, for inflammation and immune stimulation. Cat's claw may not be appropriate for people with autoimmune disease or leukemia, and may interact with a number of medications. Speak with your physician.
• Reishi mushroom (Ganoderma lucidum), 150 to 300 mg, 2 to 3 times daily, for inflammation and for immunity. DO NOT take reishi mushroom for more than one month without takin time off. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 3 times a day. High doses of Reishi may reduce blood pressure and decrease blood clotting ability. People who take blood pressure medications or blood-thinning medications should be especially cautious.

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for rubella based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum, for individuals who experience a sudden fever, rash, and thirst.
• Belladonna, for rubella that appears suddenly, is associated with high fever, flushed face and red lips, and heat that radiates from the skin. This remedy is most appropriate for individuals who perspire minimally and may experience strange dreams.
• Ferrum phosphoricum, this remedy is used early in the illness when symptoms are not specific and mild-to-moderate fever is present. Children for whom this remedy is appropriate tend to be tired with a mildly flushed face.
• Pulsatilla, for individuals with fever and chills that are worse in warm rooms and better in fresh air. Symptoms tend to be less intense than for the other remedies listed.

Electroacupuncture (in which acupuncture points are stimulated with electrodes) successfully treated two cases of visual and hearing impairments linked to congenital rubella syndrome (see Special Considerations section). Acupuncture may also help relieve joint pain.

Therapeutic massage may help relieve joint pain.

Prognosis/Possible Complications

Most people who have rubella recover completely without permanent side effects and are immune to rubella afterward. This is not the case for a fetus infected in the womb. Fetal infection can cause serious long-term effects (see Special Considerations section).

Complications are more common in adults than children and may include:

• Arthritis or joint pain. Occurs almost exclusively in women. Fingers, wrists, and knees tend to be affected. This develops along with rash and may take several weeks to resolve.
• Encephalitis (inflammation of the brain). More common in adults (especially in women) than in children. The severity can vary greatly. Up to 50% of people affected by this complication may die from it.
• Internal bleeding, including in the skin, gastrointestinal tract, brain, or kidneys. More common in children than in adults. This may last for days or, rarely, months.
• Inflammation of the testicles, nerves, and brain
• Pregnancy complications. Rubella infection during pregnancy can lead to miscarriage or stillbirth, as well as to congenital rubella syndrome in the child (see Special Considerations section).

Special Considerations

If a fetus is infected with rubella in the womb, this can cause severe defects known as congenital rubella syndrome. The younger the fetus is at the time of infection, the more likely the syndrome is to occur and the more severe effects are likely to be. Temporary effects of congenital rubella syndrome may include:

• Slow growth in the womb
• Low birth weight
• Bleeding disorder
• Overgrowth of the liver and spleen
• Anemia
• Jaundice (yellowish coloration of the skin, tissues, and body fluids)
• Pneumonia

Permanent effects of congenital rubella syndrome may include:

• Deafness
• Heart defects
• Glaucoma and other vision problems
• Intellectual disability
• Behavior disorder
• Diabetes mellitus
• Thyroid disease
• Growth hormone deficiency

Supporting Research

Abernathy E, Cabezas C, Sun H, Zheng Q, Chen MH, Castillo-Solorzano C, Ortiz AC, Osores F, Oliveira L, Whittembury A, Andrus JK, Helfand RF, Icenogle J. Confirmation of rubella within 4 days of rash onset: comparison of rubella virus RNA detection in oral fluid with immunoglobulin M detection in serum or oral fluid. J Clin Microbiol. 2009;47(1):182-8.

Afzal MA, Minor PD, Schild GC. Clinical safety issues of measles, mumps and rubella vaccines. Bull World Hlth Org. 2000;78(2):199-204.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Brown K, Shanley R, Cowley NA, et al. Attitudal and demographic predictors of measles, mumps and rubella (MMR) vaccine acceptance: development and validation of an evidence-based measurement instrument. Vaccine. 2011;29(8):1700-9.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Ferri: Ferri's Clinical Advisor 2015. Philadelphia, PA; Elsevier Mosby; 2014.

Halperin SA, Ferrera G, Scheifele D, Predy G, Stella G, Cuccia M, Douha M, Willems P. Safety and immunogenicity of a measles-mumps-rubella-varicella vaccine given as a second dose in children up to six years. Vaccine. 2009;27(20):2701-6.

Hurwitz E, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90.

Jones A, Cork C, Chowdhury U. Autistic spectrum disorders 2: diagnosis and management. Community Pract. 2006 Apr;79(4):128-30. Review.

LeBaron CW, Forghani B, Matter L, Reef SE, Beck C, Bi D, Cossen C, Sullivan BJ. Persistence of rubella antibodies after 2 doses of measles-mumps-rubella vaccine. J Infect Dis. 2009;200(6):888-99.

Lessler J, Metcalf CJ. Balancing evidence and uncertainty when considering rubella vaccine introduction. PLoS One. 2013;8(7):e67639.

Maldonado Y. Rubella. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, PA: W.B. Saunders; 2000:951-953.

Mandell: Mandell, Douglass, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA. Elsevier Churchill Livingstone; 2009.

Marin M, Broder K, Temte J, Snider D, Seward J. Use of Combination Measles, Mumps, Rubella and Varicella Vaccine. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention; 2010;59(RR03):1-12.

Ouhilal S. Viral diseases in pregnancy: a review of rubella, chickenpox, measles, mumps and 5th disease. Prim Care Update Ob/Gyn. 2000;7:31-34.

Peter G. Immunization practices. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, PA: W.B. Saunders; 2000:1081-1089.

Rakel. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Shi J, Yu J, Pohorly JE, Kakuda Y. Polyphenolics in grape seeds-biochemistry and functionality. J MedFood. 2003;6(4):291-9.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Starr M. A rash of exanthems: how they affect children and pregnant women. Aus Fam Phys. 2000;29(7):631-637.

Wang Z, Yan R, He H, et al. Difficulties in eliminating measles and controlling rubella and mumps: a cross-sectional study of a first measles and rubella vaccination and a second measles, mumps, and rubella vaccination. PLoS One. 2014;9(2):e89361.

Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.