Causes of Rubella

Rubella, commonly known as German measles, is a contagious viral infection that primarily affects the skin and lymph nodes. Although rubella is generally mild in children and adults, it poses serious risks to pregnant women and their unborn babies. Prevented largely through vaccination, rubella remains a public health concern in areas with low immunization coverage.

In many developed countries, rubella was once a common childhood illness. However, with the widespread use of vaccines, rubella has been largely controlled and even eliminated in some parts of the world. Despite this success, rubella remains a major concern in regions with low vaccination rates or where immunization programs are not readily available. In pregnant women, rubella can lead to Congenital Rubella Syndrome (CRS), a condition that can cause serious birth defects in unborn babies.

What Is Rubella?

Rubella is an infectious disease caused by the rubella virus, a member of the Matonaviridae family. It is often confused with measles because of its similar red rash, but rubella is a different disease with typically milder symptoms. The virus is transmitted from person to person, mainly through respiratory droplets, and can lead to severe complications in pregnant women, particularly during the first trimester.

The Rubella Virus: The Primary Cause

The root cause of rubella is infection by the rubella virus. Once a person is exposed, the virus multiplies in the nose and throat before entering the bloodstream and spreading throughout the body. The incubation period (time between exposure and symptoms) usually ranges from 14 to 21 days.

The virus primarily targets the immune system and soft tissues, causing symptoms like :-

1. Low-grade fever

2. Sore throat

3. Rash that starts on the face and spreads

4. Swollen lymph nodes behind the ears and neck

5. Joint pain, especially in adults

Rubella is often so mild in children that it may go unnoticed. However, its ability to cross the placenta and cause birth defects makes it especially dangerous during pregnancy.

Causes of Rubella

Understanding how rubella spreads helps identify its root causes on a community level. Rubella is highly contagious and spreads in the following ways :-

1. Respiratory Droplets :- Rubella spreads through the air when an infected person coughs, sneezes, or talks. The droplets carry the virus and can be inhaled by others in close proximity. This is the most common mode of transmission.
2. Direct Contact :- Touching the nasal or throat secretions of an infected person can also transmit the virus. This can happen through shared utensils, towels, or contaminated surfaces.
3. Congenital Transmission :- Perhaps the most serious form of rubella transmission occurs from mother to fetus. If a pregnant woman contracts rubella, especially during the first trimester, the virus can cross the placenta and infect the developing baby. This leads to Congenital Rubella Syndrome (CRS), which can cause severe birth defects such as :-

• Deafness

• Heart abnormalities

• Cataracts

• Intellectual disabilities

• Liver and spleen damage

Congenital transmission underscores the importance of rubella vaccination, especially for women of childbearing age.

Risk Factors: Who Is More Likely to Get Rubella?

While rubella can affect anyone, certain factors increase the likelihood of contracting the virus :-

1. Unvaccinated individuals :- Those who have not received the MMR (Measles, Mumps, Rubella) vaccine are at the highest risk.

2. Infants born to unvaccinated mothers :- Without maternal antibodies or immunization, these infants are vulnerable.

3. Travelers to endemic regions :- People visiting countries where rubella vaccination is not common face higher exposure risks.

4. Pregnant women with no immunity :- This group is at particular risk due to the threat to fetal development.

Environmental and Social Causes Behind Rubella Spread

While the biological cause of rubella is the virus itself, environmental and societal factors play a major role in outbreaks.

1. Low Immunization Coverage :- In communities where vaccine access is limited or vaccine hesitancy is high, rubella outbreaks are more likely to occur. The MMR vaccine, typically administered in childhood, is the most effective preventive measure against rubella.
2. Lack of Prenatal Screening :- In some regions, routine prenatal screening for rubella immunity is not practiced. Without this screening, women may unknowingly face serious risks during pregnancy.
3. Poor Public Health Infrastructure :- Areas lacking robust healthcare systems may struggle to identify, treat, and prevent rubella outbreaks, contributing to its persistence in certain populations.

Is Rubella Still a Concern Today?

Yes, rubella continues to be a public health concern, especially in countries with inadequate vaccination programs. While many developed nations have nearly eliminated the disease through widespread immunization, rubella still causes complications in parts of Africa, Southeast Asia, and other low income regions.

The global goal is rubella elimination, which can only be achieved through strong immunization campaigns and awareness efforts.

Importance of the MMR Vaccine in Preventing Rubella

The MMR vaccine (Measles, Mumps, and Rubella) is the cornerstone of rubella prevention. Administered in two doses usually the first at 12-15 months and the second at 4-6 years the vaccine provides long lasting protection.

Vaccination not only protects individuals but also contributes to herd immunity, preventing outbreaks in the community. Pregnant women should be screened for rubella immunity and vaccinated at least one month before trying to conceive if they are not immune.

Conclusion

Rubella is primarily caused by infection with the rubella virus, but the conditions that allow the virus to spread like low vaccine coverage, lack of awareness, and inadequate prenatal care are just as important to address. By understanding these causes, both biological and environmental, we can take effective steps toward prevention and eventual eradication.