Rubella

Rubella is a viral infection that usually causes mild symptoms in most people, but it poses a serious threat to unborn babies when it infects pregnant women, potentially leading to severe birth defects or pregnancy loss.

Table of contents

• What is rubella?
• Other names for rubella
• Symptoms of rubella
• Congenital rubella syndrome
• How rubella spreads
• Diagnosis
• Treatment
• Prevention and vaccination
• Who is affected by rubella?

What is rubella?

Rubella is a contagious viral infection caused by the rubella virus (RuV). A contagious disease is one that spreads easily from person to person^[1][2]. The infection is usually mild and many people who get rubella have few or no symptoms at all. About 25% to 50% of people infected with rubella do not have any symptoms but can still spread the virus to others^[2][4].

Although rubella typically causes only mild illness in children and adults, it can have devastating consequences for unborn babies. When a pregnant woman gets rubella, especially during early pregnancy, the virus can pass to her developing baby and cause serious birth defects or pregnancy loss^[1][9].

Rubella is not the same disease as measles, even though both illnesses cause a rash. They are caused by different viruses, and rubella is generally less severe than measles^[1][2].

German measles, three-day measles

Other names for rubella

Rubella is also known as German measles or three-day measles^[1][2][6].

Symptoms of rubella

Many people with rubella have no symptoms or only very mild ones. When symptoms do appear, they usually show up 2 to 3 weeks after a person is exposed to the virus. The time between exposure and the start of illness is called the incubation period, which typically ranges from 12 to 23 days, with an average of 14 days^[1][4][5].

Symptoms usually last about 1 to 5 days and may include^[1][2][7]:

• A fine rash that begins on the face and spreads to the neck, chest, and then to the rest of the body. The rash can appear pink or red on white skin but may be harder to see on Black or brown skin
• Mild fever, usually 102 degrees Fahrenheit (38.9 degrees Celsius) or lower
• Swollen lymph nodes (glands), especially at the base of the skull, back of the neck, and behind the ears
• Headache
• Stuffy or runny nose
• Red, itchy eyes or pink eye
• Sore throat
• Cough
• Joint pain, particularly common in adults, especially women
• Generally feeling unwell

In young children, the rash is often the first symptom they develop. In older children and adults, other symptoms may appear a few days before the rash^[2].

The rash typically lasts about three days, which is why rubella is sometimes called three-day measles. Red spots may appear in the mouth 1 to 5 days before the rash develops on the skin^[5][26].

Congenital rubella syndrome

Congenital rubella syndrome (CRS) is the most serious form of rubella. It occurs when a pregnant woman passes the rubella virus to her developing baby through the bloodstream^[2][5].

When a woman is infected with rubella early in pregnancy, particularly in the first trimester, she has up to a 90% chance of passing the virus to her unborn baby. The infection can result in miscarriage, fetal death, stillbirth, or babies born with severe birth defects^[4][9].

Up to 85% of babies infected with rubella in the first trimester of pregnancy will suffer birth defects or neurological problems^[5][7]. The risk of serious damage is highest when the mother gets rubella during the first 8 to 10 weeks of pregnancy. The risk decreases to about 10% to 20% if rubella occurs at 16 weeks of pregnancy, and defects are rare after the 20th week^[4][8].

Birth defects associated with congenital rubella syndrome include^[2][6][7]:

• Deafness or hearing loss
• Eye problems, including cataracts, glaucoma, and vision loss
• Heart defects
• Brain damage and developmental delays
• Liver and spleen damage
• Low birth weight
• Skin problems
• Bone changes

Some of these problems are noticed at birth or within the first two years of life. Others, such as diabetes, may occur later in childhood^[7]. Babies born with CRS can remain infectious and shed the virus in their nose, throat secretions, and urine for months or even years^[4][6].

How rubella spreads

Rubella spreads when an infected person coughs or sneezes, releasing tiny droplets containing the virus into the air. Other people can become infected by breathing in these droplets or by touching surfaces contaminated with the virus and then touching their eyes, nose, or mouth before washing their hands^[2][7][13].

A person with rubella can spread the virus to others about 1 week before the rash appears and for at least 7 days after the rash first appears. This means people can be contagious even before they know they are sick, and some people can spread rubella without ever developing symptoms^[2][5][13].

Pregnant women infected with rubella can pass the virus directly to their developing babies through the bloodstream^[2][5].

Diagnosis

Because the rubella rash looks similar to rashes caused by other viral infections, healthcare providers usually confirm rubella through laboratory testing rather than relying on symptoms alone^[1][7][11].

Diagnosis typically involves a blood test that looks for rubella antibodies. Antibodies are proteins your body makes to fight infections. The presence of certain antibodies indicates whether you have a recent or past infection, or have been vaccinated against rubella^[2][11].

Healthcare providers may also collect samples from the throat, nose, or urine to test for the presence of the rubella virus itself^[6][7].

For pregnant women, testing is particularly important. If a pregnant woman has been exposed to rubella or has symptoms, blood tests can determine if she is immune or if she has been recently infected^[4].

Treatment

There is no specific medicine or antiviral treatment that can cure rubella or make it go away faster^[5][7][13]. For most people, rubella is a mild illness that gets better on its own in about a week with simple care at home^[8][11].

Treatment focuses on relieving symptoms and includes^[1][11]:

• Getting plenty of rest
• Drinking lots of fluids like water or juice
• Taking over-the-counter pain relievers such as acetaminophen or ibuprofen to reduce fever and discomfort. Aspirin should not be given to children or teenagers under age 18 because it has been linked to a serious illness called Reye syndrome
• Using cold, wet cloths on the rash to reduce itching

It is important to stay away from others, especially pregnant women, while you are infectious. You should avoid work, school, or daycare for at least 7 days after the rash first appears to prevent spreading the infection^[8][11].

If you are pregnant and have been exposed to rubella, your healthcare provider may give you a shot of immunoglobulin (IG). While IG does not prevent infection, it may make symptoms less severe and lower the chance of birth defects, although it does not always prevent them^[10].

Babies born with congenital rubella syndrome need specialized care depending on which problems they have. They may need treatment from a team of specialists for heart defects, eye problems, hearing loss, and developmental issues^[15].

Prevention and vaccination

The best way to prevent rubella is through vaccination. The rubella vaccine is safe, highly effective, and provides lifelong protection against the disease^[1][9][13].

The rubella vaccine is given as part of the MMR vaccine, which protects against three diseases: measles, mumps, and rubella. A newer combination called the MMRV vaccine also protects against varicella (chickenpox)^[1][5].

One dose of the rubella vaccine is about 97% effective at preventing rubella. Children should receive two doses of the MMR vaccine for the best protection. The first dose is usually given between 12 and 15 months of age, and the second dose before starting school, typically between ages 4 and 6^[5][13].

Adults who were born on or after January 1, 1957, and have not been vaccinated or do not have evidence of immunity should also receive the MMR vaccine. People born before 1957 are generally considered immune because rubella was common before the vaccine was available^[5].

Women who are planning to become pregnant and do not know if they are immune to rubella should get a blood test. If they are not immune, they should receive the rubella vaccine at least one month before becoming pregnant. The vaccine should not be given during pregnancy, but it can be safely given immediately after delivery^[5][7].

Healthcare workers, childcare staff, and anyone who travels internationally should make sure they are vaccinated against rubella^[5][7].

Who is affected by rubella?

Anyone who has not been vaccinated or has not had rubella before can get the disease. Rubella has been eliminated from the United States since 2004, meaning it is no longer continuously spreading in the country. However, travelers can still bring rubella into the United States from other parts of the world where the disease remains common^[2][5][13].

There are approximately 17,865 to 26,000 cases of rubella worldwide each year. The disease is most common in Asia, Africa, and the Middle East, where vaccination programs may not be as widespread^[2][9].

The people most at risk for serious complications from rubella are^[2][13]:

• Unborn babies of pregnant women who get rubella
• Pregnant women who are not immune to rubella
• People who have not been vaccinated
• Travelers to countries where rubella is still common

Once a person recovers from rubella or receives the vaccine, they are usually protected for life and will not get rubella again^[5][6].