Rubella (German Measles)

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Rubella (German Measles)

Topic Overview

What is rubella?

Rubella is a disease caused by the rubella virus. It is usually a mild illness that does not cause long-term problems.

But if you are pregnant and get infected with the rubella virus, you can give the disease to your baby (fetus). This can cause birth defects, including serious defects known as congenital rubella syndrome (CRS). CRS can cause hearing loss, cataracts, heart problems, and other health problems.

Rubella also is called German measles or 3-day measles.

What causes rubella?

The rubella virus most often is spread through droplets of fluid from the mouth, nose, or eyes of someone who has the infection. A person who has the infection can spread these droplets by coughing, sneezing, talking, or sharing food or drinks. You can become infected by touching something that has the droplets on it and then touching your eyes, nose, or mouth before washing your hands.

What are the symptoms?

Symptoms of rubella may include:

  • A mild fever.
  • Swollen glands, especially behind the ear and at the back of the head.
  • A skin rash that starts on the face and spreads to the neck, the chest, and the rest of the body.

Women also may have joint pain. Older children and teens also may have eye pain, a sore throat, and body aches. Young children may have only a rash.

Symptoms may not start until 14 to 21 days after you've been near someone who has the infection. Some people don't have symptoms. But everyone who is infected can spread the disease.

If you have rubella, you are most likely to spread it a few days before the rash starts until 5 to 7 days after the rash first appears. See a picture of a rash caused by rubella.

How is rubella diagnosed?

A blood test can help your doctor find out if a recent infection you've had was caused by the rubella virus. The test also shows if you have been immunized against rubella or are immune to the virus.

You also may need a viral culture. But the results may not be available for several weeks.

How is it treated?

Treatment for rubella focuses on treating the symptoms. Acetaminophen, such as Tylenol, can be given to children and adults to help with fever and body aches. Do not give ASA to anyone younger than age 20. It has been linked to Reye syndrome, a serious illness.

Can rubella be prevented?

In Canada, the rubella shot is part of the normal childhood measles, mumps, and rubella immunization (MMR). At least 9 out of 10 people who get the shot develop antibodies that protect them from getting this disease.1 Outbreaks may occur in people who haven't gotten the shot. Outbreaks are more likely to happen in college, military, health care, and child care settings and among people who have recently moved from other countries.

If you are planning to become pregnant and you don't know if you're immune to rubella, get a blood test to find out. If you're not immune, you can safely get the rubella shot up to 1 month before you become pregnant.

It is very unlikely that a person who has had rubella will get the disease again.

Frequently Asked Questions

Learning about rubella:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Symptoms

Typical symptoms of rubella are a mild rash, swollen and tender glands (especially behind the ear, at the back of the neck, and under the skull), and a slight fever. Also, some adolescent girls and adult women get joint pain (arthritis), especially in the small joints of the hands.

  • Swollen glands in the neck area are common with many viral infections. The glands that are most affected by rubella are those located behind the ear and at the back of the head. The degree to which they become swollen and tender is unique to rubella.
  • Sometimes a rash is the only symptom of rubella that young children develop.
  • Older children and teens may have fever, eye pain, sore throat, and body aches. They may or may not get a rash.
  • Symptoms of rubella, especially pain and swelling at the joints, may be more severe in adults than in children. Joint pain (more commonly seen in women) may take as long as a month to go away.

The rubella rash is mild, starts on the face, and spreads to the neck, the chest, and the rest of the body. It may first appear as a mild blush before it develops into a more pinpoint rash with distinctive spots. Rubella infection without a rash is also common. Even if you do not have a rash, you are still contagious.

Complications, such as infection of the brain (encephalitis), can arise from rubella. Encephalitis from rubella is very rare but serious.

A fetus that becomes infected with rubella is at risk for miscarriage, fetal death, and birth defects. And fetuses exposed to rubella during the first trimester are at highest risk for congenital rubella syndrome (CRS). This syndrome can result in serious birth defects. Hearing impairment is the most common, although cataracts and glaucoma, other eye problems, heart defects, brain problems, intellectual disability, physical retardation (stunted growth), and bone disease may also occur.

Other viral illnesses and conditions can cause symptoms and rashes similar to rubella. For this reason, rubella may be confused with:

  • Mild cases of scarlet fever, an illness that most often occurs in children ages 2 to 10 who have recently had strep throat.
  • Measles, also called rubeola or red measles.
  • Fifth disease (parvovirus B19), a contagious and usually mild viral illness that is common in children.
  • Roseola, a mild viral illness that affects young children. It often starts with a sudden high fever of 39.5°C (103°F) to 40.5°C (105°F) that lasts 2 to 3 days.
  • Infectious mononucleosis (sometimes called "mono"), a viral illness usually caused by the Epstein-Barr virus. Mono is most common in teens and young adults.
  • Allergic reactions to medicines.
  • Some stomach and intestinal viral infections, such as stomach flu (gastroenteritis).

Examinations and Tests

A rubella test detects antibodies to the rubella virus in a sample of blood. This information can help a doctor find out:

  • Whether a recent infection was caused by the rubella virus.
  • Whether you have been vaccinated against rubella or are otherwise immune to the virus.

Sometimes, a viral culture may also be used to determine whether a current infection is caused by the rubella virus. But the results from this test may not be available for several weeks.

Children and adults

If you or your child have not been immunized and your doctor suspects rubella, a blood test for rubella antibodies should be done to confirm the diagnosis.

Rubella may be diagnosed without testing if you have not been immunized. This can occur if you develop typical symptoms after being exposed to someone with a confirmed case of rubella infection.

Pregnant women

As part of your prenatal care, your doctor may want you to have a blood test to find out if you have had rubella or the vaccine. (Your body will make antibodies if you have had the disease or the vaccine.) If your body has made antibodies, you have immunity.

If your body does not have antibodies, you are not immune. This means if you were exposed to rubella, you could get the disease and pass it on to your baby. To help prevent rubella, avoid close contact with people infected with the virus.

If you don't know if you are immune and if you have been around people who have rubella, your doctor will use the blood test to see if you have antibodies to fight the disease.

  • If antibodies are not found, the test is negative. This means you are not immune to the disease.
  • If antibodies are found, the test is positive. This means you are immune to rubella. To be safe, the blood test may be repeated again in 6 weeks.

Newborns

An infant born with defects that suggest congenital rubella syndrome (CRS) should be evaluated immediately to find out whether rubella is the cause. Diagnosis of a newborn with CRS is based upon the newborn's physical examination and the mother's medical history, including prenatal care records. If CRS is diagnosed, measures are taken to prevent the transmission of the virus to others who are in the hospital.

Some provinces test every newborn for hearing impairment, the most common birth defect related to rubella. If a problem is found, the infant is usually further tested for rubella. This helps doctors know whether they should look for other birth defects and signs of CRS.

Treatment Overview

Treatment for rubella focuses on caring for the specific symptoms, such as getting plenty of rest and drinking extra fluids so you do not get dehydrated. Acetaminophen, such as Tylenol, can be given to children and adults for fever. Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give. Do not give ASA to anyone younger than 20 because of the possible link between ASA and Reye syndrome.

A baby (fetus) can get infected from a mother who has rubella during her pregnancy. Babies may also develop birth defects, especially if infected in the first trimester. Treatment varies according to the specific problem.

Pregnant women or those considering pregnancy

Women considering pregnancy who are unsure of their immunity to rubella may be vaccinated safely up to 1 month before becoming pregnant.

If you are pregnant and have been infected with the rubella virus, you may want to seek counselling about the risk that the baby will be born with congenital rubella syndrome (CRS) and what options are available to you.

Home Treatment

Home treatment for rubella includes getting plenty of rest and drinking extra fluids so you do not get dehydrated. Acetaminophen, such as Tylenol, may help relieve fever and body aches. Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give. Do not give ASA to anyone younger than 20 because of the possible link between ASA and Reye syndrome.

You are at risk of getting rubella if you have not been immunized or have not had the illness. Try to avoid contact with people who have rubella.

Children, teens, and adults with rubella should not attend daycare, school, or work or be around other people, especially pregnant women, for 7 days after the rash first appears.2

Prevention

If your baby was born with rubella, take precautions to avoid exposing your baby to people who are not immune to the disease. In daycare centres and at home, good hygiene and careful handwashing are the most important control measures.

Extra care should be taken around pregnant women. Pregnant women working in child care facilities should minimize direct exposure to saliva and avoid kissing babies or young children on the mouth. An infant born with rubella can be contagious for as long as 1 year after birth.

An immunization to prevent rubella is available. It is given in combination with the measles and mumps vaccines in a single shot called MMR. Two doses of the vaccine are given at least 4 weeks apart. The first shot is given when a child is between 12 and 15 months old, and the second is given before the age of seven. In some provinces children age 12 and younger can get immunized with MMRV instead of MMR. The MMRV shot also includes the chickenpox (varicella) vaccine. Talk to your child's doctor about the pros and cons of the MMRV shot.

Teens and adults who should be given the MMR vaccine include:

  • People who were born during or after 1970 who have not received the MMR vaccine.
  • Health care workers.
  • College students and international travellers who do not have proof of immunization or immunity.

If you are planning to become pregnant and are uncertain of your immunity to rubella, get a blood test to find out whether you are immune or not. If you are not immune, you are advised to get the vaccine and wait at least 1 month before trying to conceive. If it so happens that you are immunized during early pregnancy before you know that you are pregnant, the risk to your fetus is very low. The important thing is to seek prenatal care.

Some parents are concerned that the MMR vaccine causes autism. Many studies have been done, and no link has been found between this vaccine and autism.3

For more information on the standard immunization schedule, see the topic Immunizations.

Other Places To Get Help

Online Resource

Caring for Kids
Canadian Paediatric Society
Web Address: www.cps.ca/caringforkids
 

Caring for Kids is produced by the Canadian Paediatric Society, a national association that advocates for the health needs of children and youth.


Organizations

Canadian Paediatric Society
2305 Saint Laurent Boulevard
Ottawa, ON  K1G 4J8
Phone: (613) 526-9397
Fax: (613) 526-3332
Email: info@cps.ca
Web Address: www.cps.ca
 

The Canadian Paediatric Society (CPS) promotes quality health care for Canadian children and establishes guidelines for paediatric care. The organization offers educational materials on a variety of topics, including information on immunizations, pregnancy, safety issues, and teen health.


Public Health Agency of Canada: Infectious Diseases
Web Address: www.phac-aspc.gc.ca/id-mi/index-eng.php
 

The Public Health Agency of Canada's Infectious Disease webpage provides information on many different infectious diseases.


References

Citations

  1. National Advisory Committee on Immunization (NACI) (2006). Rubella vaccine. In Canadian Immunization Guide, 7th ed., pp. 298–307. Ottawa: Public Health Agency of Canada.
  2. American Academy of Pediatrics (2009). Rubella. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 579–584. Elk Grove Village, IL: American Academy of Pediatrics.
  3. Demicheli V, et al. (2007). Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews (1).

Other Works Consulted

  • American Public Health Association (2008). Rubella (German measles). In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 529–534. Washington, DC: American Public Health Association.
  • Centers for Disease Control and Prevention (2001). Control and prevention of rubella: Evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR, 50(RR-12): 1–23.
  • Cherry JD (2009). Rubella virus. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 2271–2300. Philadelphia: Saunders Elsevier.
  • Levin MJ, Weinberg A (2009). Rubella section of Infections: Viral and rickettsial. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 1103–1104. New York: McGraw-Hill.
  • Maldonado Y (2004), Rubella. In RE Behrman et al., eds., Nelson's Textbook of Pediatrics, 17th ed., pp. 1032–1034. Philadelphia: Saunders.
  • National Advisory Committee on Immunization (NACI) (2006). Rubella vaccine. In Canadian Immunization Guide, 7th ed., pp. 298–307. Ottawa: Public Health Agency of Canada.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Susan C. Kim, MD - Pediatrics
Last Revised October 19, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.