Rubella: German measles

Rubella is no longer a common disease of childhood in the UK. This is a result of the Mumps, Measles and Rubella (MMR) vaccination programme (see Immunisation article) - although there are concerns that if MMR vaccination rates continue to drop then cases of rubella will reappear.

Rubella is caused by a virus which is spread in the air as droplets - through close contact and by coughing and sneezing. Infection acquired after birth rarely causes any problems and is often without symptoms, but if caught by a woman in the early stages of pregnancy it poses a substantial risk to the unborn baby. Those born with congenital rubella infection may have congenital defects, generally involving the heart, eye and ear.

Common problems:

• Many children have sensorineural hearing loss (see entry, Deafness) in one or both ears. This is because the inner ear, which links the ear to the brain, has been damaged. Hearing loss is the most common manifestation of congenital rubella and often occurs in isolation and may not be obvious at birth. A child's hearing may also get worse over time. Before the MMR vaccination was introduced, fifteen to twenty per cent of cases of children born with sensorineural hearing loss were caused by rubella.
• Babies may be born with cataracts (cloudy lenses) in one or both eyes. Others may have rarer visual conditions or find that their sight gets worse as they get older. Children with congenital rubella cataract usually have associated defects of the heart and hearing, a syndrome referred to as "congenital rubella syndrome" This follows exposure to rubella infection early in pregnancy.
• Rubella can affect the heart in many different ways. Children may have heart problems (see entry, Heart defects) from birth and require hospital treatment.
• Rubella can also affect a child's brain and nervous system. Difficulties can vary from mild to severe (see entry, Learning disability) .

If a woman catches rubella in the later stages of pregnancy then this can cause hearing loss.

Worldwide rubella epidemics prior to the introduction of rubella vaccine, such as that in the 1960's, resulted in many babies being born with Congenital Rubella Defects. Those babies are now adults and even though rubella epidemics are now less common in the UK, the ongoing effects of congenital rubella remain. In fact, many individuals with Congenital Rubella may go on to develop additional problems to the ones they were born with - such as diabetes, declining vision and hearing, and disturbances in behaviour.

Inheritance patterns
None.

Prenatal diagnosis
This depends on whether specific abnormalities can be identified by a scan.

Medical text written September 2004 by Sense. Approved October 2004 by Professor Catherine Peckham, Professor of Paediatric Epidemiology, Institute of Child Health, London, UK.

Further Online Resources
Medical texts in The Contact a Family Directory are designed to give a short, clear description of specific conditions and rare disorders. More extensive information on this condition can be found on a range of reliable, validated web sites and links to them are included in the CD-ROM version of this Directory. Further information on these resources can be found in our Medical Information on the Internet article.

Information, support and advice is available from Sense (see entry, Deafblindness).