Rubella (German Measles)
What is rubella (German measles)?
Rubella is a contagious illness you get from the RuV virus. It causes a rash that usually starts on your face and moves down your body. It can cause serious illness in newborns of people who had rubella while pregnant.
Rubella is also called German measles or three-day measles. Even though it causes a rash like measles, rubella happens because of a different virus than measles.
What is congenital rubella syndrome?
Congenital rubella syndrome (CRS) is the most serious form of rubella. It happens when a pregnant person passes rubella to the fetus. This can cause skin, hearing, vision, heart and brain problems in newborns.
Are rubella and measles the same?
No, rubella and measles are different illnesses. They both give you a rash, but different viruses cause them.
Who does rubella affect?
Anyone can get rubella, but the most serious form of rubella, congenital rubella syndrome, affects newborns born to someone who had rubella during pregnancy.
The U.S. eliminated rubella (meaning it’s no longer continuously spread) in 2004, but you can still get rubella in other parts of the world.
How common is rubella?
There are about 26,000 cases of rubella worldwide each year. It’s most common in Asia, Africa and the Middle East. There are only a few cases diagnosed each year in the U.S. since the disease’s elimination.
Symptoms and Causes
What are the symptoms of rubella?
Rubella’s prominent symptom is a rash that usually starts on your face and moves down the rest of your body. In young children, a rash is often their first symptom. In older children and adults, the rash can appear a few days after other symptoms start.
Up to 50% of people have no symptoms at all but can still spread rubella to other people.
Symptoms of rubella include:
- Low fever.
- Sore throat.
- Runny nose.
- Pink eye.
- Joint pain.
- Generally feeling unwell (malaise).
- Swollen lymph nodes.
What causes rubella?
The cause of rubella is the RuV virus. Viruses are small shells with a genetic code inside (RNA or DNA). They use cell “machinery” from humans, animals or plants to make more copies of themselves.
Is rubella contagious?
Yes, rubella is contagious — it spreads from person to person when you cough, sneeze or touch surfaces with the virus on them. It can also spread from a pregnant person to the fetus. You can be contagious with rubella without symptoms.
How long am I contagious with rubella?
You’re contagious with rubella for about a week before and a week after the rash appears.
Can adults get rubella?
Yes, rubella is contagious and adults can get it from kids or other adults.
What is rubella in pregnancy?
Rubella is most serious in pregnancy. If you’re pregnant and get rubella, especially in the first trimester, your child is at high risk for congenital rubella syndrome (CRS). CRS is preventable if you get vaccinated before getting pregnant.
What causes a positive rubella test in pregnancy?
If you’re not sick and your healthcare provider does a blood test for rubella before you get pregnant or while you’re pregnant, they’re looking for antibodies to rubella. Your body makes antibodies when it finds a harmful invader in your body.
If you test positive to a rubella antibody test, it means you either had rubella before or received a vaccination for it. Either way, you’re immune to rubella and are unlikely to get it while you’re pregnant.
What are the symptoms of congenital rubella syndrome (CRS)?
Symptoms of congenital rubella syndrome are present at birth. If you get rubella while pregnant, your baby could be born with one or more symptoms of CRS, including:
- Vision loss from eye disease, including cataracts and glaucoma.
- Hearing loss.
- Heart defects.
- Neurological (brain) differences, including underdeveloped brain (microcephaly), brain inflammation and learning and behavioral differences.
- Bone disease.
- Low blood counts (thrombocytopenia, hemolytic anemia).
- Thyroid disease.
- Enlarged liver and spleen (hepatosplenomegaly).
- Type 1 diabetes (insulin-dependent diabetes mellitus).
Diagnosis and Tests
How is rubella diagnosed?
To diagnose rubella, your healthcare provider will give you a physical exam and look at your rash if you have one. They might test your blood, pee (urine) or mucus from your nose or throat for signs of rubella.
What tests are used to diagnose rubella?
Tests used to diagnose rubella include:
- Blood tests. Your provider will take a sample of blood from your arm with a small needle. They’ll look for antibodies to rubella, which would show that you’re either currently sick, have had rubella before or are vaccinated against rubella.
- Nasal or throat swabs. Your provider will use a soft-tipped stick (swab) to get a sample from your nose or throat. A lab will test the sample for signs of rubella.
- Urine tests. You’ll pee in a sterile cup. A lab will test your pee (urine) for signs of rubella.
What does it mean if my rubella test is positive?
If your nose, throat or pee is tested and comes back positive, it means you’re currently infected with rubella. If your rubella blood test is positive, it means you have antibodies to rubella. Antibodies are special proteins that know how to identify specific invaders, like viruses and bacteria.
If you test positive when you’re not sick, having antibodies means you were sick with rubella before or received a vaccination for it. You’re likely to be immune to rubella if you have antibodies to it — in other words, your immune system knows how to destroy it before you get sick.
Management and Treatment
How is rubella treated?
There’s no specific medicine for treating rubella. It usually gets better on its own. You can treat symptoms at home with over-the-counter medications. Your healthcare provider may suggest quarantining away from others to reduce the spread of rubella.
How do I manage symptoms of rubella?
Most of the time, you can manage the symptoms of rubella at home with over-the-counter medicines, like acetaminophen (also known as paracetamol or under the brand names Tylenol® or Panadol®) or cough and cold medicines. Ask your healthcare provider about the best way to treat your symptoms. Check with your pediatrician before giving medications to your child for rubella.
How is congenital rubella syndrome treated?
The ways to treat congenital rubella syndrome depend on its severity. Some conditions are treatable with medication or surgery. Other damage is permanent, and it’s only possible to manage the condition to improve quality of life.
How can I prevent rubella?
The best way to prevent rubella is vaccination with the MMR vaccine. It’s about 97% effective at preventing rubella infection. That means that out of 100 fully vaccinated people, three or fewer will get rubella. Both children and adults can receive a rubella vaccination.
If you plan on becoming pregnant, you should get vaccinated or tested for rubella antibodies at least one month before trying to get pregnant.
Other ways to protect yourself against rubella include:
- Wash your hands frequently, especially if you’re sick.
- Don’t share personal items — like cups or utensils — with anyone else.
- Cover your mouth and nose when sneezing or coughing.
- If traveling, know if rubella or other infectious diseases are more common at your destination.
What vaccines are available for rubella?
Rubella vaccination can involve either the MMR or the MMRV vaccine.
- MMR vaccine. The MMR vaccine protects against measles, mumps and rubella. Anyone over 12 months old can get the MMR vaccine.
- MMRV vaccine. The MMRV vaccine protects against measles, mumps, rubella and chickenpox (varicella). Only children between 12 months and 12 years old can get the MMRV vaccine.
Who can get the rubella vaccine?
Most children and adults over the age of 12 can get vaccinated against rubella. Some people don’t need to get the vaccine and others shouldn’t get it.
You don’t need the rubella vaccine if you:
- Have already been vaccinated (you may need written documentation for travel, school or work).
- Get a blood test that shows you have antibodies to rubella (you’re immune to rubella).
- Were born before 1957. That's because anyone born before vaccines became available has almost certainly had rubella.
Experts recommend against getting the rubella vaccine if you:
- Are allergic to anything in the vaccine.
- Are pregnant.
- Have a weakened immune system due to HIV/AIDs, cancer or medications you’re taking.
- Have recently had a blood transfusion. Ask your healthcare provider if you should postpone vaccination.
- Have tuberculosis.
- Have gotten other vaccines within the past four weeks.
If you bruise or bleed easily or have a close relative who has immune system problems, ask your provider if you should get the rubella vaccination.
Outlook / Prognosis
What can I expect if I have rubella?
Rubella usually causes mild illness and goes away on its own. Since it can be contagious for up to two weeks, you should avoid being around other people as much as possible while you have symptoms and for a week after your rash appears.
If you get rubella while pregnant, talk to your healthcare provider about how it might affect the developing fetus.
How long does rubella last?
Rubella causes a rash that usually lasts about three days. Other symptoms can last a few days to a week.
When can I go back to work/school after having rubella?
Rubella can be contagious for up to a week after the rash starts. Don’t go back to work or school if you have a rash or any symptoms. Talk to your healthcare provider, employer, school or child’s school to know what you need to do to return.
What are the complications of rubella?
The most common and serious complications of rubella are pregnancy loss (miscarriage) and congenital rubella syndrome (CRS). CRS happens in babies born to someone who had rubella while pregnant. Less common complications include:
Does rubella cause miscarriage?
Yes, rubella can cause miscarriage in a pregnant person. It can also cause conditions like cataracts, heart disease and hearing loss in your baby from birth.
When should I see my healthcare provider about rubella?
If you or your child have symptoms of rubella, contact your healthcare provider. If you plan on getting pregnant, talk to your provider about protecting yourself against rubella before getting pregnant.
When should I go to the ER?
If you’re pregnant, contact your healthcare provider or go to the nearest ER if you’re experiencing:
- Heavy bleeding.
- Abdominal (stomach) pains.
What questions should I ask my healthcare provider?
Some questions to ask your healthcare provider include:
- How can I treat my symptoms at home?
- How can I make sure I don’t spread rubella to others?
- How can I protect myself from rubella?
- If I’m pregnant or become pregnant, how can I protect the fetus from rubella?
- Should I get vaccinated for rubella?
Frequently Asked Questions
What’s the difference between rubella, rubeola (measles) and chicken pox?
Rubella, measles and chicken pox can look similar since they all come with a skin rash. But they’re all different diseases, and they happen because of different viruses.
What type of virus is rubella?
Rubella is a rubivirus of the family Matonaviridae. Its instructions are written on RNA. It has a protective shell (capsid) and an envelope that helps it invade human cells.
What’s the history of rubella in the United States?
Before a vaccine was widely available, most people in the U.S. got rubella. The last major rubella epidemic in the U.S. was from 1964-1965. In those years, 12.5 million people got rubella, 20,000 babies were born with CRS, 11,000 miscarriages from rubella were reported and 2,100 newborns died.
After vaccines for rubella went into widespread use (starting in 1969), cases of rubella drastically dropped in the U.S. There are now only a few cases each year. In recent years, all cases of rubella diagnosed in the U.S. were acquired when traveling or living overseas.
A note from Cleveland Clinic
Rubella is often a mild illness, but it can be dangerous in pregnant people. If you’re pregnant and get rubella, your child is at high risk for organ damage and other life-threatening conditions. Getting vaccinated greatly reduces your risk of getting rubella and spreading it to others.
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