Rubella (sometimes referred to as German measles)

Rubella was first described in German medical literature in 1814. The most serious consequences of rubella infection occur when a pregnant woman is infected in the early stages of pregnancy. Damage to foetus is common in early pregnancy.

What is rubella?
Usually a mild acute viral disease accompanied by a low grade fever and a red rash usually starting on the face and progressing from head to foot. It may be fleeting but typically lasts about 3 days. It can be itchy. The rash is fainter than the measles rash and may be more obvious after a hot shower or bath.

What are the symptoms?
Symptoms are often mild. Up to 50% of infections may be subclinical, particularly in children.

Swelling of the lymph glands behind the ear and around the neck usually precede the rash by 5-10 days and may last several weeks.

Older children and adults are more likely to experience a low grade fever headache, fatigue, mild runny nose and conjunctivitis for 1-5 days before the rash develops.

How is it spread?
Rubella is spread through direct airborne transmission or droplet spread (usually by coughing or sneezing) from someone who is infected person with rubella.

The incubation of rubella is 14 days (range 12-23 days). The rash typically appears 14-17 days after exposure.

How infectious is rubella?
Rubella is moderately infectious. Individuals with rubella are most infectious one week before rash onset to 5-7 days after rash onset. Infants with congenital rubella may shed large amounts of virus from their nasal or throat secretions or urine for as long as one year after birth.

Are there any complications with rubella?
Apart from pregnancy related complications (see next section), complications of rubella are not common but are more likely to occur in adults than children.

Complications  Risk of complication Comment 
Arthralgia (pains in joints) 70% women Rare in children and men
Typically affects fingers, wrists and knees
Symptoms may last up to one month
Encephalitis 1 in 6,000 cases More frequent in women
Bleeding disorder 1 in 3,000 cases More common in children

Rubella in pregnancy – risk of congenital rubella
Infection with rubella in early pregnancy can cause serious birth defects in the developing foetus, may lead to foetal death, spontaneous abortion, or premature delivery.

The risk of foetal damage depends on the stage of pregnancy when the mother is infected with rubella. The risk of congenital rubella syndrome developing when infection occurs during the first trimester is about 85% and during the second trimester about 10%-20%. Congenital defects are rare after 20 weeks.

Protect unborn babies from rubella - Infographic (ECDC)

What is Congenital Rubella Syndrome (CRS)?
CRS comprises either one, or a number, of the following defects: deafness, eye defects (cataracts, underdeveloped eyes, glaucoma, pigmented retina), heart defects, neurologic abnormalities (small head, mental retardation behavioural problems), bone abnormalities, splenomegaly (big spleen), hepatitis, bleeding problems (due to low platelets and vascular damage).

Other diseases associated with CRS
Diabetes mellitus, progressive encephalopathy, autism are more common in children with CRS.

Congenital rubella elimination
The European Office of the World Health Organization has set a strategy to eliminate congenital rubella in Europe. The target date is 2015. WHO provides information on next steps towards eliminating measles and rubella in Europe.

How is rubella diagnosed?
It may be indistinguishable from other viral rash illnesses such as measles, dengue, parvovirus B19, human herpesvirus 6, Coxsackie virus, Echovirus, adenovirus, scarlet fever. Laboratory diagnosis is therefore always recommended. Diagnosis may be made with oral fluid swab sample or serum.

How is rubella prevented?
Rubella infection is prevented by vaccination. Rubella vaccine was first introduced into Ireland in 1971. Since 1988 the combined measles-mumps-rubella (MMR) vaccine has been routinely used in the childhood immunisation programme. Two doses are recommended, the first dose at 12 months and the second at 4-5 years of age. Over 98% of vaccine recipients develop immunity to rubella after vaccination with two doses of MMR.

Rubella, both acute infection in children and adults as well as congenital rubella infection is notifiable. All cases should be reported to the Medical Officer of Health in the local HSE Department of Public Health.

Last reviewed: 15 February 2016