Concerns raised over “German measles” with potential stigma

A proper name of disease or virus is expected to be scientifically pithy and socially acceptable, with the faith of minimizing unintentional negative impacts on nations, economies, and people.

Abstract: In scientific sphere, understanding the way naming rules to strengthen the integrity and quality of naming zoonotic diseases and viruses remains nominal rather than substantial. Arguably, the looming worry is that the public are vulnerable to “German measles” with potential stigma in this week’s issue of Nature (1) and Science (2). Stigmatizing names have always come at the cost of unintentional social impacts and economic damaging, despite their seemingly harmless origins.

Newly discovered viruses suggest ‘German measles’ jumped from animals to humans. Researcher Andrew Bennet carefully removes a bat from his net to collect data on the species in Kibale National Forest, Uganda. (EMILY JULKA)(Source: Ref. 2)
Evolutionary relationships among viruses. a, Comparative genome architecture of RuV, RuhV and RusV, showing five ORFs (coloured), two untranslated regions at the 5′ and 3′ termini (white) and an intergenic region (white) between the ORFs that encode the non-structural (nsPP) and structural (sPP) polyproteins. b, Maximum likelihood phylogenetic tree of RusV, RuhV and RuV genotypes 1A–1J and 2A–2C. Black silhouettes represent the natural hosts of each virus, and red silhouettes represent spill-over hosts in the case of RusV. Numbers beside nodes indicate bootstrap values (as a percentage; only values for major branches are shown); the scale bar indicates the number of amino acid substitutions per site. (Source: Ref. 1)

Marginal cost of contextualizing stigma

Less aligned emphasis has been given to the stigmatized proper names of naming viruses and zoonotic diseases. Punctuated “German measles” (1, 2) reminder us that some strongly-held but flawed names may brand discrimination and stoke panic. In the early 19th century, the name rubella was proposed as a substitute for German Rötheln, and then the epidemic entity “German measles” was accepted gradually (3). A proper name of disease or virus is expected to be scientifically pithy and socially acceptable, with the faith of minimizing unintentional negative impacts on nations, economies, and people. Arguably, the looming worry is that such usages with potential stigma might fuel the infodemic unconsciously (4).

In recent years, humans have witnessed several outbreaks of pathogenic diseases, with proper names given by stakeholders. However, each round of naming practice is not always successful. For examples, “Middle Eastern Respiratory Syndrome” (5) and “Swine flu” (6, 7) was accused of unintentional social impacts and negative economic. Since these incidents, in May 2015, WHO released some naming conventions for the naming of new human diseases (8). The marginal cost of contextualizing stigmas is far beyond financial damage. Naming conventions should not be compromised with any plausible reason. Naming conventions is not merely for naming a disease but for the vitality of science and the promotion of social progress.

Admittedly, understanding the way naming rules to strengthen the integrity and quality of naming practices with the original mission remains nominal rather than substantial. In the COVID-19 infodemic, multifarious monikers have become explicit consideration in the COVID-19 paper tsunami, and global profusion of tangled hashtags has found their ways in daily communication. Just as the remarks of the editorial of Nature, “As well as naming the illness, the WHO was implicitly sending a reminder to those who had erroneously been associating the virus with Wuhan and with China in their news coverage — including Nature. That we did so was an error on our part, for which we take responsibility and apologize” (9). The stigmatized names somewhat aggravate the collective perceptual biases in the public and contribute to recent backlash against Chinese and diaspora (10). Thus, it is critical that individuals should verse themselves in naming conventions and do not feed the trolls.

Lexicographical and historiographical origins

The diachronic discourse and lexical dynamics of synonyms “rubella” and “German measles” remains unclear (1, 3, 1114). Arguably, lexicographical and historiographical study promises to articulate the bedrock of scientific storytelling (15)(Fig. S1).

Fig. 1. Historiographical study. Google Books Ngram Corpus (GBNC) facsimiles the diachronic discourse of “morbilli” (English corpus), “rubeola” (English corpus), “Rötheln” (German corpus) and “German measles” (English corpus) from 1719 to 2019.

According to the Oxford English Dictionary Online (OED Online), the earliest known references to “German measles” and “rubella” date back as far as 1856 and 1866, respectively. In fact, their earliest usages could be stemmed back to about 1814 and 1768, respectively.

Clinically first described in 1740, and confirmed in 1752, “German Measles” was established as a separate disease in 1814, with the name “rubella” first used in 1768, and official recognition by the International Congress of Medicine in 1881. Shortly before (1768), for more learned occasions, “Rötheln” and “morbilli” seems more decidedly to mark a distinct disease, than any other yet proposed (3, 14). Sauvages first applied the term “rubeola” in his Nosology to what had been previously termed “morbilli” in 1768. And while almost immediately after him, the German physicians, Selle, Orlow, and Ziegler, clearly laid down the distinctive marks between “rubeola” and “morbilli”. On April 4, 1814, Dr. George W. Maton read a paper entitled “Some Account of a Rash Liable to be Mistaken for Scarlatina” at the Royal College of Physicians in London (16), which resulting in the name “German measles” as a substitute for “Rötheln” (3, 11). Then, the epidemic entity “German measles” as a synonym of “rubella” was accepted gradually. Later, “German measles”, “Rötheln” or “rubeola” per se, was officially ratified as a distinct disease at the 7th International Congress of Medicine, London, August 2 to 9, 1881 (13, 17).


  1. A. J. Bennett et al., Relatives of rubella virus in diverse mammals. Nature. 586, 424–428 (2020).
  2. A. Gibbons, Newly found viruses suggest rubella originated in animals. Science. 370, 157 (2020).
  3. Scotus, The rubeola epidemic. Lancet. 68, 57 (1856).
  4. V. Chandrashekhar, The burden of stigma. Science. 369, 1419–1423 (2020).
  5. M. Enserink, Amid Heightened Concerns, New Name for Novel Coronavirus Emerges. Science. 340, 673–673 (2013).
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  7. N. K. Dhand, M. Hernandez-Jover, M. Taylor, P. Holyoake, Public perceptions of the transmission of pandemic influenza A/H1N1 2009 from pigs and pork products in Australia. Prev. Vet. Med. 98, 165–175 (2011).
  8. WHO, World Health Organization Best Practices for the Naming of New Human Infectious Diseases, 1–3 (2015).
  9. Editorial, Stop the coronavirus stigma now. Nature. 580, 165–165 (2020).
  10. A. J. London, J. Kimmelman, Against pandemic research exceptionalism. Science. 368, 476–477 (2020).
  11. J. A. Forbes, Rubella: Historical Aspects. Arch. Pediatr. Adolesc. Med. 118, 5–11 (1969).
  12. P. R. Ziring, A. L. Florman, L. Z. Cooper, The Diagnosis of Rubella. Pediatr. Clin. North Am. 18, 87–97 (1971).
  13. J. E. Banatvala, D. Brown, Rubella. Lancet. 363, 1127–1137 (2004).
  14. C. Murchison, Clinical lectures on medicine: Lecture IV. Lancet. 96, 595–598 (1870).
  15. Z. Hu, J. Zhang, Y. Huang, X. Wang, Origins of Terminology Pending Further Discovery. Science. (2019) (available at
  16. W. G. Maton, Some account of a rash liable to be mistaken for scarlatina. Med. Trans. Coll. Physicians. 5, 149–165 (1815).
  17. International Congress of Medicine, in Transactions of the International Congress of Medicine (London, 1881), pp. 14–34.
About Sunney 108 Articles
I am currently a Professor of Zhejiang Gongshang University, Hangzhou, China.

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