Rubella — commonly known as German measles or 3-day measles — is an
infection that mostly affects the skin and lymph nodes. It is caused by the rubella
virus (not the same virus that causes measles).
Rubella spreads when people breathe in virus-infected fluid, such as the
droplets sprayed into the air when a person with rubella sneezes or coughs, or
share food or drink with someone who's infected. It also can pass through a
pregnant woman's bloodstream to infect her unborn child.
It's a generally mild disease in children; the primary medical danger of rubella
is the infection of pregnant women because it can cause congenital rubella syndrome
in developing babies.
Before a vaccine against rubella
became available in 1969, rubella epidemics happened every 6-9 years, usually among
kids 5 to 9 years old, along with many cases of congenital rubella. Thanks to immunization,
there are far fewer cases of rubella and congenital rubella.
Most rubella infections today appear in young, non-immunized adults rather than
in kids. In fact, experts estimate that 10% of young adults are currently susceptible
to rubella, which could pose a danger to any children they might have someday.
Signs and Symptoms
Rubella infection may begin with 1-2 days of mild fever
(99-100°F, 37.2–37.8°C) and swollen, tender lymph nodes, usually in the back
of the neck or behind the ears. A rash then begins on the face and spreads downward.
As it spreads, it usually clears on the face.
The rubella rash is often the first sign of illness that a parent notices. It can
look like many other viral rashes, appearing as either pink or light red spots, which
may merge to form evenly colored patches. The rash can itch and lasts up to 3 days.
As the rash clears, the affected skin might shed in very fine flakes.
Other symptoms of rubella (these are more common in teens and adults) can include
headache, loss of appetite, mild conjunctivitis
(inflammation of the lining of the eyelids and eyeballs), a stuffy or runny nose,
swollen lymph nodes in other parts of the body, and pain and swelling in the joints
(especially in young women). Many people with rubella have few or no symptoms.
Rubella in a pregnant woman can cause congenital rubella syndrome, with potentially
devastating consequences for the developing fetus. Children who are infected with
rubella before birth are at risk for growth problems; intellectual disability; defects
of the heart and eyes; deafness; and liver, spleen, and bone marrow problems.
The rubella virus passes from person to person through tiny drops of fluid from
the nose and throat through sneezing and coughing. People who have rubella are most
contagious from 1 week before to 1 week after the rash appears. Someone who is infected
but has no symptoms can still spread the virus.
Infants who have congenital rubella syndrome can shed the virus in urine and fluid
from the nose and throat for a year or more and may pass the virus to people who have
not been immunized.
Rubella can be prevented by the rubella vaccine. Widespread immunization against
rubella is critical to controlling the spread of the disease, thereby preventing birth
defects caused by congenital rubella syndrome.
The vaccine is usually given to children at 12–15 months of age as part of
the scheduled measles-mumps-rubella
(MMR) immunization. A second dose of MMR usually is given at 4–6 years of age.
As with all immunization schedules, there are important exceptions and special circumstances.
For example, if your child will be traveling outside the United States, the vaccine
can be given as early as 6 months of age. Talk
to your child's doctor to see when the vaccine is needed.
The rubella vaccine should not be given to pregnant women or to a woman who may
become pregnant within 1 month of receiving the vaccine. If you are thinking about
becoming pregnant, make sure that you're immune to rubella through a blood test or
proof of immunization. If you're not immune, you should receive the vaccine at least
1 month before you become pregnant.
Pregnant women who are not immune should avoid anyone who has the illness and should
be vaccinated after delivery so that they will be immune during any future pregnancies.
The incubation period for rubella is 14–23 days, with an average incubation
period of 16–18 days. This means that it can take 2–3 weeks for a child
to get rubella after being exposed to someone with the disease.
The rubella rash usually lasts 3 days. Lymph nodes may remain swollen for a week
or more, and joint pain can last for more than 2 weeks. Children who have rubella
usually recover within 1 week, but adults may take longer.
Rubella cannot be treated with antibiotics because they do not work against viral
infections. Unless there are complications, rubella will get better on its own.
Any pregnant woman who has been exposed to rubella should contact her obstetrician
Rubella usually is mild in kids, who often can be cared for at home. Monitor your
child's temperature and call the doctor if the fever
climbs too high.
To ease minor discomfort, you can give your child acetaminophen
or ibuprofen. Remember,
you should nevergive aspirin to
a child who has a viral illness, as its use in such cases has been associated with
the development ofReye syndrome.
When to Call the Doctor
Call your doctor if your child appears to be getting sicker than the mild course
of symptoms described above.