Complications of German Measles
The complications of German measles are uncommon in the general population but can be extremely serious in specific groups, particularly pregnant women and individuals with compromised immune systems. German measles, or rubella, is typically a mild illness in healthy children and adults. However, under certain conditions, it can lead to long-term health consequences, disability, or even death.
Understanding the possible complications allows healthcare providers and the public to act swiftly in managing infection, initiating treatment where necessary, and prioritising prevention.
Congenital Rubella Syndrome (CRS)
The most severe and well-documented complication of rubella is congenital rubella syndrome (CRS), which occurs when a pregnant woman becomes infected, especially during the first trimester. The rubella virus crosses the placenta and disrupts the development of the foetus.
Potential outcomes of CRS include:
Sensorineural deafness (most common defect)
Congenital heart defects, such as patent ductus arteriosus or pulmonary artery stenosis
Cataracts and other eye abnormalities (e.g. retinopathy)
Microcephaly and intellectual disabilities
Liver and spleen damage
Low birth weight or growth restriction
Bone lesions
Endocrine disorders, including diabetes and thyroid dysfunction
The risk of CRS is highest if infection occurs:
Within the first 12 weeks of pregnancy – risk exceeds 80%
Between 13–16 weeks – moderate risk
After 20 weeks – risk significantly declines, though not eliminated
Babies born with CRS may require lifelong care, including hearing aids, heart surgeries, special education, and physical therapy. In severe cases, stillbirth or neonatal death may occur.
Miscarriage and Stillbirth
Rubella infection during pregnancy increases the risk of:
Spontaneous abortion
Foetal death in utero
Preterm labour
These outcomes are particularly likely when infection occurs during early pregnancy and are part of the reason rubella is classified as a high-priority illness in maternal care settings.
Encephalitis
Rubella can, in rare cases, cause inflammation of the brain (encephalitis). Symptoms include:
Severe headache
Altered consciousness or confusion
Seizures
Neurological deficits
Rubella-related encephalitis affects approximately 1 in 6,000 adult cases and is more common in adult males. While rare, it can be fatal or lead to long-term disability.
Thrombocytopaenic Purpura
Another rare but serious complication is thrombocytopaenic purpura, a condition where the number of platelets in the blood falls dangerously low. This can result in:
Unexplained bruising
Nosebleeds or gum bleeding
Blood in urine or stool
This complication is more commonly seen in children and usually resolves with supportive care, but in some cases, medical intervention is required to stabilise the blood clotting process.
Arthralgia and Arthritis
Joint pain is a common symptom, especially in adult women, but in some cases, it may develop into persistent arthritis-like symptoms, including:
Swelling and stiffness in multiple joints
Reduced mobility
Chronic discomfort
Although this condition is usually self-limiting, some individuals may experience prolonged symptoms lasting weeks or months.
Otitis Media and Respiratory Complications
While rubella primarily affects the skin and lymphatic system, secondary complications can include:
Ear infections (otitis media)
Bronchitis or mild pneumonia
These are more common in young children or individuals with pre-existing respiratory issues but are usually treatable.
Impact on Public Health
Rubella outbreaks can cause considerable disruption, especially when they:
Affect schools, childcare centres, or maternity wards
Expose unvaccinated pregnant women to infection
Trigger travel advisories or mass immunisation campaigns
As rubella often causes mild or unnoticed symptoms, identifying the source of an outbreak can be challenging. This underscores the need for routine immunisation and public health vigilance.
Psychological and Social Complications
Being diagnosed with rubella during pregnancy can be distressing and may lead to:
Anxiety and fear over foetal outcomes
Depression or guilt
Difficult reproductive decisions, including termination of pregnancy in severe cases
Parents of children born with CRS may experience:
Financial strain
Caregiver fatigue
Social isolation
Access to mental health support and community resources is crucial for families navigating these challenges.
Preventing Complications
Most complications of rubella are entirely preventable through:
Routine MMR vaccination in childhood
Booster doses or catch-up immunisation for adults
Preconception screening and vaccination for women of childbearing age
Timely diagnosis and public health response during outbreaks
Complications of German Measles
Maintaining high vaccination rates and proactive healthcare policies remains the best defence.
Recognising and managing the complications of German measles ensures better outcomes for individuals and communities, and reinforces the importance of sustained global vaccination efforts.
