Rubella (German Measles)

Topic Overview

What is rubella?

Rubella, also called German measles or 3-day measles, is a disease caused by the rubella virus. Rubella is generally a mild illness that does not result in long-term problems.

What causes rubella?

The rubella virus is most often spread through droplets of fluid from the mucous membranes that contain the virus. An infected person can spread these droplets by coughing, sneezing, talking, or sharing food and drinks. You can become infected by touching a surface contaminated with the droplets and then touching your eyes, nose, or mouth before washing your hands. Less commonly, you can get the virus through contact with infected blood if it gets on broken skin or on your hands and you don't wash them right away.

What are the symptoms?

Symptoms of rubella include a mild fever, swollen glands (especially behind the ear and at the back of the head), and a skin rash that starts on the face and spreads to the neck, the chest, and the rest of the body. Older children and teenagers may have fever, eye pain, sore throat, and body aches. They may or may not develop a rash. See a picture of a rash caused by rubella .

If you have rubella, you are most contagious a few days before the rash starts until 5 to 7 days after it first appears. The incubation period-the time from exposure to the virus until you develop symptoms-is 14 to 21 days. Some infected people don't have symptoms. But everyone who is infected can spread the disease.

Generally, rubella causes only mild illness and no long-term problems. But if you are pregnant and get infected with the rubella virus, you can give the disease to your baby (fetus). Serious birth defects called congenital rubella syndrome (CRS) may occur in the first trimester. CRS birth defects include cataracts and other eye problems, hearing impairment, and heart disease. The rubella vaccine was developed mainly to prevent these birth defects.

How is rubella diagnosed?

A rubella blood test identifies antibodies to the rubella virus in a sample of blood. This information can help a doctor determine whether a recent infection was caused by the rubella virus. It is also used to determine whether you have been vaccinated against rubella or are otherwise immune to the virus.

Sometimes, a viral culture may also be used to determine whether a current infection is caused by the rubella virus. But the results from this test may not be available for several weeks.

How is it treated?

Treatment for rubella involves caring for the specific symptoms. Acetaminophen, such as Tylenol, can be given to children and adults for fever. Do not give aspirin to anyone younger than 20because of the possible link between aspirin and Reye syndrome.

If you are pregnant and susceptible (not immune) to rubella, talk to your doctor. He or she may recommend an injection of immune globulin (IG) if you are exposed to the virus. Immune globulin does not prevent rubella infection, but it may reduce the severity of the symptoms and lower the risk for birth defects. But immune globulin does not eliminate the risk of a child being born with a birth defect due to congenital rubella syndrome (CRS). Children with CRS have been born to mothers who have received immune globulin.

Can rubella be prevented?

In the United States, the rubella vaccine is part of the normal childhood measles, mumps, and rubella immunization (MMR). The rubella vaccine protects at least 90 out of 100 immunized people from getting this disease.¹ Outbreaks may occur in people who haven't been immunized, especially in college, military, health care, and child care settings and among recent immigrants.¹

In the U.S., most infants who are born with congenital rubella syndrome (CRS) have foreign-born mothers.² Babies born with rubella (passed from an infected mother during pregnancy) may be contagious through their first birthday.¹ These infants can spread the illness to others who have not developed protection through immunization or prior history of the disease.

It is very unlikely that a person who has had rubella could get the disease again.

Frequently Asked Questions

Symptoms

Typical symptoms of rubella are a mild rash , swollen and tender glands (especially behind the ear, at the back of the neck, and under the skull), and a slight fever. Also, some adolescent girls and adult women get joint pain (arthritis), especially in the small joints of the hands.

• Swollen glands in the neck area are common with many viral infections. The glands that are most affected by rubella are those located behind the ear and at the back of the head. The degree to which they become swollen and tender is unique to rubella.
• Sometimes a rash is the only symptom of rubella that young children develop.
• Older children and teens may have fever, eye pain, sore throat, and body aches. They may or may not get a rash.
• Symptoms of rubella, especially pain and swelling at the joints, may be more severe in adults than in children. Joint pain (more commonly seen in women) may take as long as a month to go away.

The rubella rash is mild, starts on the face, and spreads to the neck, the chest, and the rest of the body. It may first appear as a mild blush before it develops into a more pinpoint rash with distinctive spots. Rubella infection without a rash is also common. Even if you do not have a rash, you are still contagious.

Complications, such as infection of the brain (encephalitis), can arise from rubella. Encephalitis from rubella is very rare but serious.

A fetus that becomes infected with rubella during the first trimester is at risk for miscarriage, fetal death, and birth defects.² Up to 90% of fetuses exposed to rubella during the first 11 weeks of pregnancy develop congenital rubella syndrome (CRS).² This syndrome can result in serious birth defects. Hearing impairment is the most common, although cataracts and glaucoma, other eye problems, heart defects, brain problems, mental and physical retardation (stunted growth), and bone disease may also occur.

Other viral illnesses and conditions can cause symptoms and rashes similar to rubella. For this reason, rubella may be confused with:

• Mild cases of scarlet fever, an illness that most often occurs in children ages 2 to 10 who have recently had strep throat.
• Measles, also called rubeola or red measles.
• Fifth disease (parvovirus B19), a contagious and usually mild viral illness that is common in children.
• Roseola, a mild viral illness that affects young children. It often starts with a sudden high fever of 103°F (39.4°C) to 105°F (40.6°C) that lasts 2 to 3 days.
• Infectious mononucleosis (sometimes called "mono"), a viral illness usually caused by the Epstein-Barr virus. Mono is most common in adolescents and young adults.
• Allergic reactions to medicines.
• Some stomach and intestinal viral infections, such as stomach flu (gastroenteritis).

Exams and Tests

A rubella test detects antibodies to the rubella virus in a sample of blood. This information can help a doctor find out:

• Whether a recent infection was caused by the rubella virus.
• Whether you have been vaccinated against rubella or are otherwise immune to the virus.

Sometimes, a viral culture may also be used to determine whether a current infection is caused by the rubella virus. But the results from this test may not be available for several weeks.

Children and adults

If you or your child have not been immunized and your doctor suspects rubella, a blood test for rubella antibodies should be done to confirm the diagnosis.

Rubella may be diagnosed without testing if you have not been immunized. This can occur if you develop typical symptoms after being exposed to someone with a confirmed case of rubella infection.

Pregnant women

As part of your prenatal care, your doctor may want you to have a blood test to find out if you have had rubella or the vaccine. (Your body will make antibodies if you have had the disease or the vaccine.) If your body has made antibodies, you have immunity.

If your body does not have antibodies, you are not immune. This means if you were exposed to rubella, you could get the disease and pass it on to your baby. To help prevent rubella, avoid close contact with people infected with the virus.

If you are not immune and have been around people who have rubella, your doctor will use the blood test to see if you have antibodies to fight the disease.

• If antibodies are not found, the test is negative. This means you are not immune to the disease. Your doctor may order immune globulin (IG) for you. Immune globulin does not prevent rubella infection, but it may reduce your symptoms and reduce the chance of birth defects.
• If antibodies are found, the test is positive. This means you are immune to rubella. To be safe, the blood test may be repeated again in 6 weeks.

Newborns

An infant born with defects that suggest congenital rubella syndrome (CRS) should be evaluated immediately to determine whether rubella is the cause. Diagnosis of a newborn with CRS is based upon the newborn's physical exam and the mother's medical history, including prenatal care records. If CRS is diagnosed, measures are taken to prevent the transmission of the virus to others who are in the hospital.

Some states test every newborn for hearing impairment, the most common birth defect related to rubella. If a problem is found, the infant is usually further tested for rubella.² This helps doctors know whether they should look for other birth defects and signs of CRS.

Treatment Overview

Treatment for rubella focuses on caring for the specific symptoms, such as getting plenty of rest and drinking extra fluids so you do not get dehydrated. Acetaminophen, such as Tylenol, can be given to children and adults for fever. Do not give aspirin to anyone younger than 20 because of the possible link between aspirin and Reye syndrome.

A baby (fetus) can get infected from a mother who has rubella during her pregnancy. Babies infected in the first trimester may also develop birth defects. Treatment varies according to the specific problem.

Pregnant women or those considering pregnancy

Women considering pregnancy who are unsure of their immunity to rubella may be vaccinated safely up to 1 month before becoming pregnant.

If you are pregnant and susceptible (not immune) to rubella, talk to your doctor. He or she may recommend an injection of immune globulin (IG) if you have been exposed to the virus. Immune globulin does not prevent rubella infection, but it may reduce the severity of the symptoms and lower the risk for birth defects. But immune globulin does not get rid of the risk of a child being born with a birth defect due to congenital rubella syndrome (CRS). Children with CRS have been born to mothers who have received immune globulin.

If you are pregnant and have been infected with the rubella virus in the first months of your pregnancy, you may want to seek counseling about the risk that the baby will be born with congenital rubella syndrome (CRS) and what options are available to you.

Home Treatment

Home treatment for rubella includes getting plenty of rest and drinking extra fluids so you do not get dehydrated. Acetaminophen, such as Tylenol, may help relieve fever and body aches. Do not give aspirin to anyone younger than 20 because of the possible link between aspirin and Reye syndrome.

You are at risk of getting rubella if you have not been immunized or have not had the illness. Try to avoid contact with people who have rubella.

Children, teens, and adults with rubella should not attend day care, school, or work or be around other people, especially pregnant women, for 7 days after the rash first appears.¹

Prevention

If your baby was born with rubella, take precautions to avoid exposing your baby to people who are not immune to the disease. In day care centers and at home, good hygiene and careful hand-washing are the most important control measures.

Extra care should be taken around pregnant women. Pregnant women working in child care facilities should minimize direct exposure to saliva and avoid kissing babies or young children on the mouth. An infant born with rubella can be contagious for as long as 1 year after birth.

An immunization to prevent rubella is available. It is given in combination with the measles and mumps vaccines in a single shot called MMR (What is a PDF document?) . Two doses of the vaccine are given at least 4 weeks apart. The first shot is given when a child is between 12 and 15 months old, and the second is given when a child is between 4 and 6 years of age or no later than age 11 to 12. Children ages 12 and younger can get immunized with MMRV instead of MMR. The MMRV shot includes the chickenpox (varicella) vaccine.

Teens and adults who should be given the MMR vaccine include:

• People who were born during or after 1957 who have not received the MMR vaccine.
• Health care workers.
• College students and international travelers who do not have proof of immunization or immunity.

If you are planning to become pregnant and are uncertain of your immunity to rubella, get a blood test to find out whether you are immune or not. In some states, a blood test is required for a marriage license to see whether the woman is immune to rubella. If she is not immune, she is advised to get the vaccine and wait at least 1 month before trying to conceive. If it so happens that you are immunized during early pregnancy before you know that you are pregnant, the risk to your fetus is very low. The important thing is to seek prenatal care.

Some parents are concerned that the MMR vaccine causes autism. Many studies have been done, and no link has been found between this vaccine and autism.³

For more information on the standard immunization schedule, see the topic Immunizations.

Other Places To Get Help

Organizations

Related Information

• Hand-Washing
• Immunizations
• Pregnancy
• Rash, Age 11 and Younger
• Rash, Age 12 and Older
• Swollen Glands and Other Lumps Under the Skin
• Vaccine Information Statements

References

Citations

1. American Academy of Pediatrics (2006). Rubella. In LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 574-579. Elk Grove Village, IL: American Academy of Pediatrics.

2. Centers for Disease Control and Prevention (2001). Control and prevention of rubella: Evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR, 50(RR-12): 1-23.

3. Demicheli V, et al. (2005). Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

Other Works Consulted

• American Public Health Association (2004). Rubella. In DL Heymann, ed., Control of Communicable Diseases Manual, 18th ed., pp. 464-468. Washington, DC: American Public Health Association.

• Cherry JD (2004). Rubella virus. In RD Feigin et al., eds., Textbook of Pediatric Infectious Diseases, 5th ed., vol. 2, pp. 2134-2162. Philadelphia: Elsevier Saunders.

• Levin MJ, Weinberg A (2007). Rubella section of Infections: Viral and rickettsial. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 1132-1133. New York: McGraw-Hill.

• Mason WH (2007). Rubella. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 1337-1341. Philadelphia: Saunders Elsevier.

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