Rubella (German measles) is an infection caused by the rubella virus. Although it most commonly occurs in young children, it can affect anyone. The illness is usually mild. However, rubella in a pregnant woman can cause serious damage to the unborn child. Immunisation has made rubella uncommon in the UK.
What is rubella?
Rubella (German measles) is usually a mild illness. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child or cause a miscarriage. Rubella can lead to damage to the heart, brain, hearing and sight. The baby is likely to be born with a very serious condition called the congenital rubella syndrome.
Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome. Rubella is now a very uncommon infection in the UK as a result of the vaccination programme. However, rubella is still common in many developing countries.
What are the symptoms of rubella?
The majority of people have no symptoms when they are infected with rubella. This is called a subclinical infection. If symptoms do develop, they include the following:
- Swollen glands, usually behind the ears and at the back of the neck. Sometimes glands in other parts of the body swell. The glands gradually go back to normal over a week or so.
- A spotty, pink-red rash develops any time up to seven days after the glands swell. The rash usually starts behind the ears, then spreads to the face and neck and then spreads to the rest of the body. The rash lasts 3-5 days before fading.
- A mild fever, cold, cough and sore throat are common.
- Sore red eyes (conjunctivitis) may develop for a few days.
- Joint pains, like a mild arthritis, may develop for a week or so. This is less common in children, but is quite common in adults with rubella.
- Other symptoms may include fever, tiredness and headache.
Bleeding disorders and brain inflammation (encephalitis) are rare complications.
Note: rubella rarely causes complications in healthy people. The main concern of rubella is that is can cause complications in pregnancy.
Is rubella infectious?
Yes. It is passed on by direct contact and by coughing and sneezing the virus into the air. It takes 2-3 weeks to develop symptoms after being infected. You are infectious from one week before symptoms begin until four days after the rash appears. Therefore, affected children should stay away from school and not mix with others for four days after the rash starts.
Rubella and pregnancy
If you are pregnant and have rubella in the first few months of pregnancy, there is a high chance that the virus will cause severe damage to your developing baby. The virus affects the developing organs and the baby may be born with serious disability - the congenital rubella syndrome.
Complications of congenital rubella syndrome include cataracts, deafness, heart, lung and brain abnormalities.
Having rubella infection in the first three months of pregnancy also increases your risk of having a miscarriage:
- If you are pregnant and come into contact with someone with rubella you should check your rubella status. Your midwife or doctor will normally have a record of this if you do not know. (A blood test is routinely taken early in pregnancy. This checks to see if you are immune and have antibodies in your blood against rubella.) Most women are immune due to previous immunisation and will not develop rubella. No further action is needed if you are known to be immune.
- If you are not immune and come into contact with someone with rubella then blood tests may be advised. These can tell if you are developing rubella before symptoms begin. Further action depends on the results of these tests.
- See a doctor if you are pregnant and develop an illness that you think may be rubella. Rubella is uncommon now due to immunisation. Other viruses can cause rashes similar to rubella. Most viruses do not harm the unborn child. Blood tests can confirm or rule out rubella if it is suspected.
In the unlikely case that you are confirmed to have rubella, then you will be referred to an obstetrician to discuss the possibility of your baby having congenital rubella syndrome. The risk is greater if you are less than 20 weeks pregnant. If you are more than 20 weeks pregnant, then the risk of your unborn baby developing congenital rubella syndrome is very small. No treatment can prevent the development of congenital rubella syndrome.
Note: it is very rare for a pregnant woman to catch rubella in the UK. See separate leaflet called 'Pregnancy and Rubella' for more detailed information.
How can you test for immunity to rubella?
Even if you have had a rubella immunisation, or have had rubella infection, there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunisation has worked is to have a blood test. This checks for rubella antibodies.
Because the congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time, you should have a blood test to check that you are protected.
This blood test is offered to all women in the UK who are pregnant and also it may be offered to younger women in routine health checks. However, if you have not had it, you should ask your practice nurse for the blood test. In particular, women who have come to the UK from overseas and have not been immunised are at greatest risk of having a baby with congenital rubella syndrome.
What is the treatment for rubella?
There is no treatment that will kill the virus. Most people with rubella are not very ill, do not need any treatment, and soon make a full recovery. The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one bout of rubella.
- Paracetamol will ease fever or aches and pains. Ibuprofen is an alternative.
- You should give children lots to drink if they have a fever.
- See a doctor if any worrying or unusual symptoms develop.
Immunisation is now offered to all children in the UK as part of the MMR vaccine. Two doses of the vaccine are needed to provide satisfactory protection against rubella.
The first dose is usually given between 12 and 13 months. A second dose is usually given at age 3 years and four months to 5 years, at the same time as the preschool booster of DTaP/IPV(polio) (given as a separate injection). (DTaP stands for diphtheria (D), tetanus (T) and acellular pertussis (aP) (whooping cough). IPV stands for inactivated polio vaccine. Polio is short for poliomyelitis.)
Immunisation gives very good protection and so rubella is now uncommon in the UK. The number of babies born with congenital rubella syndrome has greatly reduced since routine immunisation was introduced.
It is extremely important that all children be immunised against the rubella virus to prevent any complications of rubella occurring.
If you are a woman and are planning to get pregnant, if you are unsure if you are immune then see your practice nurse. A blood test will confirm if you are immune. If you are not immune then you can be immunised before you become pregnant.
Rubella and MMR
Information about rubella, congenital rubella syndrome, and immunisation against rubella from Sense. Sense was founded in 1955 as a support group for the parents of children born deaf-blind as a result of their mothers catching rubella in pregnancy.
Further reading & references
- Guidelines on Rubella (German Measles), Health Protection Agency (2009)
- Rubella; NICE CKS, December 2009
- Muscat M, Zimmerman L, Bacci S, et al; Toward rubella elimination in Europe: An epidemiological assessment. Vaccine. 2011 Dec 14.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Louise Newson
Dr John Cox