Rubella - DBI

What is Rubella Syndrome

Rubella, or German measles, is a mild disease caused by a virus. If you get it you may feel unwell, with swollen glands and a slight temperature or sore throat. You may develop a rash, usually behind the ears and on the face and neck, but equally some people have rubella and don’t develop a rash, or any of the other symptoms.
Rubella used to be common in childhood with most children catching it over the winter. It is spread by droplets in the air from the coughs and sneezes of an infected person.
According to the UK’s Department of Health’s publication “Immunisation against infectious diseases”, the incubation period (the time that someone has the virus in their system before they develop symptoms) is 14-21 days with the majority of affect individuals developing a rash 14-17 days after exposure. replica watches Individuals are then infectious from one week before the symptoms appear to four days after the rash starts.
Remember though that some people don’t have the symptoms so many never know that they are infectious and are passing the disease on to others.
Rubella can seriously affect pregnant women, damaging their unborn child - particularly the developing sight, hearing, heart and brain.

About rubella

What is rubella?
Prior to immunisation, rubella was a common disease of childhood. It is caused by a virus which is spread in the air as droplets - by coughing and sneezing.
When someone has been in contact with the virus it takes two to three weeks to develop. When it does, they will generally feel unwell and off-colour for the first five days, with swollen glands, and a light temperature or a sore throat. If a rash develops, it will start on the face, and spread downwards over the body and limbs, and this may cause pain and discomfort in the limbs - especially in women. omega replica watches Some people have rubella, but show no symptoms at all.

What happens if a woman has rubella when she is pregnant?
Sometimes the mother will not pass the rubella onto the baby. However, if she has rubella in the early stages of her pregnancy then there is a greater chance of the virus passing through the cord to the developing baby.
A child affected by rubella during pregnancy will be said to have congenital rubella. Children born with congenital rubella will have the virus circulating in their bloodstream for up to 20 months after they are born. rolex replica They will normally pose no risk to others, but anyone in direct contact with children with congenital rubella is advised to be screened and immunised as necessary.

About vaccination
Most women today choose to protect themselves from rubella by being immunised before they become pregnant, and this has greatly reduced the numbers of children affected. Even if a woman has already been immunised however, it is important that she has a blood test before becoming pregnant to ensure that she is still immune. panerai replica uk The rubella vaccine is now given to children when they are between 12 and 15 months old. This is given in combination with the vaccinations for measles and mumps - called the MMR vaccination. Children receive a booster injection before they start school.

How can rubella affect the baby?
We do not fully understand how the baby is affected by the virus. The virus seems to affect the cells of parts of the baby's body that are being developed at the time of infection. Sometimes there is insufficient blood supply which can harm organs which have developed already. However, every child is different. Some children will appear to be unaffected, but they should be followed up during childhood, particularly for hearing loss. Anyone with congenital rubella should have regular health check-ups, including vision and hearing assessments throughout their life.

Where might the damage occur?
The stage of pregnancy when the rubella infection occurs is the most important factor determining what kind of harm, if any, occurs. rado replica sale Rubella in the first two months of pregnancy is likely to affect the baby and may cause a number of impairments. After 18 weeks gestation, although rubella infection may be passed on to the baby, the chances of the baby being affected may be minimal. The most commonly affected organs include the ears, the eyes, and the heart.

The eyes
The eyes develop during the early stages of pregnancy. Several things may happen:

• Cataracts
  

Between three and seven weeks the eye lenses may be affected and become cloudy. A cloudy lens is called a cataract - sometimes people will use the term congenital cataracts. This means that the baby will have cloudy lens from birth. Again, the degree of cataract can vary enormously - from a small clouded area to the complete lens being affected. Sometimes one eye only will be affected- sometimes both.

• Small eye
  

Sometimes the size of one or both eyes will be affected, although this is quite rare.

• Colouring of the retina
  

Babies who are born with rubella have speckled colouring or pigment on the back of their eye, although this does not affect their sight.

• Eye movement
  

The eyes may jump from side to side in a flickering movement. This eye condition is known as nystagmus.
Less common eye problems
There are several rare conditions which may affect the baby - optic atrophy, corneal haze, and glaucoma. If your child has these problems please ask your ophthalmologist (see below) for more information.

The heart
The heart is a complicated organ, and many different problems can be caused by the virus. These problems are best explained to you on an individual basis by your paediatrician in the hospital who will explain the difficulties your child is facing.

The ears
A common problem for babies affected by the rubella virus is hearing loss. This can vary considerably from mild to severe, and may affect one or both ears. The part of the ear which is damaged is the Corti. This is the inner ear or Cochlea which links the ear to the brain. fake breitling sale The hearing loss is known as sensori neural.
The amount of hearing loss can vary a great deal, and hearing may deteriorate over a period of time.

Neurological problems
The rubella virus may or may not affect the child's brain, and difficulties can vary from mild to severe. If a child has any of these problems, then it is best to discuss these with a paediatrician who can offer individual advice.

Conditions that may occur:
Lethargy, irritability, learning difficulties, small head (microcephaly), large soft spot on the head, movement problems, poor balance and posture, lack of coordination seizures. Some children may have associated behaviour problems. Other rarer conditions have been associated with babies affected by rubella. If you notice anything out of the ordinary, it is best to discuss the situation with your health visitor or GP who can refer you to a paediatrician for specialist advice.

What support do children affected by rubella need?
Children who have been affected by Rubella may have to cope with an impairment of both sight and hearing, as well as other disabilities - although this will vary a great deal. Many children will have some sight and/or hearing however, and it is important to make as much use of these possible. The other senses - touch and smell in particular - must also be developed to the full.
The biggest challenges facing children affected by Rubella, will be to learn to communicate, to move around safely, and to find out about the world around them. It is vital that these children get specialist help which is geared towards their particular combination of abilities and impairments as soon as possible. Intensive one-to-one teaching developed for work with deafblind children for example, can help them to understand the human interaction that is the basis of communication. Children can learn various ways to communicate such as using symbols, objects of reference, sign language, and braille.
All children and adults affected by Rubella have the capacity to learn and achieve.

What is Congenital Rubella Syndrome?

Rubella, also known as German measles, was once a common disease of childhood. It is caused by a virus which is spread in the air as droplets – through close contact and by coughing and sneezing.
Rubella infection in childhood usually presents no serious complications, but if caught by a woman in the early stages of pregnancy may cause miscarriage, stillbirth or serious health problems for the affected foetus. The term ‘Congenital Rubella Syndrome’ is used to describe the range of health problems that may be present at or around the time of birth. The effects of Congenital Rubella vary depending on what stage of pregnancy the infection was contracted and how invasive it has been.
Worldwide rubella epidemics from the 1940’s to the 1960’s resulted in many babies being born with Congenital Rubella Syndrome. Those babies are now adults and even though rubella epidemics are now less common, 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.
This factsheet aims to provide affected individuals, their families, carers and other involved professionals with an overview of the early, ongoing and delayed effects of Congenital Rubella. Knowing what may develop can help in earlier diagnosis and the implementation of appropriate medical treatment and management programmes where necessary.

Common early problems
Many organs that develop in the early stages of pregnancy can be affected by rubella infection. Some of the common effects of rubella during pregnancy include impairments to ears, eyes, heart, brain and nervous system:

• Many children have sensorineural hearing loss in one or both ears . This is because the inner ear, which links the ear to the brain, has been damaged. A child’s hearing may also get worse over time.
  

• 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.
  

• Rubella can affect the heart in many different ways. Children may have heart problems from birth and require hospital treatment.
  

• Rubella can also affect a child’s brain and nervous system. Difficulties can vary from mild to severe.
  

The above, are only brief descriptions of what can happen as a result of rubella, and it is important to remember that no two individuals will experience the effects of Congenital Rubella in exactly the same way. Most people will have one effect (usually hearing loss) as well as some combination of the other effects mentioned in this factsheet.
A paediatrician can help explain how a child has been affected.

Delayed effects associated with congenital rubella syndrome
We do not know for certain how the rubella virus continues to affect an individual with Congenital Rubella Syndrome. Most experts believe that new problems are either due to a persistent infection of the rubella virus in the affected organ, or to the old infection which sets up an auto-immune response (i.e. the body’s immune system reacts against its own tissue in the mistaken belief that it is the rubella virus).
Most people are able to identify changes in their own health and seek advice and treatment. However, many people with congenital rubella are not able to communicate underlying symptoms. It is therefore important to regularly monitor an individual’s well-being. Monitoring should include regular medical assessment.
The increased incidence of the following conditions has been confirmed by research1. This means that these conditions occur more frequently amongst people with congenital rubella than they do in the general population. However, no two individuals are affected by congenital rubella in the same way.

Diabetes Mellitus
Diabetes occurs when there is a high level of glucose in the blood (hyperglycaemia). This occurs when the pancreas does not produce enough insulin or the body is unable to utilise the insulin produced.

Signs and symptoms to look out for include:

• increased thirst
  

• going to the toilet all the time – especially at night
  

• extreme tiredness
  

• weight loss
  

• genital itching or regular episodes of thrush
  

• blurred vision
  

If you, or someone you know, experiences any of these symptoms, seek advice from your GP who may do a blood test to check your glucose levels. Although there is no cure, careful monitoring and treatment means diabetes can be managed very successfully.

Thyroid dysfunction
The thyroid is a small gland situated in the neck. Its function is associated with the body’s use and turnover of energy. The thyroid can be underactive (hypothyroidism) or overactive (hyperthyroidism).

Signs and symptoms to look out for include:

If any of the above symptoms are being experienced, these should be discussed with the individual’s GP. The GP may ask some questions and decide to do a blood test. Thyroid dysfunction can be detected by measuring levels of hormone in the blood. Again, there is no cure but careful monitoring and treatment means thyroid disorders can be managed very successfully.

Glaucoma
Glaucoma is an abnormal increase of pressure within the eye (intraocular pressure - IOP) which may result in optic nerve injury and affect the vision. As pressure in the eye builds up, there is a progression from mild visual impairment, and if left unchecked can lead to blindness. Glaucoma can develop later in life as a result of cataract surgery.

• Loss of peripheral vision
  

• Pain in the eye
  

• Redness of the eye
  

• Increased rubbing of the eye
  

• Misty rainbow coloured rings can be seen around white lights
  

An optometrist can perform several tests to check for glaucoma. If glaucoma is identified, it can usually be managed with the daily use of eye drops.

Other delayed manifestations that have been reported by affected individuals, families and professionals
Other possible delayed effects described below have been reported by affected individuals, families and other professionals from around the world. However, there is no scientific evidence to indicate that individuals with congenital rubella are at an increased risk of developing these conditions.

Declining Hearing Loss
Hearing loss may range from mild to severe and is the single commonest effect of Congenital Rubella. For most people it remains stable but for others it may be progressive.

A person with declining hearing loss may experience new problems, which can include:

• Having to turn the television volume up louder
  

• Difficulty maintaining a telephone conversation
  

• Difficulty hearing some high frequency sounds
  

• Difficulty identifying the direction that sounds are coming from
  

• For example, wax in the ears can reduce an individual’s ability to hear, and even though not progressive, can have an adverse impact on an individual’s ability to make sense of their environment and may need regular monitoring.
  

Declining vision
Some individuals may experience declining vision. Again, indicators of declining vision may not always be evident and regular monitoring is recommended. Visual loss may be unilateral or bilateral and may accompany another medical condition such as diabetes (retinopathy).
A person with declining vision may experience new problems such as bumping into objects. They may adjust to their reduced vision by:

• Sitting closer to the television
  

• Increasing use of touch to identify objects
  

• Holding objects closer to the eyes.
  

The above indicators may not be relevant to a person who is profoundly deaf or blind and unable to communicate what is happening them. In this case, people known to the affected individual such as family members or carers may be the first to notice that there are changes. In some instances though, changes may not be evident, but as the affected individual relies on whatever hearing or vision they have to make sense of their environment, an annual hearing and visual assessment may be a good way of identifying problems early.
Regular monitoring of hearing and vision can help to identify any changes, and where necessary the implementation of management programmes and communication strategies.

Disturbances in behaviour
Behavioural disturbances have been reported in individuals with congenital rubella, but it is not certain what may be causing this. It has been suggested that they may be due to a neurological problem, hormonal problem and problems with the eye and/or ears. Puberty may also have a role to play and environmental changes should not be forgotten as a possible factor.
It is important to note that behavioural changes may not necessarily mean that there is a medical problem. Changes in behaviour could be as a direct consequence of an individual’s inability to communicate their needs, particularly where their ability to do so is limited or non-existent.