Rubella is a contagious disease that is usually benign. But it can have serious consequences when contracted by a pregnant woman. Vaccination has been mandatory for children since January 1, 2018 and was previously recommended in France since 1970. This has led to a significant reduction in cases of congenital rubella.

HOW DOES RUBELLA MANIFEST?

It is a viral, eruptive disease that most often begins with a low fever and the appearance of lymph nodes at the nape of the neck and behind the ears. Then a rash of pink spots appears on the face (without itching), which spreads over the entire body. The signs are sometimes very discreet and the disease can often go unnoticed. The rash lasts about 3 days.

HOW IS IT TRANSMITTED?

Transmission occurs through tiny particles that we project when coughing, sneezing or speaking. In a contagious person, these particles are loaded with virus and transmit it to those around them. Objects or surfaces soiled by nasal secretions can also transmit the virus. People who have not already had rubella and have not been vaccinated can thus be contaminated.

Another mode of transmission is through the placenta of a pregnant woman, then contaminating the fetus she is carrying.

The problem is that contagious subjects are not always sick: contagion begins a week before the appearance of signs of the disease. These signs are sometimes so discreet that they go unnoticed. A person can therefore contaminate others without anyone knowing that they are sick.

WHY DO WE SAY THAT RUBELLA CAN BE VERY SERIOUS?

The seriousness is that rubella can be transmitted to a pregnant woman. The virus passes through the placenta and contaminates the embryo or fetus. The consequences vary depending on when the infection occurs during the pregnancy. When rubella occurs in the mother during the first trimester of pregnancy, the risk of the virus passing through the placenta and contaminating the fetus exceeds 80%. This risk then decreases, then increases again to reach 100% after 36 weeks. This is why screening for rubella immunization (rubella serology) is carried out every month during pregnancy if the woman is not immunized. This allows for rapid detection of a possible infection.

WHAT HAPPENS IF THE FETUS IS CONTAMINATED BY THE RUBELLA VIRUS?

If contamination occurs during the first 12 weeks of development, there is a very high risk that the newborn will be born with serious problems that are grouped under the term "malformation syndrome". He may have eye damage (cataracts), heart damage, inner ear abnormalities and brain development abnormalities.

If the contamination occurs later in the pregnancy, in the 2nd or 3rd trimester, he will have what is called progressive congenital rubella which can be responsible for intrauterine developmental delay and a lower than normal birth weight. The child's further development may also be disrupted. Various other conditions may occur and be completely cured or leave permanent after-effects.

IS RUBELLA DURING PREGNANCY COMMON IN FRANCE?

The number of infections occurring during pregnancy has fallen significantly in France since 2000 and has been less than 10 cases per year since 2006. The number of children with congenital rubella or malformation syndrome is between 0 and 2 per year.

HOW CAN THE TRANSMISSION OF THE VIRUS BE PREVENTED?

If a child is diagnosed with rubella, it is necessary to inform the entourage, staff and other parents if the child lives in a community. The entourage must adopt the usual hygiene measures in these cases of viral infections. Pregnant women must check, if necessary by seeking the advice of their doctor, whether they are protected against rubella.

However, these measures are not enough since the disease is not always apparent. The best protection is vaccination.

WHO IS VACCINATED FOR?

The rubella vaccine is combined with the measles and mumps vaccine (MMR). It is mandatory for all children at the age of 12 months, with a booster around 16-18 months. A catch-up is possible at any age for people who have not been fully vaccinated. Finally, all women of childbearing age should have their protection checked. If they are not and/or the vaccination has not been carried out or is incomplete, it is recommended to be vaccinated before pregnancy, under the cover of effective contraception started 1 month before vaccination and continued 2 months after. 

For women whose rubella serology is negative at the beginning of pregnancy, the vaccine is recommended immediately after delivery, even before leaving the maternity ward.

IS THE VACCINE RISK-FREE?

Serious complications are extremely rare. As with all vaccines, it is possible to see a local reaction at the injection site, or fever or rash 7 to 12 days after the injection. The vaccine does not contain aluminum or mercury and can be received by people allergic to egg. An article published in 1998 reported a possible link between autism and the MMR vaccine. Many other studies conducted since then have firmly contradicted this association. Several of the authors of the 1998 study have themselves reversed their conclusions.

Author: Andrés ARANDA