Rubella
	Know before you go!
	Disease profile
	Transmission
	Geographic distribution
	Symptoms
	Treatment
	Vaccine
	Prevention & precautions
	Some things to think about

Rubella

Updated: April 2005

Know before you go!

Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
The Public Health Agency of Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician 6 to 8 weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.

Some facts from the experts
The information below has been developed and is updated in consultation with Public Health Agency of Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about the prevention of measles for Canadians travelling internationally.

Rubella, also known as German measles, is caused by the rubella virus, a togavirus of the genus rubivirus. Although usually a mild febrile disease in children, when contracted by women during early pregnancy, rubella frequently leads to a serious and sometimes fatal condition in the unborn child, known as congenital rubella syndrome (CRS). CRS carries a high incidence of miscarriage, stillbirths, and birth defects including congenital heart diseases, cataracts, deafness, and mental retardation. CRS occurs in up to 90% of infants born to women who are infected with rubella during the first 3 months of pregnancy. The risk falls to 10% - 20% by the 16 th week, and defects are rare when a woman is infected after the 20 th week of pregnancy.

Transmission

Rubella is highly contagious. Individuals infected with the rubella virus are contagious for about one week before and at least four days after the onset of rash. It is important to note, however, that u p to half all individuals infected with rubella do not develop a rash. Rubella is transmitted from person to person, most often through close contact with an infected person. Coughing, sneezing and talking can all spread rubella when small droplets leave the infected person and are inhaled by others. Transmission can also occur indirectly through contact with articles freshly contaminated with saliva or mucous from an infected person. Of greatest significance is the transmission from an infected mother across the placenta to her baby during pregnancy, frequently resulting in congenital rubella syndrome, as previously outlined. Infants born with congenital rubella syndrome are highly contagious as in addition to their saliva and mucous, their urine also contains large quantities of the rubella virus. Infants with CRS may shed the virus for months after birth.

Rubella occurs worldwide and is more common in winter and spring. During the last decade, rubella vaccination programs have greatly reduced incident rates of rubella in several industrialized countries. In countries without comprehensive rubella vaccination, periods of relatively low rates of infection alternate with epidemics at intervals of 4 to 8 years.

In Canada

Rubella is very rare in Canada. Since 2002, fewer than 30 cases of rubella have been reported annually.

Symptoms of rubella usually appear within 14 to 21 days of infection, however 25% to 50% of infections are asymptomatic. Children may experience a slight fever and may develop a rash that first appears on the face and neck, which then spreads downwards, and lasts from 2 to 3 days. However, as previously mentioned, up to ½ of all individuals infected with rubella do not develop a rash. Older children and adults with rubella may experience 1 to 5 days of mild to moderate fever, fatigue, headache, inflammation of the tissues around the eyes, upper respiratory infection, swelling of the lymph nodes in the back of the neck and pain, swelling or stiffness in their joints.

As the illness itself is usually mild, medical intervention is rarely necessary. Management of individuals with rubella focuses primarily on providing comfort and supportive measures. Efforts should be made to prevent the spread of infection, particularly to pregnant women.

Vaccine

The primary objective of vaccination against rubella is to prevent infection during pregnancy. A vaccine against rubella exists in Canada and is administered as an injection either in combination with other vaccines (i.e., measles and mumps) or on its own. One dose of live rubella vaccine is recommended routinely for all children, although in practice a second dose is given as MMR – (Measles, Mumps, Rubella). Rubella vaccine should not be administered to children younger than 12 months. In addition, all female adolescents and women of childbearing age should be vaccinated unless they have proof of immunity either through documented evidence of prior immunization or laboratory evidence of antibodies. Pregnant women should not be administered the vaccine. Women of childbearing age are advised to avoid pregnancy for 1 month after vaccination.

Recommendations
The Public Health Agency of Canada strongly recommends that Canadian international travellers contact a physician or travel medicine clinic prior to departure for an individual risk assessment. Based on traveller's current health status, previous immunization history and anticipated travel itinerary, their need for rubella vaccination can be assessed.

Canadian travellers should ensure that their rubella immunization status is up-to-date in accordance with the recommendations of the National Advisory Committee on Immunization. This is especially important for female adolescents and women of childbearing age.

For more information...

• To view "Immunizations recommended for travel outside of Canada".
• For more Know before you go! information.

• For health care practitioners, to view the Canadian Immunization Guide by the National Advisory Committee on Immunization.