Rubella

Overview

What is rubella?

Rubella is also known as German measles or three-day measles, but the rubella and measles viruses are different. The rash caused by rubella is milder and does not last as long as the measles rash.

Rubella starts quickly and is very contagious. For the most part, it is a mild childhood disease. In adults, rubella is more serious, but not life-threatening. This is not true for pregnant women. If a pregnant woman becomes infected, she can spread the disease to her unborn child. This can cause a miscarriage or birth defects.

How common is rubella?

Rubella was common in the U.S. before 1970, with epidemics breaking out every six to nine years. The last U.S. rubella epidemic was in 1964-1965.

A rubella vaccine was developed in 1969. Since then, the disease has mostly been eliminated from the U.S.

Rubella is still present in other parts of the world, and an infected person in another country can bring the disease here. However, fewer than 10 cases of rubella are reported in the United States every year, and most of those cases originated outside the country. Nevertheless, anyone who is not vaccinated is at risk.

Symptoms and Causes

How is rubella transmitted?

Rubella is spread through the air when an infected person coughs or sneezes. Also, a pregnant woman can transfer rubella to her unborn baby.

A person with rubella is most contagious after the rash shows up, but the disease can be spread a week before that. Once someone is infected, the virus takes about five to seven days to travel throughout the body. If symptoms start, it is usually about two to three weeks after exposure.

What are the symptoms of rubella?

Symptoms of rubella include:

  • Red or pink rash that lasts about three days. It starts on the face and neck, then spreads to other body parts.
  • Fever of about 102 degrees Fahrenheit
  • Sore throat
  • Cough
  • Runny or stuffy nose
  • Headache
  • Mild redness or swelling of the eye
  • Feeling unwell
  • Swollen lymph nodes, especially behind the ears and in the neck
  • Joint pain (mostly in women)
  • Loss of appetite
  • Nausea
  • Temporary pain in testicles (men)

However, between 25 percent and 50 percent of rubella patients show no symptoms.

Diagnosis and Tests

Can tests determine if someone has rubella or is at risk?

Blood testing is the only way to diagnose rubella with certainty. It can identify the virus, verify a past infection and establish whether the body contains enough rubella antibodies to prevent future infections.

Management and Treatment

How is rubella treated?

For the most part, rubella must run its course. No treatment or medication can bring healing faster. Bed rest is the best option for mild symptoms. You can use acetaminophen (such as Tylenol®) and fluids for a fever. You should call a doctor if you have concerns about any symptoms in a child or an adult.

Having rubella builds immunity against future infections. It is rare to get a second case of the disease.

Are there complications associated with rubella?

A pregnant woman who gets rubella, especially in the first trimester, can miscarry or deliver her baby prematurely. The baby also might die after birth or develop birth defects. Up to 85 percent of babies that get rubella in the womb during the first trimester are born with some type of birth defect. But birth defects are rare if infection occurs after 20 weeks of pregnancy.

Rubella-caused birth defects are called congenital rubella syndrome (CRS). Defects may include:

  • Heart problems
  • Loss of hearing and/or eyesight
  • Learning problems
  • Liver and/or spleen damage
  • Autism
  • Thyroid problems
  • Diabetes

There is no cure for CRS, but like rubella itself, CRS was declared eliminated in the U.S. in 2004, and is rare today. Between 2005 and 2015, eight babies with CRS were reported in the United States.

Women should make sure they are vaccinated against rubella at least four weeks before they become pregnant. A pregnant woman who is exposed to rubella or who comes down with rubella should call her healthcare provider.

What about other complications from rubella?

Women with rubella experience arthritis or joint pain in about 70 percent of cases, but it is usually temporary. Arthritis in men and children with rubella is rare.

Also, in rare cases, rubella can lead to brain infections and bleeding and bruising problems. Encephalitis occurs in one of every 6,000 rubella cases, mostly in adults.

Lasting aftereffects in children are rare, but there have been reports of ongoing joint pain, sleeping sickness and blood-clotting issues in children.

Prevention

What should I know about the measles-mumps-rubella (MMR) vaccine?

The MMR vaccine protects against all three diseases. It contains weak, but live, strains of each virus that let the body build immunity against them. The vaccination is especially important for children and women of childbearing age. More than 90 percent of those who receive the vaccination never contract rubella.

The Centers for Disease Control and Prevention (CDC) recommends vaccination in children when they are 12-15-months-old, and a second dose at 4-6-years-old, or at least 28 days after the first vaccination. Unvaccinated adolescents should receive two doses, at least 28 days apart.

Adults born before 1957 and adults who have laboratory evidence of having had rubella or immunity to rubella do not need the vaccine. Scientists consider the following items to be “evidence of immunity:”

  • Being born prior to 1957 (because you likely did contract these diseases before vaccines were available)
  • Having actual records of getting the MMR vaccine
  • Having laboratory evidence that you are immune or you did have the vaccine

Adults born during or after 1957 should receive at least one rubella vaccination if they have not done so previously.

If you are in the healthcare field and you were born before 1957 and have no evidence of immunity, your doctor may consider giving the MMR vaccine.

Is the measles-mumps-rubella (MMR) vaccine safe?

The vaccine is safe. Over the years, hundreds of millions of rubella and combined MMR vaccines have been administered in the United States, and the safety record is excellent. The vaccination is recommended by the CDC, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American College of Physicians.

What are the side effects of the measles-mumps-rubella (MMR) vaccine?

Occasional side effects are mild and may include:

  • Muscle aches and redness and/or pain near the injection area
  • Fever
  • Mild rash
  • Temporary joint pain (true for about 25 percent of women who get the vaccine)
  • Temporary cases of thrombocytopenia, or low blood platelet count. (This happens in about one of every 30,000 to 40,000 cases.)

Also, since vaccines are live but weakened strains of the virus, they may cause mild cases of rubella.

Allergic reactions to the vaccine are more serious, but rare. You should get emergency help if they happen. Reactions include:

  • Hives
  • Swelling in the throat, tongue and/or lips
  • Having a hard time breathing

Severe side effects like deafness and permanent brain damage are so rare that doctors are not sure if the vaccination causes them.

No evidence exists that the MMR vaccine causes autism. Experts at the National Academy of Sciences’ Institute of Medicine, and other groups in the United States, have looked for links and found none.

Are there exceptions to those who should receive the rubella vaccine?

Pregnant women should not receive the rubella vaccine. A woman should wait at least four weeks after vaccination before getting pregnant. Other people who should not get the vaccine include:

  • Patients with impaired immune systems, including those with AIDS, leukemia and lymphoma
  • Patients with cancer who are undergoing drug or radiation therapy
  • Patients who are being treated with large doses of corticosteroids and other immunosuppressive medications

A woman who is breastfeeding CAN get the vaccine.

Last reviewed by a Cleveland Clinic medical professional on 08/14/2018.

References

  • Centers for Disease Control and Prevention. Accessed 8/15/2018Rubella (German Measles, Three-Day Measles). (https://www.cdc.gov/rubella/index.html)
  • American Association for Clinical Chemistry. Accessed 8/15/2018Rubella Test. (https://labtestsonline.org/tests/rubella-test)
  • Immunization Action Coalition. Accessed 8/15/2018.Rubella: Questions and Answers. (http://www.immunize.org/catg.d/p4218.pdf)
  • National Organization for Rare Disorders. Accessed 8/15/2018.Rubella. (https://rarediseases.org/rare-diseases/rubella/)
  • National Foundation for Infectious Diseases. . Accessed 6/26/2020.Rubella (https://www.nfid.org/infectious-diseases/rubella/)
  • World Health Organization. Accessed 8/15/2018.Rubella. (http://www.who.int/en/news-room/fact-sheets/detail/rubella)

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