Rubella

Rubella is a viral illness that causes a skin rash and joint pain. For most people the infection is mild, but it can have devastating consequences for an unborn baby. If a pregnant woman catches rubella, her baby is at risk of severe and permanent birth defects, or death.

Rubella is sometimes called German measles, but it is a different disease from measles. Where widespread immunization programs are in place, rubella has become uncommon and has even been eliminated in some regions.

Elimination does not mean eradication#

Even where rubella has been eliminated, outbreaks can still occur. This is why it remains important to keep vaccinating children, to stop the infection spreading to pregnant women.

Symptoms of rubella#

About half of all rubella cases are so mild that there are no symptoms at all. When symptoms do appear, they usually show up two to three weeks after infection and may include:

• mild fever
• headache
• runny nose
• sore eyes
• a skin rash
• swollen lymph nodes
• joint pain

Rubella is mild compared with measles, and most people recover within about three days. Complications are uncommon but can include:

• encephalitis (inflammation of the brain), which can occasionally be fatal
• arthralgia (lingering joint pain that may take a month or more to settle)
• otitis media (inflammation of the middle ear)

Rubella and pregnancy#

A pregnant woman can pass rubella to her unborn baby. This can lead to miscarriage or to serious birth defects known as congenital rubella syndrome (CRS), especially if she catches the infection during the first trimester (the first three months of pregnancy). Around nine in every 10 babies exposed to rubella during the first 10 weeks of pregnancy will have a major congenital abnormality.

Birth defects linked to CRS include:

• deafness
• blindness
• heart defects
• intellectual disability
• impaired growth
• inflammation of organs such as the brain, liver or lungs

Babies born with CRS can shed the rubella virus in their nose and throat secretions and in their urine for months, or even years.

If you are pregnant and think you may have been exposed to rubella, see your doctor.

How rubella spreads#

Rubella spreads most commonly when someone swallows or inhales droplets from the cough or sneeze of an infected person. Symptoms usually appear 14 to 17 days after infection, and sometimes up to 21 days. A person with rubella is infectious for about a week before the rash appears and for at least four days afterwards.

Anyone who has not been vaccinated is at risk, in particular unborn babies whose mothers have little or no immunity. Some groups face a higher risk of exposure, including:

• travellers to, and visitors from, areas where rubella vaccination is not widespread
• childcare workers
• people who work in healthcare settings such as hospitals

Diagnosis#

Rubella can be hard to diagnose because the signs and symptoms are vague. Many other illnesses also cause fever, and the rash can look like other rashes. Diagnosis is usually based on:

• medical history, including immunization and travel history
• a physical examination
• blood tests

Treatment#

There is no specific treatment for rubella, and antibiotics do not help because the illness is caused by a virus. Symptoms are usually mild, so treatment aims to ease discomfort and reduce the risk of complications. This may include:

• rest and plenty of fluids
• paracetamol to relieve pain and fever

It is important to stay away from others for at least four days after the rash appears, to reduce the risk of passing the infection on. If you are pregnant and catch rubella, discuss your options with your doctor.

Immunization is the best protection#

A single rubella infection usually gives most people lifelong immunity. Vaccination is the best way to prevent the disease, although in rare cases it is still possible to catch rubella even after a vaccination or a previous infection.

The rubella vaccine is given in combination with other vaccines:

• as the measles, mumps and rubella (MMR) vaccine
• as the measles, mumps, rubella and varicella (chickenpox) vaccine, known as MMRV

Routine childhood immunization schedules include doses of a rubella-containing vaccine, with catch-up doses available for those who missed out. Schedules vary from place to place, so ask your doctor or immunization provider about the schedule where you live and whether you or your child need any catch-up doses. Where two doses are required, they should be given at least 28 days apart.

The MMRV vaccine is generally not recommended from 14 years of age. From this age, people usually receive the MMR vaccine together with a separate chickenpox vaccine.

Planning a pregnancy#

If you are planning to become pregnant, have a blood test to check your immunity to rubella, and be vaccinated if needed. The blood test matters because you may not be immune even if you were vaccinated in the past. Women who are not immune need two doses of vaccine at least 28 days apart, and should avoid pregnancy for at least 28 days after immunization.

If you are already pregnant, do not have the MMR or MMRV vaccine. If you are pregnant and not immune, avoid anyone who has rubella, arrange immunization soon after your baby is born, and then avoid another pregnancy for at least 28 days.

If you work with children#

If you work with children, you are at greater risk of catching and passing on infectious diseases. Stay up to date with all recommended vaccinations to protect yourself and the children (and their mothers) you are in regular contact with. Some diseases that cause only mild illness in adults can be very serious for young children — for example, whooping cough (pertussis) can be deadly for young babies.

Who should not be vaccinated#

Rubella vaccination is not recommended for some people. Anyone with a weakened immune system should not be vaccinated. Causes of impaired immunity include:

• infection with HIV, or AIDS resulting from HIV infection
• an immune deficiency with very low antibody levels, such as hypogammaglobulinaemia, multiple myeloma or chronic lymphocytic leukaemia
• taking certain medicines, such as high-dose corticosteroids
• having immunosuppressive treatment, including chemotherapy and radiotherapy
• having some cancers, such as Hodgkin’s disease or leukaemia

If any of these apply to you, talk to your doctor before being vaccinated.

Key points#

• Rubella is a viral illness that causes a skin rash and joint pain.
• If a pregnant woman catches rubella, her baby is at risk of severe and permanent birth defects or death.
• Rubella is uncommon where widespread immunization programs are in place.
• About half of rubella cases are so mild that there are no symptoms.
• When symptoms do occur, they usually appear two to three weeks after infection.

Where to get help#