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Rubella

(German Measles; 3-Day Measles)

By

Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Jun 2023 | Modified Aug 2023
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Rubella is a contagious viral infection that typically causes in children mild symptoms, such as joint pain and a rash. Rubella can cause death of a fetus or severe birth defects if the mother becomes infected during early pregnancy.

  • Rubella is caused by a virus.

  • Typical symptoms include swollen lymph nodes, rose-colored spots on the roof of the mouth, and a characteristic rash.

  • The diagnosis is based on symptoms.

  • Treatment of rubella is aimed at relieving the symptoms.

  • Routine vaccination can prevent rubella.

Rubella used to be called "German measles" or "3-day measles" because it causes a rash similar to the rash caused by measles Measles Measles is a highly contagious viral infection that causes various cold-like symptoms and a characteristic rash. Measles is caused by a virus. Symptoms include fever, runny nose, hacking cough... read more Measles . However, it is caused by a different virus.

Rubella is spread mainly by breathing in small virus-containing droplets of moisture that have been coughed into the air by an infected person. Close contact with an infected person can also spread the infection. People who have rubella are most contagious from 1 week before to 1 week after a rash appears, and the infection is usually spread while the rash is present. However, people who do not have a rash or any symptoms can still spread the virus to other people. An infant infected before birth can spread the infection for many months after birth.

A person who has had rubella develops immunity and usually cannot contract it again.

Rubella was once common during spring, with major epidemics infecting millions of people every 6 to 9 years. The infection is now rare in the United States because of widespread vaccination. Nonetheless, some young adult women have never had rubella or rubella vaccination and are thus at risk of having children with serious birth defects if they become infected during early pregnancy.

Since 2004 in the United States, all cases of rubella have been imported by people traveling from areas where rubella is more common and acquiring rubella while abroad before returning to the United States.

Did You Know...

  • Routine vaccination can prevent rubella and many viral infections.

Symptoms of Rubella

Rubella symptoms differ somewhat between children and adults. Many cases are mild.

Symptoms of rubella begin about 14 to 21 days after infection.

In children, rubella usually causes mild or no noticeable symptoms.

Mild symptoms may occur in children 1 to 5 days before the rash appears:

  • A low fever (under 102° F [39° C])

  • General discomfort

  • Pink eye

  • Swollen lymph nodes in the neck and back of the head

  • Red or irritated throat

  • Joint pain

The rash caused by rubella is similar to the rash caused by measles Measles Measles is a highly contagious viral infection that causes various cold-like symptoms and a characteristic rash. Measles is caused by a virus. Symptoms include fever, runny nose, hacking cough... read more Measles but is not as intensely red and does not merge to form large red areas. The rash begins on the face and neck and quickly spreads to the trunk, arms, and legs. As the rash appears, a mild reddening of the skin (flush) occurs, particularly on the face. Painless red spots may appear on the back of the roof of the mouth and throat (Forchheimer spots). The rash usually lasts about 3 days but may last for several days longer.

Diagnosis of Rubella

  • A doctor's evaluation

  • Tests to measure antibody levels in high-risk people

Doctors suspect rubella in people who have swollen lymph nodes at the back of their head and the characteristic rash.

A definite diagnosis of rubella is necessary for pregnant women, people who have encephalitis, and newborns. The diagnosis can be confirmed by measuring levels of antibodies to rubella virus in the blood or by testing throat, nose, or urine specimens.

Before birth, the diagnosis may be made in the fetus by testing the amniotic fluid or the fetus's blood. Pregnant women are routinely screened with blood tests during early pregnancy to confirm they are immune to rubella.

Treatment of Rubella

  • Acetaminophen or ibuprofen for fever and aches to provide comfort

There is no treatment for rubella infection. Most people recover fully without treatment. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be given for fever and aches.

No treatment is available for encephalitis, which must just run its course with supportive care.

Prevention of Rubella

  • MMR vaccine

There is no longer a separate vaccine just for rubella. The measles-mumps-rubella (MMR) vaccine Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more is a combination vaccine that contains live but weakened measles, mumps, and rubella viruses. The MMR vaccine is one of the routine immunizations of childhood Childhood Vaccination Schedules Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more and is given to children in most nations that have a robust health care system. The MMR vaccine and the varicella (chickenpox) vaccine are also available as a combined vaccine (MMRV vaccine).

Two doses of MMR vaccine are routinely recommended. The first dose is given between 12 months and 15 months of age but can be given to children as young as 6 months during a measles outbreak or before international travel. The second dose is given between 4 years and 6 years of age.

Children who were less than 1 year of age when immunized still need 2 more doses after their first birthday.

The MMR vaccine generally provides lasting immunity.

MMR is a live vaccine and is not given during pregnancy.

Pregnant people who are not immune should avoid anyone who has rubella. Although MMR vaccine cannot be given during pregnancy, it can be given immediately after birth to people who are not immune so that they will be immune during any future pregnancies.

People who were vaccinated during childhood who want to become pregnant may have blood tests to confirm immunity because some people do not develop immunity after that first vaccination. Once immunity is confirmed, people do not need to be tested again before subsequent pregnancies.

To prevent passing on the infection to a fetus, unvaccinated people who could become pregnant should receive one dose of the MMR vaccine and then wait 4 weeks before trying to conceive.

Drugs Mentioned In This Article

Generic Name Select Brand Names
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
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