Thousands of journalists, auto industry executives and others may have been exposed to rubella, or the German measles, in January at the North American International Auto Show in Detroit, health officials said.
A person from New York attended the Detroit auto show’s press preview days Jan. 13-15 while possibly contagious, said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services.
The Free Press interviewed Dr. Trini Mathew, medical director of hospital epidemiology and infection control at Beaumont Hospital Royal Oak, and compiled facts from the U.S. Centers for Disease Control and Prevention and the state DHHS to answer questions about what the exposure might mean for their health.
QUESTION: What should the people who might have been exposed to rubella at the Detroit auto show do now?
A: Anyone born prior to 1957 is considered immune because they likely contracted rubella in childhood, Mathew said. But anyone who was born after that should check their immunization status.
“If you were at the auto show around that time frame, you could always contact your primary care doctor, and say, ‘Hey, I just want to make sure my immunity is there, that I have protection. I might have been exposed,’ ” she said.
“A blood draw would confirm protection or your prior immunization record.”
That’s especially important, Mathew said, because it is possible to have rubella and not exhibit any symptoms, all while spreading the virus.
“It’s called asymptomatic presentation,” she said, and it’s especially risky because a carrier could spread the virus to a pregnant woman or someone with a compromised immune system.
In addition, Mathew said, anyone who has rubella-like symptoms should see a doctor.
“If they start having any kind of concerns, they should get evaluated,” Mathew said.
Q: What are the symptoms of rubella and how soon do they appear after exposure?
A: Symptoms of rubella can begin 12 to 23 days after exposure, but a person might be contagious up to one week before a rash appears and remain contagious for up to seven days afterward, according to the CDC.
Symptoms include a rash that starts on the face before spreading to the rest of the body, a low-grade fever, sore throat, and sometimes, pink eye and headache as well as general malaise.
“Adults may have a really mild illness, Dr. Mathew said. “Some people may not have any symptoms.”
Q: Why is rubella such a concern for pregnant women?
A: If a woman who does not have immunity to rubella is exposed to the virus during pregnancy, it can lead to stillbirth or miscarriage, according to the CDC, or birth defects known as congenital rubella syndrome, or CRS.
The most common birth defects are:
- Heart abnormalities
- Intellectual disabilities
- Liver and spleen damage
- Low birth weight
- Skin rash at birth
Other, less common birth defects can include glaucoma, brain damage, hormonal problems and lung inflammation.
Another concern about potential rubella exposure is for people in close contact with unvaccinated infants or others with compromised immune systems.
Q: How does a person get immunity to rubella?
A: Prior to the late 1960s, the only way to get immunity from rubella was to contract the virus.
An estimated 12.5 million Americans got rubella during a 1964-65 German measles epidemic, according to the CDC. During that time, 11,000 pregnant women miscarried, 2,100 infants died and 20,000 babies were born with birth defects caused by congenital rubella syndrome.
Scientists developed a vaccine for rubella and licensed it in 1969. It was combined with immunizations for the measles and the mumps in 1971, and became known as the MMR vaccine, Sutfin said.
Vaccines for measles and rubella became a requirement to attend school in Michigan in 1978, she said. The mumps vaccine was added as a requirement for school enrollment in the state in 1979.
The CDC recommends that children should get two doses of the MMR vaccine, with the first dose at 12 to 15 months of age, and the second dose between the ages of 4 and 6.
Q: How effective is MMR vaccine?
A: Two doses of the MMR vaccine are 97% effective against measles and 88% effective against mumps. One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella, Sutfin said.
“It is thought the measles and rubella protection is for a lifetime,” Sutfin said in an email to the Free Press. “Recent data has indicated that there is a waning immunity to the mumps portion of the vaccine and we are seeing some breakthrough disease in some populations.”
Q: Is there anyone who should not get the MMR vaccine?
A weak form of the live rubella virus is given to patients in the vaccine, Dr. Mathew said, which means it is not recommended for pregnant women and people who have weakened immune systems. People who have cancer, HIV/AIDS, and those on certain medications such as steroids or chemotherapy also should not get the vaccine.
For a full list from the CDC of people who should not be vaccinated, go to: https://bit.ly/2WFPP6m.
Q: What is the difference between the measles (rubeola) and German measles (rubella)?
A: “There is rubella, also known as German measles, and then there is rubeola, which is known just as measles. They are two distinct infections,” Mathew said.
The names are so similar, it’s understandable that people can get confused,” she said.
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Rubella is the virus that may have been circulated at the auto show.
According to the CDC, it presents with a rash that starts in the facial area and spreads throughout the body, which can be accompanied by low-grade fever, runny nose, sore throat, cough, pink eye and general malaise. Some people never exhibit symptoms at all.
Rubeola, or measles, can be a serious infection that usually presents with a high fever, runny nose, cough, red eyes and sore throat. Those symptoms are typically followed by a rash.
Children younger than 5 and older adults with measles are most likely to have complications, according to the CDC. Those complications can include ear infections, hearing loss, diarrhea, pneumonia and encephalitis. In pregnant women, measles can cause premature birth or a low-birth-weight baby.
“The good news is that both of these diseases are easily preventable by immunization,” Mathew said. “And it’s the same vaccine, MMR, that can cover both.”
Q: If you had the measles as a child, what does that mean for your immunity to rubella?
A: Because they are two entirely different viruses, having measles (rubeola) as a child does not protect you from contracting German measles (rubella).
Q: How contagious is rubella?
A: “Rubella exposure requires much close contact, direct contact with nasopharyngeal secretions or droplets,” Mathew said. “We call this a droplet contact. Someone would have to be close by and potentially shedding it onto you directly” by sneezing or coughing on you.
“It’s less than concerning than, for example, the regular measles, which is airborne, and the virus can stay suspended in the air for two hours even after the person has left the area,” she said.
Q: What is the MMR vaccination rate in Michigan?
A: In all, 86 percent of Michigan children ages 2-18 have received one dose of the MMR vaccine, said Sutfin, which protects them from measles, mumps and rubella.
The same percentage of 5- to 18-year-old Michigan children — 86 percent — have received two doses of the MMR vaccine and have complete coverage, she said.
Q: Does that mean the other 14 percent of children in Michigan are potentially at risk for contracting measles, mumps and rubella and can spread the diseases?
Dr. Mathew said the World Health Organization now classifies vaccine hesitancy as one of the top 10 biggest threats to global health.
Refusing immunizations and declining vaccines for children puts their health at risk, but also other people’s health, Dr. Mathews said.
Her concern is that many are refusing to vaccinate their children because of misinformation. “The myths have been debunked,” she said.
“It’s a global concern,” she said. “We have to keep on addressing this otherwise these diseases are going to keep happening.”
A measles outbreak has sickened 36 people in Oregon and Washington since Jan. 1. Most of the patients are children under 10, and one child has been hospitalized. (Jan. 30)
She pointed to outbreaks of measles (rubeola) in New York and Washington states as an example, where so-called herd immunity is at risk.
“If I, for example, have a weakened immune system, and I cannot take the vaccination, but everyone around me has got protection, then my risk of coming down with the infection is low,” Dr. Mathew said. It’s how society can protect the weakest among us from disease.
“However, if the people around me have also chosen not to be immunized, then I am not protected,” she said.
Q: If a person is diagnosed with rubella, what is the treatment?
A: There is no treatment for rubella, according to the CDC. People with rubella should be isolated for seven days after they develop a rash.
If you are concerned about symptoms, contact your doctor.
Contact Kristen Jordan Shamus: 313-222-5997 or email@example.com. Follow her on Twitter @kristenshamus.
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