Paramyxoviruses: German Measles

German Measles is also known as Rubella or 3-day measles and is brought about by Rubella virus. Rubella virus, although classified as in the family of Togaviridae because of its physical and chemical properties, it can be considered with the paramyxoviruses on epidemiological bases. Incubation of this virus is from 7 to 21 days and it is transmitted through droplet infection in which it enters the upper respiratory tract.

German measles is an acute viral illness characterized by fever, mild catarrhal inflammation of the respiratory tract, lymphadenopathy, and skin rashes similar to that of scarlet fever and measles. It is the mildest common form of viral exanthem and it usually affects children and young adults alike. Although it is the mildest form, german measles can be very dangerous especially if it affects pregnant women.  German measles is classified into two: Postnatal Rubella Infection and Congenital Rubella Infection.

Postnatal Rubella Infection

Postnatal Rubella Infection usually starts with body malaise, low-grade fever, headache, red eyes, sore throat, runny nose and morbilliform rash appearing on the same day. This appearance of rashes coincides with the development of antibody. The rash starts on the face, extends over the trunk and the extremities which rarely lasts for three days thus the name 3-day measles. There is no specific feature of the rash that is pathognomonic for German measles. Temporary arthralgia and arthritis are common among adults especially for females.

German measles is mild and self limiting viral illness with no specific treatment indicated. Rare complications of this illness, includes: thrombocytopenia (decreased platelet count), encephalitis (Inflammation of the brain) and leucopenia (decreased white blood cell count).

Congenital Rubella Infection

Congenital Rubella Infection is an infection during pregnancy in the placenta and the fetus. The timing of the infection in regards with the age of gestation, determines the extent of teratogenic effects. In general, the earlier in pregnancy the infection has occurred, the greater damage it can cause the fetus.  This infection can lead to spontaneous abortion and even fetal death.

Clinical features of this viral infection are divided into three: first, transient effects in the fetus; second, permanent manifestations that may be apparent at birth or through the first year; and third, developmental abnormalities that appear and progresses during childhood to adolescent. The classic triads of abnormalities expected in a fetus affected with this infection are as follows: cardiac abnormalities, deafness and cataracts.

There is no specific treatment indicated for Congenital Rubella Infection, however some result to therapeutic abortion when the infection occurred at the first trimester of the pregnancy.

Nursing Consideration

German measles can be prevented by childhood immunization with rubella vaccine to ensure that women of childbearing age is protected with such viral infection. It is the nurse responsibility to ensure that each child, during his immunization years, has received all the immunizations which he needs to receive. It is important to properly educate the mother of these children on the importance of submitting their child for immunizations and their strict compliance with the dates on when to back for the succeeding shots.

In case with pregnant mothers, it is the responsibility of the nurse to educate these mothers the importance of staying away from those people having an active German measles infection so as to prevent them from acquiring the infection.

Photo credits:

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

What Do You Think?