Rubella

What is rubella?

Rubella is a contagious infection caused by the rubella virus. It is sometimes called “German measles” or “three-day measles,” but it is a different illness from measles and is caused by a different virus. In most children and adults, rubella is a mild illness that causes a low fever, a pink or red rash, and swollen glands. Many people who catch it have such mild symptoms that they do not realize they were infected.

The main reason rubella matters is its effect during pregnancy. If a woman catches rubella in early pregnancy, the virus can pass to the developing baby and cause serious birth defects. This group of problems is called congenital rubella syndrome (“congenital” means present at birth). Because of this risk, rubella is one of the infections that routine childhood vaccination programs around the world aim to prevent.

Rubella can affect anyone who has not been vaccinated or who has not had the infection before. Before widespread vaccination, it was mostly a childhood illness. Today, in countries with high vaccination rates, cases are uncommon and are often linked to travel or to communities with low vaccine coverage. In hospital settings such as Acibadem, suspected rubella in children is usually managed by the pediatrics department, while adults and pregnant women are cared for by infectious disease and obstetrics teams.

Rubella symptoms

Rubella symptoms usually appear about two to three weeks after a person is exposed to the virus. This waiting period is called the incubation period. Symptoms are often mild, and up to half of infected people may have few or no noticeable symptoms at all. When symptoms do occur, they commonly include:

• Low-grade fever, usually mild and short-lived
• A pink or light red rash that typically starts on the face and spreads downward to the trunk, arms, and legs
• Swollen, tender lymph nodes (glands), especially behind the ears and at the back of the neck
• Headache
• Runny or stuffy nose
• Red, mildly inflamed eyes (conjunctivitis)
• General tiredness and feeling unwell
• Aching or swollen joints, particularly in adult women

The rash of rubella is usually made up of small, flat or slightly raised spots that may merge together. It typically lasts about three days, which is where the name “three-day measles” comes from. Unlike the measles rash, it tends to be fainter and does not usually cause the high fever and severe cough that measles does.

Symptoms can differ by age and stage:

• Young children often have the mildest illness. The rash may be the first and only obvious sign.
• Older children and adults may notice a few days of low fever, swollen glands, and tiredness before the rash appears. Adults, especially women, are more likely to develop joint pain that can last for several weeks.
• Babies born with congenital rubella syndrome do not have the typical rash and fever. Instead, they may have hearing loss, eye problems such as cataracts, heart defects, a small head, developmental delays, or a low birth weight. Some problems are found at birth, while others, such as hearing loss, may only become apparent later.

A person with rubella is contagious from about one week before the rash appears until about one week after it appears. This means people can spread the virus before they know they are sick.

Rubella causes and risk factors

Rubella causes are straightforward: the illness is caused by infection with the rubella virus, which belongs to a family of viruses known as togaviruses. Humans are the only known host, meaning the virus does not circulate in animals.

The virus spreads from person to person mainly in the following ways:

• Respiratory droplets. When an infected person coughs, sneezes, or talks, tiny droplets containing the virus enter the air and can be breathed in by people nearby.
• Direct contact. Touching the nose or throat secretions of an infected person and then touching your own mouth, nose, or eyes can pass the virus on.
• Mother to baby. A pregnant woman who is infected can pass the virus through the placenta to her developing baby. Babies born with congenital rubella syndrome can also shed the virus for many months after birth and can infect others.

Certain factors increase the chance of catching rubella or of having a serious outcome:

• Not being vaccinated. This is the single most important risk factor. Two doses of the measles, mumps, and rubella (MMR) vaccine provide long-lasting protection in most people.
• Never having had rubella. People who have had the infection usually develop lifelong immunity.
• Travel to areas where rubella still circulates. In some parts of the world, vaccination coverage is lower and the virus spreads more widely.
• Living in or visiting communities with low vaccination rates. Outbreaks can occur when many people in a group are unprotected.
• Pregnancy without immunity. The risk to the baby is highest when infection happens in the first twelve weeks of pregnancy, when the baby’s organs are forming.
• Weakened immune system. People with certain medical conditions or on treatments that suppress the immune system may have a harder time fighting infections in general.

Rubella diagnosis

Because the rash and other symptoms of rubella look similar to many other viral illnesses, doctors do not rely on appearance alone. A rubella diagnosis is usually confirmed with laboratory tests. Your doctor will typically start by asking about your symptoms, vaccination history, recent travel, and any contact with someone who was sick. A physical exam looks at the pattern of the rash and checks for swollen lymph nodes.

Tests that may be used include:

• Blood test for rubella antibodies. Antibodies are proteins the immune system makes in response to an infection or a vaccine. A type called IgM usually appears during a recent infection, while IgG suggests past infection or vaccination. Doctors often take two blood samples a few weeks apart to see whether antibody levels are changing, which helps confirm a recent infection.
• Throat or nasal swab. A swab from the throat, nose, or sometimes urine can be tested for the virus’s genetic material using a method called PCR (polymerase chain reaction). This test can detect the virus directly and is most useful in the first few days after the rash appears.
• Viral culture. In some laboratories, the virus may be grown from a sample, although this is used less often today because PCR is faster.

In pregnancy, testing takes on added importance. A pregnant woman who has been exposed to rubella or who has a suspicious rash will usually have blood tests to determine whether she is immune. If a recent infection is confirmed, further testing and specialized ultrasound scans may be offered to look at the baby’s development. In some cases, a sample of amniotic fluid (the fluid around the baby) may be tested for the virus. These decisions are made with a specialist and depend on the individual situation.

For newborns, congenital rubella syndrome may be suspected based on findings such as cataracts, heart murmurs, or hearing problems. Diagnosis is supported by blood tests for rubella IgM antibodies in the baby and by detecting the virus in throat, urine, or blood samples.

Rubella is a reportable disease in many countries, which means doctors notify public health authorities of confirmed cases so that outbreaks can be tracked and contacts can be protected.

Rubella treatment options

There is no specific medicine that kills the rubella virus. Rubella treatment therefore focuses on relieving symptoms and preventing the spread of infection while the body’s immune system clears the virus on its own. For most otherwise healthy children and adults, this means care at home.

Supportive measures your doctor may recommend include:

• Rest. Getting enough sleep and avoiding strenuous activity while you feel unwell.
• Fluids. Drinking water and other fluids regularly to prevent dehydration, especially if there is a fever.
• Fever and pain relief. Over-the-counter medicines such as acetaminophen (paracetamol) or ibuprofen may be used to reduce fever and ease headaches or joint pain, following the dosing instructions and your doctor’s guidance. Aspirin is generally not given to children or teenagers with a viral illness because of the risk of a rare but serious condition called Reye’s syndrome.
• Isolation. Staying home from school, daycare, or work for about seven days after the rash appears helps protect others, particularly pregnant women.

Antibiotics are not helpful because rubella is caused by a virus, not bacteria. There are no procedures or surgeries for treating the infection itself.

For pregnant women, treatment is more individualized. If a pregnant woman has been exposed to rubella and is not immune, her doctor will discuss the timing of exposure and the possible risks to the baby. In some situations, an injection of immune globulin (a preparation of antibodies) may be considered after exposure. It is important to understand that this does not reliably prevent infection of the baby, and it is not a substitute for vaccination before pregnancy. The rubella vaccine itself is not given during pregnancy because it contains a live, weakened virus.

For babies born with congenital rubella syndrome, there is no cure for the underlying condition, but many of its effects can be managed. Care may involve a team of specialists and can include:

• Hearing tests and hearing aids or cochlear implants for hearing loss
• Eye surgery, such as cataract removal, and ongoing eye care
• Heart evaluation and, in some cases, surgery to correct structural heart defects
• Developmental support, including physical therapy, speech therapy, and educational support

Because babies with congenital rubella can remain contagious for a long time, their care team will also give guidance on limiting contact with unvaccinated people, especially pregnant women.

Living with rubella and outlook

For most children and adults, the outlook after rubella is very good. The illness usually runs its course within about a week, the rash fades on its own, and there are no lasting effects. After recovering, people are generally immune for life.

Some people experience longer-lasting joint pain or stiffness, most often adult women. This usually settles over a period of weeks, although it can occasionally persist for longer. Rare complications can occur in any age group. These include a drop in blood platelets (the cells that help blood clot), which can lead to unusual bruising or bleeding, and encephalitis, an inflammation of the brain. Both are uncommon and usually improve with medical care, but they are the reason doctors advise watching for warning signs during recovery.

The outlook for a baby with congenital rubella syndrome varies widely depending on when in pregnancy the infection occurred and which organs were affected. Infection very early in pregnancy carries the greatest risk, and some pregnancies may end in miscarriage or stillbirth. Babies who survive may have a range of lifelong conditions, from mild hearing loss to more complex heart, eye, and developmental problems. With early diagnosis and coordinated care, many of these challenges can be managed, and children can be supported to reach their potential, although the degree of disability differs from child to child.

Prevention remains the most effective strategy. The MMR vaccine has made rubella rare in many countries. Women who are planning a pregnancy can ask their doctor to check whether they are immune, and if not, they can be vaccinated before becoming pregnant. Doctors usually advise waiting a period of time after vaccination before trying to conceive; your doctor can tell you what is currently recommended.

Frequently asked questions

How do I know if a rash is rubella or something else?

It is difficult to tell rubella apart from other rashes just by looking. Many viral infections, allergic reactions, and other conditions cause pink or red spots. Rubella is more likely if there is also a mild fever, swollen glands behind the ears or at the back of the neck, and a history of contact with someone who was infected or of travel to an area where rubella circulates. Only a blood test or a swab for the virus can confirm a rubella diagnosis, so it is best to see a doctor rather than guess.

What are the first rubella symptoms in children?

In children, the rash is often the first noticeable sign and may appear without much warning. Some children have a day or two of mild fever, runny nose, or tiredness beforehand, but many seem well until the pink spots appear on the face. Swollen glands may be felt around the ears and neck. Because the illness is usually mild, parents sometimes only realize it was rubella after a doctor has confirmed it or after another family member becomes unwell.

What causes rubella and how does it spread?

Rubella is caused by the rubella virus, which spreads from person to person through droplets released when an infected person coughs or sneezes, and through contact with their nose or throat secretions. A pregnant woman can also pass it to her unborn baby. People are contagious from about a week before the rash appears until about a week after, which is why the infection can spread before anyone knows they are sick.

Is there a specific rubella treatment or cure?

There is no medicine that directly kills the rubella virus. Treatment focuses on rest, fluids, and medicines to ease fever and aches while the body clears the infection, which usually takes about a week. Antibiotics do not work against viruses. The most effective approach to rubella is prevention through vaccination rather than treatment after infection.

Can I get rubella if I have been vaccinated?

The MMR vaccine is highly effective, and most people who have had two doses are protected for life. No vaccine works in every single person, so a small number of vaccinated people may still catch rubella, although the illness in these cases tends to be milder. If you are unsure of your vaccination history, a blood test can show whether you have protective antibodies, and your doctor can advise whether a dose is needed.

What should I do if I am pregnant and think I have been exposed to rubella?

Contact your obstetrician or midwife as soon as possible. They will usually check your vaccination records and arrange a blood test to see whether you are already immune. If you are immune, the risk to your baby is very low. If you are not immune, your care team will discuss the timing of the exposure, arrange follow-up testing, and explain the possible options. Avoid further contact with the infected person while this is being sorted out.

How long should someone with rubella stay away from others?

Health authorities generally recommend staying home and avoiding contact with others for about seven days after the rash first appears. It is especially important to avoid pregnant women during this time. Children should not attend school or daycare until this period has passed. Your doctor or local public health service can confirm the current advice for your area.

When to see a doctor

Most cases of rubella are mild and can be managed at home, but it is important to have a suspected case confirmed by a doctor so that others, particularly pregnant women, can be protected. Consider seeing a doctor promptly if you or your child develop a rash together with fever and swollen glands, especially after contact with someone known to have rubella or after travel.

Seek medical care urgently if any of the following red-flag signs appear:

• Severe headache, stiff neck, confusion, unusual drowsiness, or seizures, which could indicate inflammation of the brain
• Unexplained bruising, tiny red or purple spots that do not fade when pressed, nosebleeds, or bleeding gums, which may suggest a drop in blood platelets
• Very high fever or a fever that does not come down with medication
• Difficulty breathing or persistent vomiting
• Signs of dehydration, such as very little urine, a dry mouth, or unusual lethargy in a young child
• Any rash or possible rubella exposure during pregnancy, even if symptoms are mild or absent
• A newborn with cataracts, poor feeding, a heart murmur, or concerns about hearing, particularly if the mother had a rash during pregnancy

If you are planning a pregnancy and are unsure whether you are immune to rubella, a routine appointment to check your vaccination status is a sensible step.