Rubella

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Causative agent

Rubella is also known as "German Measles" and is caused by rubella virus.

Clinical features

People usually present with a diffuse rash, fever, headache, malaise, enlargement of lymph nodes, upper respiratory symptoms and conjunctivitis. The rash usually lasts for about 3 days, but some patients may not have rash at all. Arthralgia or arthritis occurs more commonly in adult women with rubella. Rubella infection can also cause anomalies in the developing foetus. Congenital rubella syndrome, characterised by deafness, cataract, heart malformations, mental retardation etc., is likely to occur in infants born to women who got infected during the first 3 months of pregnancy.

Mode of transmission

It can be transmitted by contact with secretions from nose and throat of infected persons through droplet spread or direct contact with patients. This is a highly infectious disease and the patient can pass the disease to other persons from 1 week before to 1 week after onset of rash.

Incubation period

It ranges from 12 – 23 days, usually 14 days.

Management

There is no specific treatment but drugs may be prescribed to reduce discomfort.

Prevention

• Perform hand hygiene frequently, especially before touching the mouth, nose or eyes, after touching public installations such as handrails or door knobs or when hands are contaminated by respiratory secretion after coughing or sneezing. Wash hands with liquid soap and water, and rub for at least 20 seconds. Then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, hand hygiene with 70 to 80% alcohol-based handrub is an effective alternative.
• Cover your mouth and nose with tissue paper when sneezing or coughing. Dispose of soiled tissues into a lidded rubbish bin, then wash hands thoroughly.
• When having respiratory symptoms, wear a surgical mask, refrain from work or school, avoid going to crowded places and seek medical advice promptly.
• Affected persons should be advised to stay at home for 7 days from the appearance of rash and avoid contact with any susceptible persons, particularly pregnant women and women preparing for pregnancy. This is because pregnant women who do not have the immunity to rubella would contract the disease and their foetus could also be affected as well. Therefore, close pregnant contacts should be traced and their immune status should be checked.

• Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15 – 30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
• Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water), leave for 15 – 30 minutes and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
• Maintain good indoor ventilation. Avoid going to crowded or poorly ventilated public places; high-risk individuals may consider putting on surgical masks while in such places.

• Immunisation with rubella-containing vaccine is effective in preventing the disease. Under the Hong Kong Childhood Immunisation Programme, children receive a two-dose course of rubella vaccination (Please refer to the Hong Kong Childhood Immunisation Programme).
• Women of childbearing age who are not immunised should check their immune status before planning for pregnancy and receive rubella-containing vaccine if necessary.
• Different places will develop different immunisation programmes in light of their epidemiological profiles. Parents should arrange their children to receive vaccines according to the local immunisation programme of their place of residence. For instance, children aged under one who frequently travel to or stay in the Mainland should follow the Mainland's schedule of rubella immunisation with the first dose of rubella-containing vaccine at 8 months old, followed by another dose at 18 months.
• All foreign domestic helpers (FDH) who are non-immune^@ to rubella should receive Measles, Mumps and Rubella (MMR) vaccine, preferably before they arrive in Hong Kong. If this is not possible, they can consult a doctor after they have arrived in Hong Kong. Employment agencies can consider adding the assessment of immune status against rubella or MMR vaccination for FDH as additional items in the pre-employment medical check-up package.
• In general, the following individuals should NOT receive MMR vaccine^*:

1. serious allergic reaction to a previous dose of MMR vaccine or any component of the vaccine (e.g. gelatin or neomycin)
2. individuals with severe immunosuppression from diseases or treatment (e.g. on current cancer treatment such as chemotherapy and radiotherapy, taking immunosuppressive medicines such as high dose corticosteroid, etc.)
3. pregnancy#

^@In general, people can be considered as non-immune to rubella if (i) they did not have rubella infection confirmed by laboratory test before, and (ii) they had not been vaccinated against rubella or have unknown vaccination status.

^Medical advice should always be sought.

*According to information from the World Health Organization and the United States Centers for Disease Control and Prevention, anaphylactic reactions to MMR vaccines are not associated with hypersensitivity to egg antigens but to other components of the vaccines (such as gelatin). The risk for serious allergic reactions following receipt of these vaccines by egg-allergic persons is extremely low. Therefore, individuals with non-anaphylactic egg allergy can be safely vaccinated with MMR vaccine. Those with severe allergic reaction (e.g. anaphylaxis) to eggs should consult a healthcare professional for vaccination in an appropriate setting.

#In general, women should avoid pregnancy for three months after receipt of MMR vaccine and take appropriate contraceptive measure.

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