Rubella, or German measles, is an infection caused by the rubella virus. Symptoms are often mild, but if infection occurs during pregnancy, it can cause severe harm to the unborn child, including deafness.

Rubella is a preventable disease. Since 1969, vaccination programs have led to a dramatic fall in the number of cases, and it was declared eliminated from the United States in 2004.

However, it is important to continue vaccinating as rubella can enter the U.S. from other countries.

Between 25 and 50 percent of those who have rubella do not notice that they have it. This means that a person can come into contact with rubella and become infected without realizing it.

However, if infection occurs during early pregnancy, it can cause congenital rubella syndrome, and this can have a long-term impact on the fetus.

This article will look at the symptoms, diagnosis, and treatment of rubella.

Fast facts about rubella, or German measles

  • Rubella is viral and predominantly transmitted by coughs.
  • The virus can pass across the placenta and affect the fetus.
  • In around half of rubella cases there are very few symptoms, but symptoms include a rash, a runny nose, a headache, and fever.
  • During pregnancy, rubella can cause congenital rubella syndrome, a leading cause of deafness, in the unborn child.
  • Vaccination is the only way to prevent the disease.

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If rubella produces a rash, it will be pale pink and less red than measles.

Rubella means "little red" and the disease features a red rash, "rubella" is Latin for "little red."

Symptoms normally appear 14 to 21 days after infection.

The rash often starts on the face and moves to the trunk and limbs. After 3 to 5 days, it fades and disappears. It can be itchy.

Other symptoms include:

a stuffy or runny nose

  • headache
  • a mild fever
  • red, inflamed eyes
  • nerve inflammation
  • enlarged and tender lymph nodes
  • aching joints

Though infection can happen at any age, Rubella rarely affects young infants or people over 40 years. A person who is infected with rubella at an older age will normally have more severe symptoms.

No medications can shorten the rubella infection, and symptoms are usually mild enough that no treatment is necessary.

Bed rest and acetaminophen may help relieve any symptoms.

If a woman contracts the virus during pregnancy, hyperimmune globulin may be prescribed to help fight off the virus and reduce the chance of congenital rubella syndrome.

A person with a rubella infection should avoid coming into contact with anyone who may be pregnant and anyone who has a weakened immune system until 1 week after the rash appears.

If a child has rubella, their school should be informed.

Rubella is sometimes known as "three-day measles," as symptoms can be similar, but the symptoms of rubella are milder than those of measles.

  • Measles causes a bright red rash and spots may appear inside the mouth, but a rubella rash is pink and mild.
  • Coughing and sneezing can spread both viruses.
  • The incubation period for measles is 1 to 2 weeks, but for rubella it can take 2 to 3 weeks.
  • Rubella is less contagious than measles.
  • Symptoms will appear in around 90 percent of people exposed to measles, but only 25 to 50 percent of those infected with rubella will be symptomatic.
  • Measles can lead to fatal complications, but rubella is normally only serious if contracted during pregnancy.
  • With measles, there may be a fever of over 40 degrees Celsius (C) or 104 degrees Fahrenheit (F). With rubella, any fever will usually be below 38.3 degrees C, or 100.94 degrees F.

Infection with both viruses can be prevented with the measles mumps and rubella (MMR) vaccination.

Rubella is very dangerous during pregnancy, especially if infection occurs during the first 12 weeks, which is the first trimester. At this stage, there is a 90 percent chance of passing the virus on to the fetus.

While infection is rare in the U.S., the risk increases with international travel.

It is important to be vaccinated against rubella before becoming pregnant.

The vaccine cannot be given during pregnancy, as it uses a weakened, live virus.

Anyone who is pregnant and may have been exposed to the virus should see a doctor immediately.

The rubella virus can pass through the placenta and move through the fetal circulation. It can destroy cells or prevent them from dividing. This causes congenital rubella syndrome.

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If a woman believe she may have been in contact with rubella during pregnancy, she should see a doctor.

Congenital rubella syndrome occurs when a pregnant woman contracts the rubella virus, and it passes through the placenta to the unborn child.

This can trigger a loss of pregnancy or stillbirth, or it can cause severe damage to the developing fetus, especially eye problems, hearing problems, and heart damage.

Worldwide, there are an estimated 100,000 cases of congenital rubella syndrome every year.

Often, more than one defect can arise, with deafness being the most common.

These effects on the infant can include:

  • hearing impairment or loss
  • cataracts
  • congenital heart disease, especially pulmonary artery stenosis and patent ductus arteriosus
  • anemia
  • hepatitis
  • developmental delay
  • damage to the retina, known as retinopathy
  • an unusually small head, lower jaw, or eyes
  • liver, spleen or bone marrow issues, which sometimes disappear shortly after birth
  • low birth weight

Other conditions may appear as the child develops.

These might include:

However, if rubella is contracted after the first 20 weeks of pregnancy, problems are rare.

Rubella is currently under control in the U.S., but an outbreak can be serious if it occurs.

In 1962 to 1965, there was a global rubella pandemic, and some 12.5 million rubella cases in the U.S.

This resulted in:

  • 11,000 losses of pregnancy
  • 2,100 newborn deaths
  • 20,000 infants born with congenital rubella syndrome
  • 2,000 cases of encephalitis

Exactly how the virus influences the fetus are unknown.

Children who are infected with rubella may have mild symptoms, but they are unlikely to have any long-term problems.

Rubella spreads between people through coughs and sneezes.

The virus replicates in the lymph nodes and the nasopharynx, the tube connecting the nasal cavity and the soft palate.

Between 5 and 7 days after infection, the virus spreads throughout the body in the blood.

A person who has rubella is contagious for a week before the rash appears and a week after.

If a woman is pregnant and she may have come into contact with rubella, she should see a doctor at once.

It is best to call the doctor's office first, as they may wish to schedule an appointment at a time when there is least chance of passing the virus on.

If there are no symptoms, diagnosis is made by testing a saliva or blood sample. If IgM antibodies are present, this may indicate a new rubella infection.

If IgG antibodies are present, they indicate that a rubella infection has either been present in the past or the individual has already been vaccinated.

If neither antibody is present, the individual does not carry the virus and has never been immunized.

The only way to prevent the contraction of rubella is through vaccination.

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The MMR vaccination protects against rubella.

Taken with the measles and mumps vaccination, the rubella vaccine prevents transmission.

The vaccine comes in the form of a live attenuated, or weakened, virus. It is delivered at 12 to 15 months of age with a second dose at 4 to 6 years.

Any adult who has not yet had the measle, mumps, and rubella (MMR) vaccine should receive it.

Only the following adults do not need the MMR vaccine:

  • anyone with blood tests showing they are immune to measles, mumps, and rubella
  • those born before 1957
  • anyone who has already had two doses of MMR or one dose of MMR plus a second dose of measles vaccine
  • anyone who has already had one dose of MMR and is not at high risk of measles or mumps exposure
  • pregnant women or those thinking of getting pregnant in the next 4 weeks
  • people with severely compromised immune systems

Anyone who is sick should wait until they recover before having the vaccination.

Side effects

Side effects of the vaccine are minimal.

Around 15 percent of people will have a mild fever around 7 to 12 days after the injection, and 5 percent will develop a minor rash.

Teenage or adult women may experience joint aches. Fewer than 1 in 1,000,000 have a severe reaction.

There is no link between the MMR vaccination and autism. The dangers of not being vaccinated are higher than the danger posed by any adverse effects.