Rubella (German measles)

At a glance

  • Rubella (German measles) is a viral infection that can occur at any age.

  • It often goes unnoticed or only causes mild cold-like symptoms and a skin rash.

  • In early pregnancy rubella can lead to serious organ damage in the unborn child.

  • There is an effective vaccine against rubella.

Introduction

Photo of a girl crying
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Rubella (German measles) is a viral that can occur at any age. It is usually a harmless disease – apart from during early pregnancy: If a woman gets rubella in the first four months of pregnancy, her unborn child is very likely to have serious birth defects.

Thanks to the introduction of the rubella vaccine, this disease is very rare nowadays.

Symptoms

Rubella usually goes unnoticed or only causes mild cold-like symptoms such as a cough, runny nose and headache. Sometimes it also leads to swollen lymph nodes in the neck area, a mild fever or conjunctivitis (pink eye). That might be followed by a pink or red spotty skin rash that doesn’t itch.

The rash starts behind the ears, spreads across the face, and then across the rest of the body. It goes away again after 1 to 3 days. Children usually only have the rash. Adults often have a headache, joint pain and a fever too. 

Illustration: Typical rash in rubella

Typical rash in rubella

Causes

Rubella viruses are spread through droplets of fluid that are released into the air when speaking, coughing or sneezing. Pregnant women who have rubella might pass the viruses on to their unborn child.

Prevalence

Before the vaccine was introduced, rubella mainly occurred in children. Thanks to the vaccine, rubella infections are very rare nowadays: There are only about 20 to 40 reported cases of rubella per year in Germany. Half of these occur in adults. But because rubella often doesn't cause any symptoms, not all cases are recognized and reported.

Outlook

The symptoms of rubella only start appearing 2 to 3 weeks after . They last about one week. There is a risk of infecting others between one week before and up to one week after the rash appears.

Effects

Rubella is usually a harmless . In rare cases, it can lead to , a middle ear infection, or an of the heart muscle or brain. These complications tend to be more common in adults.

But rubella can be dangerous for unborn children: If a woman gets rubella in the first four months of pregnancy, it can seriously harm her child, for instance by causing damage to their eyes, heart, inner ear (deafness), or even their brain. It can also lead to a miscarriage or premature birth. The risk of rubella harming the baby is very low after four months of pregnancy, though.

Diagnosis

Because of the similar rash, rubella is sometimes mistaken for other diseases such as measles or scarlet fever. So in order to find out for sure whether it’s rubella, a throat swab or urine sample has to be taken and tested for the virus. A blood test for antibodies can be done too, but only provides reliable results several days after the rash appears.

Prevention

There is an effective and safe vaccine to prevent rubella infections. It is recommended for all children – and all women of childbearing age who haven’t yet had the rubella vaccine, or aren't sure if they have. The standard tests that are done as part of pregnancy check-ups include a test to see whether the woman is immune to (protected against) rubella. But she isn't allowed to be given the rubella vaccine during pregnancy.

People who are regularly in contact with pregnant women should have the vaccine too – as well as those who work in community facilities such as daycare centers, schools, hospitals or further education facilities.

The rubella vaccine is given together with the measles and mumps vaccines in a combined vaccine (the MMR vaccine), or additionally together with the chickenpox vaccine (the MMRV vaccine). You can’t get a rubella vaccine on its own in Germany.

The first dose of the vaccine is given at the age of 11 months. A second dose is given at the age of 15 months. Children who go to a daycare center before that can already be vaccinated from the age of 9 months.

After having the vaccine, people are generally protected against rubella for the rest of their lives.

It is important that people have the rubella vaccine in order to stop the disease from spreading. If most of the population has been vaccinated, that also protects people who can’t have the vaccine, such as pregnant women. This is known as herd immunity or the herd effect. For herd immunity to be achieved, as many people as possible have to have the .

Treatment

There are no effective treatments to fight the that causes rubella. If necessary, the symptoms can be relieved with painkillers or fever-lowering medications. It’s important to get plenty of bed rest so that your body can fight the and recover.

Everyday life

Children and adults who have rubella should avoid close contact with other people – particularly pregnant women. They shouldn't go to community facilities such as schools, daycare centers or nursing homes. This is also true if they work there. Until their symptoms have gone away, they should avoid public events, parties and other social occasions.

For pregnant women who haven't had the rubella vaccine, it’s very important that they avoid contact with people who have rubella. Up until 20 weeks of pregnancy (five months), they aren’t allowed to do any work that involves close contact with children and teenagers.

It is important to inform everyone who you have (had) personal contact with about the possibility of . This also includes calling the doctor's practice beforehand so that they can take the necessary safety precautions when you go there. People who don’t have enough protection against rubella are advised to have the as soon as possible if they come into contact with someone who has the disease. The aim of doing this is to prevent it from spreading further.

Further Information

In Germany and other countries, rubella is officially an infectious disease that must be reported. If a doctor suspects that you have rubella, they have to inform the relevant health authorities immediately – even if the hasn't yet been confirmed.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2020; (4): CD004407.

Leung JH, Hirai HW, Tsoi KK. Immunogenicity and reactogenicity of tetravalent vaccine for measles, mumps, rubella and varicella (MMRV) in healthy children: a meta-analysis of randomized controlled trials. Expert Rev Vaccines 2015; 14(8): 1149-1157.

Robert Koch-Institut (RKI). Infektionskrankheiten A-Z: Röteln. May 20, 2020.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on November 5, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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