Rubella

Rubella, also known as German measles, is a contagious virus that usually affects children, but can be caught by adults.

Symptoms are generally mild and pass within 7 to 10 days, often only needing minor intervention. However, the rubella virus can cause serious birth defects if caught by a pregnant person; this is referred to as congenital rubella syndrome. 1

Vaccination programs have had success in reducing the number of cases of rubella worldwide. According to The World Health Organization, several countries have eradicated rubella and congenital rubella syndrome altogether because of their vaccination programs. 2

Rubella was eliminated in the United States in 2004. Now, approximately 10 cases of rubella are reported in the U.S. every year. These rare cases are caused by people coming into contact with the virus while traveling abroad. 3

Many people will experience no symptoms at all when they contract rubella. If symptoms do appear, they will usually present at around two to three weeks after the initial infection. This time lag is known as the incubation period. 4

Rubella symptoms include: 5 6 7 8 9

• Swollen lymph glands, particularly behind the ears and on the back of the head
• Mild fever, less than 39 degrees Celsius or 102.2 degrees Fahrenheit
• Conjunctivitis/ pink eye
• Cold-like symptoms, such as a cough, sore throat or runny nose**
• Aching feelings in the body
• Feeling cold
• Loss of appetite
• Headache
• Nausea
• Pain in eyes when looking up and to sides
• Red spots on the roof of the mouth
• Sore or aching joints; more likely to be experienced by adult women and teenage girls

A rash may be the most noticeable symptom of rubella. The rash will typically develop one to five days after other symptoms and will be recognizable by:

• Pink, pinpoint bumps on a red, flat patch of skin, also known as a maculopapular rash 10
• Rash first appearing on the face, then spreading downwards, towards the trunk and limbs
• Rash covers most of the body within 24 hours

The rash tends to last three to five days. Other symptoms begin earlier and generally last around a week. 6

Symptoms of rubella are similar in adults and children. If you or a loved one is experiencing symptoms that may be linked to rubella, the free Ada app is ready to carry out a symptom assessment now.

The main complication of rubella is that birth defects can occur when a pregnant person without immunity comes into contact with the virus. This is called congenital rubella syndrome (CRS). See the Congenital rubella syndrome (CRS) section below for more information.

In rare cases, rubella may cause bleeding or problems with the brain. 11

Rubella is caused by a contagious virus. It is transmitted in a similar way to the common cold and the flu, i.e. by coming into contact with droplets of moisture coughed or sneezed out by an infected person. It is also possible to contract the virus through contact with the urine of an infected person. 4

Symptoms of rubella typically develop two to three weeks after coming into contact with the virus. People infected with the virus become contagious and may infect others from one week before symptoms appear until four to seven days after the rash has disappeared. 6

Roughly 25 to 50 percent of people infected with rubella may not develop symptoms at all, but can still spread the virus. 12

Symptoms of rubella in adults and children are generally not serious. The main risk posed by rubella is to pregnant people and their developing fetus. See the Congenital rubella syndrome (CRS) section below.

Rubella is very rare in countries where immunization against the virus is routine. However, according to the CDC and WHO, approximately 100,000 babies are born around the world each year with congenital rubella syndrome, with the vast majority of cases reported in Africa and Southeast Asia. 2 13

In countries with a vaccination program, the main risk of catching rubella is for an unvaccinated person to come into contact with an infected person.

The rubella virus is still present in large areas of: 13

• Africa
• South and Southeast Asia
• The Middle East

In recent years there have been rubella outbreaks in Poland and Japan. 14

The CDC recommends that anyone over the age of one should be vaccinated with MMR before travelling. Women in the first 20 weeks of pregnancy, who do not have immunity to rubella, should not travel to areas where rubella is present. 13

Symptoms such as a rash and swollen glands may indicate rubella, but a blood or saliva test is the only way to definitively diagnose infection. The blood test is sometimes referred to as an antibody titer test, which is a way of measuring antibodies in a blood sample. 15

Blood and saliva tests for rubella check for antibody levels in the body. There are two types of antibody that indicate rubella: 6 16

• IgM antibody: this antibody will be present if someone has recently been infected with rubella. IgM antibodies can be detected a few days after the rash first occurs.
• IgG antibody: this antibody will be present if someone has been vaccinated against rubella or has been infected in the past. A diagnosis using the IgG antibody needs a test as close as possible to the initial phase of infection, the results of which are compared to a further test two to three weeks later.

If rubella is suspected, always contact the doctor before visiting the surgery. Rubella is contagious, and the doctor will likely want to prepare for the visit to limit the risk of infecting others.

The health risks posed by rubella are most severe if the affected person is in the first 20 weeks of pregnancy, as the virus can cause serious birth defects and health problems to the baby. This is known as congenital rubella syndrome (CRS). 17

A blood or saliva test can confirm whether or not there are antibodies in the blood that can provide immunity against rubella or if an infection has happened recently.

The CDC recommends testing for rubella-related antibodies before getting pregnant. If there are not enough antibodies present, the MMR vaccine should be administered. 18

MMR contains a weakened version of the rubella virus, so women should wait 30 days before getting pregnant. 18 19 Women should not be vaccinated during pregnancy. 20

If a pregnant person comes into contact with a person with rubella or develops symptoms, they should contact their doctor immediately. The pregnant person’s IgG antibody levels will be checked for immunity. It may be possible to perform a so-called passive immunization, where a person receives supplemental antibodies.

If congenital rubella infection is suspected, ultrasound scans will be offered to look for signs of developmental problems in the fetus. 6

Congenital rubella syndrome (CRS) occurs when someone in the first 20 weeks of pregnancy and without protective immunity against rubella, is exposed to the virus. Congenital rubella syndrome affects the fetus as it develops in the womb.

CRS is very rare in the United States because of widespread immunization. Between 2005 and 2015, just eight babies in the U.S. were born with CRS. 19

Symptoms of CRS affect the baby, and include: 11 19

• Congenital heart disease
• Deafness
• Eye defects, such as cataracts or glaucoma
• Low birth weight
• Learning difficulties
• A smaller head than usual, known as microcephaly
• Liver damage

Rubella infection during the first trimester of pregnancy poses the most risk to the developing fetus, but the risk does not strongly reduce until after 20 weeks: 17

• Infection within the first 10 weeks results in a 90 percent chance of CRS with the baby having multiple defects
• Infection between 11 to 16 weeks results in a 10-20 percent chance of CRS with babies having some, but fewer, defects
• Infection between 17 to 20 weeks brings a very low chance of CRS, with the only likely defect being deafness

There is no cure for CRS, only prevention through vaccination.

Congenital rubella infection is a term used to encompass all of the possible effects on the fetus if a pregnant person is infected with rubella. This includes: 21

• Miscarriage
• Stillbirth
• Combinations of birth defects
• Asymptomatic infection of the baby

The European Centre for Disease Prevention and Control states that in 20 percent of cases where someone who is pregnant has rubella, they will miscarry, or the baby will die shortly after birth. 22

Since up to half of rubella cases do not show symptoms, a person may not know they have been infected.

There is no specific treatment for rubella, and symptoms tend to pass within 7 to 10 days. Bed rest is advised. 23

Ibuprofen and paracetamol/acetaminophen can be used to reduce a temperature and ease aching joints. 6

Drinking plenty of warming fluids can prevent dehydration and help symptoms like a sore throat.

If any concerning symptoms develop, contact a doctor. The free Ada app can also be used to carry out a symptom assessment.

The best precaution against rubella is to be vaccinated against it.

The World Health Organization credits vaccination with eliminating rubella and CRS from countries where it is routinely administered. Vaccines containing rubella provide protection in 95-100 percent of cases and usually remain effective for an entire lifetime. 20

The most common way to receive a rubella vaccination is with the MMR vaccine, which also immunizes against measles and mumps. Another vaccine, called MMRV, also immunizes against varicella, commonly known as chickenpox. 24

In countries with vaccination programs, children are given MMR at around 11-15 months, with a further dose between 2 and 6 years of age. 24 Each country, however, has its own vaccination program, meaning the age at which children are given the vaccine may differ slightly from country to country.

Women who are considering becoming pregnant and are not sure if they are immune to rubella can be tested by their doctor. If necessary, they can be vaccinated with MMR before becoming pregnant.

Despite some controversy in the 1990s, there is no evidence to suggest that the MMR vaccine causes autism. 25 26 27

Someone with rubella symptoms should stay away from work or school for at least seven days after the symptoms first appear to avoid infecting others. 12

It is important to tell other people who may have come into contact with someone who has rubella. This can include:

• Work colleagues
• School, daycare or nursery
• Anyone who is pregnant

Q: Is rubella contagious?
A: Yes, rubella is caused by a moderately infectious virus. It is passed from person to person through the tiny droplets of moisture coughed or sneezed out by an infected person. The best way to protect against the rubella virus is through vaccination.

Q: Are rubella and rubeola the same?
A: No. Rubeola, more commonly known as measles, and rubella, also known as German measles, are different illnesses. They have some symptoms in common, such as:

• A rash on the skin
• Fever
• Cold-like symptoms, such as a cough and runny nose
• Conjunctivitis/pink eye

They are also both prevented by the MMR vaccine. However, measles and rubella are caused by different viruses and have different specific symptoms and complications. 28

Q: How are rubella vaccines made?
A: The rubella vaccine contains a weakened version of the virus. It stimulates the immune system into producing antibodies that will protect someone against catching rubella in the future. Various manufacturers produce vaccines. Product information is available online in the United States on the FDA website for the MMR and MMRV vaccines. 29 30 NHS Choices has more information about the general ingredients in vaccines and more information specifically about MMR, including links to product information leaflets held on the electronic Medicines Compendium (eMC). 31 32

Q: What precautions should I take against rubella?
A: The only way to prevent rubella is by having a vaccination. See the above section on Preventing rubella.

Q: What are the side effects of the rubella vaccine?
A: Side effects of the MMR vaccine can include: 33 34

• Developing a very mild form of measles 7 to 11 days after the injection
• 1 in 50 children develop a mild form of mumps 3 to 4 weeks after the injection
• Some adult women may experience stiffness in the joints for several days

Q: When can I get pregnant after the rubella vaccine?
A: The CDC advises that you should not get pregnant for a month after having the MMR vaccine. 18

Q: What does the rubella rash look like?
A: The rash associated with rubella is often the most noticeable symptom of the condition. The rash will typically develop one to five days after other symptoms and will be recognizable by:

• Pink, pinpoint bumps on a red, flat patch of skin
• Rash first appearing on the face, then spreading downwards towards the trunk and limbs
• Rash covers most of the body within 24 hours

The rash tends to last three to five days.