What is the treatment and prevention approach for Rubella (German measles)?

Treatment and Prevention of Rubella (German Measles)

There is no specific antiviral treatment for rubella infection; prevention through vaccination is the primary approach to control rubella and prevent congenital rubella syndrome (CRS). 1, 2

Prevention Strategy

Vaccination

• MMR (measles, mumps, rubella) vaccine is the cornerstone of prevention 3
• Vaccination recommendations:
  • All children should receive two doses of MMR vaccine
  • First dose at 12-15 months of age
  • Second dose at 4-6 years of age
  • Unvaccinated adults born after 1957 should receive at least one dose of MMR vaccine 3
  • College students and healthcare workers should have documentation of two doses of measles vaccine and at least one dose of rubella vaccine 3

Special Considerations for Women of Childbearing Age

• All women of childbearing age should be screened for rubella immunity at their first prenatal visit 1
• Non-immune women should be vaccinated immediately after delivery 1
• Women should avoid pregnancy for 3 months after vaccination 1
• Laboratories should retain prenatal specimens until delivery in case retesting is needed 1

Management of Acute Rubella Infection

Postnatal Rubella

• Treatment is symptomatic and supportive only 2
• No specific antiviral therapy is available 2
• Common symptoms requiring management:
  • Fever: antipyretics as needed
  • Rash: typically self-limiting
  • Joint pain: analgesics if needed (more common in adults) 4

Rubella Exposure During Pregnancy

• For pregnant women exposed to rubella:
  • Obtain serum specimen as soon as possible after exposure 1
  • Collect convalescent specimen at least 28 days after exposure 1
  • Immune globulin is not routinely recommended for post-exposure prophylaxis but may be considered in certain circumstances 1

Management of Congenital Rubella Syndrome (CRS)

Diagnosis

• Laboratory confirmation through:
  • Detection of rubella-specific IgM in cord blood 1
  • Viral isolation from nasopharyngeal secretions and urine 1
  • Documentation of persistent rubella antibody levels beyond 3 months of age 1

Infection Control

• Implement contact isolation for suspected cases 3, 1
• Only personnel with confirmed immunity should care for infants with CRS 3, 1
• Consider infants with CRS infectious throughout the first year of life unless nasopharyngeal and urine cultures are negative after 3 months of age 3, 1
• All individuals who have contact with a child with CRS should be immune to rubella 3

Outbreak Control Measures

General Approach

• Implement control measures as soon as a case of rubella is confirmed 3
• Define target populations for vaccination 3
• Ensure susceptible persons are vaccinated rapidly 3
• Exclude susceptible persons who cannot be vaccinated from possible exposure 3
• Maintain active surveillance to modify control measures as needed 3

School/Educational Settings

• Exclude individuals who cannot provide valid evidence of immunity 3
• Exclusion should continue for 3 weeks after the onset of rash of the last reported case 3
• Persons exempted from vaccination for medical, religious, or other reasons should also be excluded 3

Healthcare Settings

• Mandatory exclusion and vaccination of healthcare workers who lack evidence of immunity 3
• Exposed healthcare workers lacking immunity should be excluded from duty from the 7th day after first exposure through the 21st day after last exposure 3

Common Pitfalls to Avoid

• Confusing non-immunity with active infection 1
• Overlooking maternal vaccination history 1
• Misinterpreting serologic results (false-positive IgM can occur in certain viral infections) 1
• Failing to implement proper isolation for CRS cases 3, 1
• Relying on voluntary appeals for vaccination during outbreaks (less effective than mandatory measures) 3

International Travel Considerations

• Persons without evidence of rubella immunity who travel abroad should be vaccinated 3
• Protection is especially important for susceptible women of childbearing age 3