What is Rubella?

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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]

Symptoms of rubella

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, List of Doctors is ready to carry out a symptom assessment now.

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 the Congenital rubella syndrome (CRS) section below for more information.

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

Causes of rubella

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]

Risk factors

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.

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 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 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 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)

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

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.

Treatment of rubella

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. List of Doctors can also be used to carry out a symptom assessment.

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 routinely administered. Vaccines containing rubella provide protection in 95-100 percent of cases and usually remain effective for an entire lifetime.^[20]

Rubella vaccine

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]

Isolation

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

Rubella FAQs

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

20. World Health Organization. “Rubella.” 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. ↩

28. Centers for Disease Prevention and Control. “Measles (Rubeola.” February 2018. Accessed April 5, 2018. ↩

29. U.S. Food and Drug Administration. “Measles, Mumps and Rubella Virus Vaccine, Live.” February 2018. Accessed April 5, 2018. ↩

30. U.S. Food and Drug Administration. “Measles, Mumps, Rubella and Varicella Virus Vaccine Live.” March 2018. Accessed April 5, 2018. ↩

31. NHS Choices. “Vaccination ingredients.” February 2016. Accessed April 5, 2018. ↩

32. NHS Choices. “MMR vaccine.” August 2015. Accessed April 5, 2018. ↩

33. Centers for Disease Prevention and Control. “Measles, Mumps, and Rubella (MMR) Vaccine Safety.” May 2017. Accessed April 5, 2018. ↩

34. NHS Choices. “MMR vaccine side effects.” August 2015. Accessed April 5, 2018. ↩

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**What‍ is Rubella?**



**Definition**



Rubella is a highly contagious viral infection that primarily affects children. It ‌is ⁢also known as German⁢ Measles or Three-Day Measles due to the presence of‍ a characteristic rash that ​typically lasts three days.



**Causes**



Rubella is caused by the rubella virus, which is spread through:



* Inhalation of respiratory droplets

* ⁣Direct contact⁢ with infected mucus or saliva



**Symptoms**



The most common symptoms of‌ rubella include:



* Mild ⁢fever

* Swollen ‌lymph nodes in the neck, behind the ears, or behind the head

* Sore throat

* Headache

* Runny nose or ⁤congestion

* Pink or red rash that starts on the⁣ face and spreads to the rest of the body



**Complications**



While most cases of rubella are mild, ​it can have‌ serious complications, especially during pregnancy:



**For Children:**



* Encephalitis (brain swelling)

* ‌Meningitis (infection of the membranes surrounding the brain and spinal cord)

* Arthritis (joint pain and swelling)

* Thrombocytopenia (low platelet count)



**For Pregnant Women:**



* Congenital Rubella Syndrome (CRS) in the developing fetus, which can lead‌ to birth ‌defects​ such as:

* Heart defects

⁤ * Blindness

* Deafness

* Intellectual ​disabilities



**Diagnosis**



Rubella ‍is typically⁢ diagnosed based on:



* ​Physical exam

* Medical ​history

* Blood test to detect rubella⁣ antibodies



**Prevention**



The​ rubella vaccine is the most effective way to prevent infection. It is part of the recommended childhood ⁣immunization schedule and is usually administered as part of the MMR (measles, mumps, and rubella) vaccine.



**Treatment**



There is no specific treatment for rubella.‌ Symptoms are usually mild and can⁤ be managed with rest‍ and over-the-counter medications for fever ​and pain. In severe cases, hospitalization may be necessary.



**Frequently Asked Questions (FAQs)**



* **Can rubella cause miscarriage?** Yes, rubella can lead to miscarriage if contracted during the first trimester of pregnancy.

* **How long is the incubation​ period for rubella?** The incubation period is usually 12-23 days.

* **Is rubella a ‍lifelong infection?** No,​ rubella‍ typically confers lifelong immunity after infection or vaccination.

*⁢ **Is there a cure for rubella?** There is no specific cure, but most cases resolve within ⁣a week.