Rubella is a contagious viral infection that typically causes in children mild symptoms, such as joint pain and a rash. Rubella can be fatal to a fetus or cause severe birth defects if the mother becomes infected during early pregnancy.
Rubella is caused by a virus.
Typical symptoms include swollen lymph nodes, rose-colored spots on the roof of the mouth, and a characteristic rash.
The diagnosis is based on symptoms.
Treatment of rubella is aimed at relieving the symptoms.
Routine vaccination can prevent rubella.
(See also Rubella in Newborns.)
Rubella is a typically mild childhood infection. However, rubella may have devastating consequences for fetuses who acquire the infection during pregnancy.
Rubella used to be called "German measles" or "3-day measles" because it causes a rash similar to the rash caused by measles. However, rubella is caused by a different virus.
Rubella is spread mainly by breathing in small virus-containing droplets of moisture that have been coughed into the air by an infected person. Close contact with an infected person can also spread the infection. People who have rubella are most contagious from 1 week before to 1 week after a rash appears, and the infection is usually spread while the rash is present. However, people who do not have a rash or any symptoms can still spread the virus to other people. An infant infected before birth can spread the infection for many months after birth.
A woman with rubella, especially during the first 12 weeks of pregnancy, often passes the infection to the fetus. This infection in the fetus can cause miscarriage, stillbirth, preterm birth, or multiple, severe birth defects (referred to as congenital rubella syndrome).
This infection is now rare in the United States because of widespread vaccination. Each year in the United States, fewer than 10 people develop rubella, and most of these people acquired rubella while living or traveling outside the United States. A person who has had rubella develops immunity and usually cannot contract it again.
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Symptoms of Rubella
Rubella symptoms differ somewhat between children and adults. Many cases are mild.
Symptoms of rubella begin about 17 days after infection but can be as short as 12 days or as long as 23 days.
In children, rubella usually causes mild or no noticeable symptoms.
Mild symptoms may occur in children 1 to 5 days before the rash appears:
A low fever (under 102° F [39° C])
General discomfort
Pink eye
Swollen lymph nodes in the neck and back of the head
Red or irritated throat
The rash caused by rubella is similar to the rash caused by measles but is not as intensely red and does not merge to form large red areas. The rash begins on the face and neck and quickly spreads to the trunk, arms, and legs. As the rash appears, a mild reddening of the skin (flush) occurs, particularly on the face. Painless red spots may appear on the back of the roof of the mouth and throat (Forchheimer spots). The rash lasts about 3 to 5 days.
In rare instances, people develop a middle ear infection (otitis media) or a low platelet count (thrombocytopenia).
In contrast to children, adults with rubella may not have any symptoms at all, or they may have fever, fatigue, headache, and joint pain or stiffness.
Brain infection (encephalitis) is a very rare, but occasionally fatal, complication. Encephalitis may cause seizures.
Progressive rubella panencephalitis is a neurologic disorder that occurs in children born with congenital rubella syndrome. It can occur when the child is older, including during adolescence, and is usually fatal.
This photo shows the rash caused by rubella. This rash is similar to the rash caused by measles but is not as intensely red and does not merge to form large red areas.
Diagnosis of Rubella
A doctor's evaluation
Tests to measure antibody levels in high-risk people
Doctors suspect rubella in people who have swollen lymph nodes at the back of their head and the characteristic rash.
A definite diagnosis of rubella is necessary for pregnant people, people who have encephalitis, and newborns. Doctors confirm the diagnosis by measuring levels of antibodies to rubella virus in the blood or by testing throat, nose, or urine specimens.
(See also Diagnosis of Rubella in Newborns for more information about diagnosis in pregnant people, fetuses, and newborns.)
Treatment of Rubella
Acetaminophen or ibuprofen for fever and aches to provide comfort
There is no treatment for rubella infection. Most people recover fully without treatment. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be given for fever and aches.
No specific treatment is available for encephalitis. Treatment usually involves relieving symptoms (such as seizures and fever) until the infection subsides.
Prevention of Rubella
MMR vaccine
Rubella vaccination is given as part of the combined measles-mumps-rubella (MMR) vaccine, which contains live but weakened measles, mumps, and rubella viruses. The MMR vaccine is one of the routine immunizations of childhood and is given to children in most nations that have a robust health care system.
In some children, the vaccine causes mild fever and a rash, but it does not cause rubella, and people who receive it are not contagious.
The MMR vaccine generally provides lasting immunity.
MMR vaccine is a live vaccine and is not given during pregnancy. To prevent congenital rubella infection, unvaccinated people who could become pregnant should receive 1 dose of the MMR vaccine and then wait 4 weeks before trying to conceive. People planning to become pregnant should see a doctor to do a blood test to confirm immunity to rubella. Those who are not immune to rubella can be vaccinated before becoming pregnant.
MMR vaccine is also not given to certain people who have a severely weakened immune system or to people who have had a serious, life-threatening allergic reaction (such as an anaphylactic reaction) to a vaccine component or to a previous dose of the vaccine.
People who have rubella should stay home from school, child care, or work for 7 days after the rash begins.
See also Prevention of Rubella in Newborns for more information about preventing rubella infection in pregnant people, fetuses, and newborns.
For more information about who should and who should not receive the MMR vaccine, see Administration of MMR Vaccine. See also Side Effects of MMR Vaccine.
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