Pathogen and transmission
Rubella is a highly contagious infectious disease caused by rubella virus (Rubivirus). Person to person-transmission occurs by coughing or sneezing via air-borne droplets. Affected persons are already contagious one week before the appearance of the first symptoms.
Rubella infection during pregnancy is feared. The rubella virus can be transmitted to the child through the placenta and can cause malformations and even death in the womb.
Symptoms
The incubation time (= the interval between infection and start of the first symptoms) ranges from 14 to 21 days. In children and adults, the disease usually has a mild course and only about half of all cases have a delicate, speckled rash. Swelling of the lymph nodes is typical, especially in the neck/throat region. Joint pain is common, especially in adult women.
A rubella infection represents a particular danger during pregnancy. In the first six weeks of pregnancy, a rubella infection can lead to disease in the unborn child in more than half of cases. The risk of transmission from mother to child decreases as the pregnancy advances. The infection of the unborn child can progress without being noticed (subclinical), but can also lead to severe damage to the inner ear, brain, heart, eyes and other organs. The consequences can be disabilities such as hearing impairments, heart defects, malformations of the eye, open spine (spina bifida aperta), as well as premature birth or miscarriage. Women planning a pregnancy should therefore verify their vaccination status and make sure they have received 2 doses of an MMR vaccine.
Prevalence and frequency
Rubella only occurs in humans. The disease can occur at any age – not only in childhood.
Before the introduction of the vaccination, the majority of people were infected with rubella during childhood. Since then, it has declined sharply in countries with high vaccination coverage. In Switzerland, thanks to vaccination, only 0 to 2 cases of rubella are currently reported per year. No rubella infections in pregnant women or newborns have been detected for years. More and more people have been vaccinated during their childhood, which has largely stopped the spread of the virus. But a potential risk remains, especially for women from countries with low rubella vaccination coverage.
Prevention
A safe and effective vaccine is available. The Federal Office of Public Health recommends 2 doses of a rubella vaccination in combination with the vaccination against measles and mumps (MMR vaccine). Since 2023, the MMR vaccination is recommended preferably in combination with that against chickenpox, i.e. varicella (MMRV). The reason for the vaccination against the three diseases measles, mumps, rubella is to prevent their sometimes very severe complications. Vaccination against chickenpox also reduces the risk of contracting shingles (herpes zoster) later in life. As a routine vaccination, the first dose is recommended at the age of 9 months, the second dose at the age of 12 months. A catch-up vaccination to complete full protection with 2 doses is possible at any age. It is particularly important for women who are planning a pregnancy to make sure they have received 2 doses of an MMR-vaccine well before becoming pregnant.
Vaccination with 2 doses usually provides life-long protection from the disease and its complications. The World Health Organisation (WHO) and its member states are engaged in eliminating rubella – and especially congenital rubella (acquired by the unborn child during pregnancy) – in Europe by attaining a high vaccination coverage (> 95%) among children and young women. By 2019, 85 percent of European countries, including Switzerland, have eliminated rubella (interruption of the endemic circulation of the disease). Only rare imported or import-related cases still occur.