A Unique Child: Health - A doctor's diary ... rubella


'Doctor, I'm so worried. My daughter hasn't had the MMR vaccine and I think that she has German measles. What will happen to her?'

German measles, otherwise known as rubella, is a viral illness which has become less common since the advent of national vaccination programmes. In 2008, only 27 cases were confirmed in England and Wales. While it is self-limiting and usually of little consequence in children, rubella may prove devastating for the baby if contracted during pregnancy. In addition, German measles has some uncommon but potentially devastating complications.

The German measles virus is passed from person to person through coughing and sneezing. The virus itself is carried in water droplets. Once somebody is infected, it may take up to three weeks for them to show symptoms.

SYMPTOMS

Up to half of the people infected with the virus will not experience any symptoms at all. Some children will have a very mild fever, conjunctivitis, headache, sore throat and a runny nose prior to developing painful enlarged glands, known as lymph nodes, a high fever and a rash.

The enlarged lymph nodes often are those behind the ears, in the neck and at the back of the head. The rash, which looks like pink or red spots of around 2mm or 3mm in size, normally starts behind the ears and progresses over time to affect the face, neck, chest and back, and finally the limbs. People affected are contagious seven days before to up to seven days after the onset of the rash.

COMPLICATIONS

Complications of German measles can include a middle-ear infection called otitis media, croup, diarrhoea, vomiting and febrile convulsions. Joints may become painful and swollen, but this is unusual in children. Rarely, it may cause bronchitis or pneumonia, an infection of the brain known as encephalitis, or blood disorders.

Croup may be caused by a number of different viruses. It causes a barking or seal-like cough. Diarrhoea and vomiting may cause dehydration. Encephaliti may cause brain damage, while the low platelets can cause spontaneous bleeding.

PREGNANCY

If rubella is contracted during pregnancy it may cause miscarriage, stillbirth or congenital rubella syndrome (CRS). But the number of cases of CRS has fallen dramatically since the introduction of the MMR vaccination programme.

The risk of CRS is particularly high if the mother is infected in the first ten weeks of pregnancy, whereas risk of birth defects is virtually nil if she is infected beyond 20 weeks.

CRS causes a number of problems in babies, including deafness, cataracts, heart defects such as a hole in the heart, severe brain damage and a small head, called microcephaly. These children are more likely to develop lung infections, diabetes and encephalitis later in life, as well as thyroid disease. The thyroid gland is found in the neck and in essence, controls the body's metabolic rate.

DIAGNOSIS AND TREATMENT

A diagnosis of German measles is often made on clinical grounds but is confirmed by tests measuring particular types of antibodies in the blood.

These tests are also performed on all pregnant women to ensure they are immune to German measles, that is, they have either been previously vaccinated or had the virus in the past. Once someone has had German measles, it is rare to get it again.

There is no specific treatment for German measles, although general remedies such as paracetamol or ibuprofen are recommended, as well as ensuring the child takes plenty of fluids. Antihistamines may be used if the rash is itchy.

PREVENTION

The best way to avoid getting German measles is prevention by vaccination, particularly given that there is no evidence that the MMR vaccination is linked to autism. The vaccination should be given to both males and females as part of the national childhood immunisation programme.

If you are concerned about German measles, or indeed the MMR, you should always seek medical advice.

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