Rubella

What is 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 seven to 10 days, often only needing minor intervention. However, rubella can cause serious birth defectsif the virus is caught by a pregnant person; this is referred to as congenital rubella syndrome.[1]

Vaccination programs have had a huge impact on reducing the number of cases of rubella. The World Health Organization says that several countries have eradicated rubella and congenital rubella syndrome 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 cases are caused by people coming into contact with the virus in another country.[3]

Symptoms of rubella

Many people have no symptoms at all when they contract rubella. If symptoms do appear, they will usually present at around two to three weeks after initially being infected. 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
  • 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 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 lasts three to five days. As other symptoms begin earlier, their effects may last around a week.[6]

Symptoms of rubella are similar in adults and children.

Complications of rubella

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 Congenital rubella syndrome (CRS).)

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

Causes of rubella

Rubella is caused by a virus and is highly contagious. It is transmitted in a similar way to cold and flu, i.e. by coming into contact with droplets of moisture coughed or sneezed out by an infected person.[4]

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

25%-50% of people infected with rubella may not develop symptoms at all, but can still spread the virus.[12]

Risk factors

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

Rubella is very rare in countries where immunization against rubella is routine. However, according to the CDC and WHO, approximately 100,000 babies are born around the world each year with congenital rubella syndrome, the vast majority 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.

Travelling to countries without a vaccination program

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 year old 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]

Diagnosing rubella

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 highly contagious, and the doctor will likely want to prepare for the visit to limit the risk of infecting others.

Rubella and pregnancy

The health risks posed by rubella are most severe if a person is affected 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 someone’s body that provide immunity against rubella or if an infection has happened recently. (See Diagnosing rubella).

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

Because MMR contains a weakened version of the rubella virus,{^17] women should wait 30 days before getting pregnant.[18] Women should not be vaccinated during pregnancy.[19]

If someone who is pregnant comes into contact with another person with rubella or develops symptoms, they should contact their doctor immediately. If rubella infection could not be prevented, 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)

Congenital rubella syndrome (CRS) is caused 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 its immunization policy. Between 2005 and 2015, the CDC reports eight babies in the U.S. were born with CRS.[20]

Symptoms of CRS affect the baby, and include:[11][20]

  • 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 risk is not strongly reduced until after 20 weeks:[17]

  • Infection within the first 10 weeks results in a 90% chance of CRS with the baby having multiple defects
  • Infection between 11 to 16 weeks results in a 10%-20% 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

Congenital rubella infection is a term to encompass all 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% 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.

Treatment of rubella

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

Ibuprofen and paracetamol/acetaminophen can be given 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.

Preventing rubella

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 administered. Vaccines containing rubella provide protection in 95%-100% of cases, which usually lasts for an entire lifetime.[19]

Vaccinations

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

In countries with vaccination programs, children are given MMR at around 12-15 months, with a further dose between three and six years of age.[24]

Women who are considering becoming pregnant and are not sure if they are immune to rubella can be tested at their doctor. If necessary, they can be vaccinated with MMR before becoming pregnant. (See Rubella and pregnancy.)

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

Isolation

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

It’s 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

  1. Centers for Disease Prevention and Control. “Rubella.” September 2017. Accessed April 5, 2018.

  2. World Health Organization. “Rubella.”](http://www.who.int/immunization/topics/rubella/en/) April 2012. Accessed April 5, 2018.

  3. Centers for Disease Prevention and Control. “Rubella in the US.” September 2017. Accessed April 5, 2018.

  4. World Health Organization. “Rubella.”](http://www.who.int/immunization/topics/rubella/en/index1.html) Accessed April 5, 2018.

  5. Medline Plus. “Rubella.” March 2018. Accessed April 5, 2018.

  6. Patient Info. “Rubella (German Measles).” December 2017. Accessed April 5, 2018.

  7. Centers for Disease Prevention and Control. “Signs and symptoms.” September 2017. Accessed April 5, 2018.

  8. Centers for Disease Prevention and Control. “Complications.” September 2017. Accessed April 5, 2018.

  9. Medscape. “Pediatric Rubella Clinical Presentation.” February 2017. Accessed May 4, 2018.

  10. Healthline. “What is a maculopapular rash?” March 2017. Accessed May 4, 2018.

  11. Patient Info. “Rubella.” January 2015. Accessed April 5, 2018.

  12. Centers for Disease Prevention and Control. “Transmission.” September 2017. Accessed April 5, 2018.

  13. Centers for Disease Prevention and Control. “Travelers’ Health.” May 2017. Accessed April 5, 2018.

  14. fitfortravel. “Rubella.” Accessed April 5, 2018.

  15. Medline Plus. “Antibody titer blood test.” May 2016. Accessed April 5, 2018.

  16. University of Rochester Medical Center. “Measles, Mumps, Rubella Antibody,” Accessed April 5, 2018.

  17. Patient Info. “Rubella and Pregnancy.” January 2015. Accessed April 5, 2018.

  18. Centers for Disease Prevention and Control. “Pregnancy and Vaccinations.” August 2016. Accessed April 5, 2018.

  19. World Health Organization. “Rubella.” Accessed April 5, 2018.

  20. Centers for Disease Prevention and Control. “Pregnancy and Rubella.” September 2017. Accessed April 5, 2018.

  21. Centers for Disease Control and Prevention. “Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Congenital Rubella Syndrome.” July 2001. Accessed May 4, 2018.

  22. European Centre for Disease Prevention and Control. “Disease factsheet about congenital rubella syndrome (CRS).” Accessed April 5, 2018.

  23. Centers for Disease Prevention and Control. “Treatment.” September 2017. Accessed April 5, 2018.

  24. Centers for Disease Prevention and Control. “Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know.” February 2018. Accessed April 5, 2018.

  25. NHS Choices. “MMR vaccine ‘does not cause autism’.” February 2008. Accessed April 5, 2018.

  26. Centers for Disease Prevention and Control. “Vaccines Do Not Cause Autism.” November 2015. Accessed April 5, 2018.

  27. World Health Organization. “MMR and autism.” January 2003. Accessed April 5, 2018.