Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash. Up to half of people infected with rubella don’t have any symptoms and may not even know they’re infected but still spread it to other people. If you get infected during pregnancy, rubella can cause serious problems for your baby. Infection causes the most severe damage when the pregnant person is infected early in their pregnancy, especially in the first 12 weeks (3 months). Rubella has been nearly eliminated in the United States because of the routine vaccination of children. Vaccination protects a person against rubella for life. But people who were never vaccinated as children can get infected. You can be vaccinated as an adult when you are not pregnant. Between 2005 and 2011, 67 cases of rubella were reported in this country. This is up from the previous period—2001 to 2004—when only 5 cases were reported. Vaccination is the best way to prevent infection. Today less than 10 people in the United States are reported to have rubella and it is usually associated with travel and not being vaccinated. Rubella is common in many other countries. Travelers can bring it into the United States, or you can get it when traveling outside the country. It’s important to get vaccinated for rubella. Talk to your health care provider to make sure you’re protected against it. A blood test can provide you with information about your immunity to rubella What are the signs and symptoms of rubella?Rubella is usually mild, with flu-like symptoms followed by a pink or light red rash. The rash usually starts on the face, then spreads to the rest of the body. The rash lasts about 3 days. Other symptoms include:
Up to 7 in 10 (70 percent) teenage and adult women who get rubella develop arthritis. Arthritis is swelling and pain in your joints. Women who are infected with rubella may feel arthritis in their fingers, wrists and knees. This complication is rare in men or children who get rubella. In rare cases, rubella can cause serious problems, including brain infections and bleeding problems. Some people have no symptoms so you may not know that you or they have rubella. What causes rubella?Rubella is caused by a virus (a tiny organism that can make you sick). It is not caused by the same virus that causes measles. It’s very contagious. It spreads through the air when an infected person coughs or sneezes, or by sharing food or drinks with someone who is infected. It also can be passed to a baby from a pregnant person who is infected. A person with rubella may spread the disease to other people up to 1 week before they notice a rash. Infected people can continue to spread the disease up to 7 days after getting a rash. People infected with rubella should tell their friends, family, and the people they work with if they have rubella. If your child has rubella, it’s important to tell their school or daycare provider. Telling others helps prevent the spread of rubella to even more people. What problems can rubella cause during pregnancy?Rubella can be serious for the baby, especially during the first 3 months. Having rubella during pregnancy increases the risk of:
Can you pass rubella to your baby during pregnancy?Yes. The best way to protect your baby is to make sure you’re immune to rubella. Immune means being protected from an infection. If you’re immune to an infection, it means you can’t get the infection. You are probably immune to rubella because you were vaccinated as a child or you had the illness during childhood. A blood test can tell if you’re immune to rubella. If you’re thinking about getting pregnant and aren’t sure if you’re immune, talk to your health care provider about getting a blood test. If you were not born in the United States or came as an adult you may not be vaccinated against rubella. Ask your health care provider to do a blood test to see if you are immune to rubella. If you’re not immune to rubella, here’s what you can do to help protect your baby: Before pregnancy. Get the measles, mumps and rubella (MMR) vaccine. Wait 1 month before trying to get pregnant after getting the shot. During pregnancy. You can be tested at a prenatal visit to make sure you’re immune to rubella. If you’re not immune, the MMR vaccine isn’t recommended during pregnancy. But there are things you can do to help prevent getting infected with rubella:
After pregnancy. Get the MMR vaccination after you give birth. It is safe to get the MMR vaccine while nursing. Being protected from the infection means you can’t pass it to your baby before they get their own MMR vaccination at about 12 months. It also prevents you from passing rubella to your baby during a future pregnancy. What are the chances of passing rubella to your baby during pregnancy?You’re more likely to pass rubella to your baby the earlier you become infected during pregnancy. For example:
If you have rubella during pregnancy, your baby’s provider will carefully monitor your baby after birth to find any problems early. How is rubella treated?There is no specific medicine to treat rubella. In many cases, the symptoms of the disease are mild. Staying in bed (bed rest), drinking fluids and taking medicines to reduce fever can help. Pregnant people with rubella may be treated with acetaminophen to relieve their symptoms. In more serious cases, treatment may include blood transfusion or steroids. A blood transfusion is when you have new blood put into your body. Steroids are synthetic hormones that treat inflammation. Contact your health care provider if you are pregnant and think you have rubella or have been exposed to the disease. See also: Your baby’s vaccinations, Vaccinations and pregnancy Last reviewed: August 2021
Rubella is a viral illness that can lead to complications and death. It is characterized by a mild, maculopapular rash along with lymphadenopathy, and a slight fever. The rash usually starts on the face, becomes generalized within 24 hours, and lasts a median of 3 days; it occurs in 50% to 80% of infected people, Lymphadenopathy, which may precede rash, often involves posterior auricular or suboccipital lymph nodes, can be generalized, and lasts between 5 and 8 days. About 25% to 50% of infections are asymptomatic. Clinical diagnosis of rubella virus is unreliable and should not be considered in assessing immune status. Up to half of all infections may be subclinical or unapparent. Many rubella infections are not recognized because the rash resembles many other rash illnesses. The VirusRubella virus is an enveloped, positive-stranded RNA virus classified as a Rubivirus in the Matonaviridae family. BackgroundBefore the rubella vaccine was licensed in the United States in 1969, rubella was a common disease that occurred primarily among young children. Epidemics occurred every 6 to 9 years, with the highest number of cases during the spring. Rubella was declared eliminated (the absence of endemic transmission for 12 months or more) from the United States in 2004. However, it is still commonly transmitted in many parts of the world. As a result, less than 10 cases (primarily import-related) have been reported annually in the United States since elimination was declared. Rubella incidence in the United States has decreased by more than 99% from the pre-vaccine era. Because rubella continues to circulate in other parts of the world, an estimated 100,000 infants are born with congenital rubella syndrome (CRS) annually worldwide. ComplicationsArthralgia or arthritis may occur in up to 70% of adult women with rubella. Rare complications include thrombocytopenic purpura and encephalitis. When rubella infection occurs during pregnancy, especially during the first trimester, serious consequences can result. These include miscarriages, fetal deaths/stillbirths, and severe birth defects known as CRS. The most common congenital defects are cataracts, heart defects, and hearing impairment. TransmissionRubella is transmitted primarily through direct or droplet contact from nasopharyngeal secretions. Humans are the only natural hosts. In temperate climates, infections usually occur during late winter and early spring. The average incubation period of rubella virus is 17 days, with a range of 12 to 23 days. People infected with rubella are most contagious when the rash is erupting, but they can be contagious from 7 days before to 7 days after the rash appears. Diagnosis and TreatmentHealthcare providers should
See information on laboratory testing here. There is no specific antiviral therapy for rubella infection. Evidence of ImmunityAcceptable presumptive evidence of immunity against rubella includes at least one of the following:
Healthcare providers should not accept verbal reports of vaccination without written documentation as presumptive evidence of immunity. For additional details about evidence of immunity criteria, see Table 3 in Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). Top of Page VaccinationRubella can be prevented with rubella-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen rubella vaccine is not available. One dose of MMR vaccine is about 97% effective at preventing rubella if exposed to the virus. Vaccine RecommendationsChildrenCDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age or at least 28 days following the first dose. AdultsAdults born during or after 1957 should receive at least one dose of rubella-containing vaccine. These people include students attending colleges or other post high school educational institutions, healthcare personnel, international travelers, and non-pregnant women of childbearing age. Healthcare providers should routinely assess women of childbearing age for evidence of immunity (see section above) and vaccinate those who lack acceptable evidence of immunity and who are not pregnant. Pregnant women who do not have evidence of immunity should be vaccinated immediately after giving birth. For more information, see rubella vaccination recommendations. Some people should not get MMR vaccine. For information about contraindications, see who should NOT get vaccinated with MMR vaccine. IsolationPatients with rubella should be isolated for 7 days after they develop rash. In settings where pregnant women may be exposed, outbreak control measures should begin as soon as rubella is suspected and should not be postponed until laboratory confirmation of cases. People at risk who cannot readily provide acceptable evidence of rubella immunity should be considered susceptible and should be vaccinated. People without evidence of immunity who are exempt from rubella vaccination for medical, religious, or other reasons should be excluded from affected institutions in the outbreak area until 23 days after the onset of rash in the last case of rubella. Unvaccinated people who receive MMR vaccine as part of rubella outbreak control may immediately return to school provided all people without documentation of rubella immunity have been excluded. Top of Page |
A nurse is providing teaching about the rubella immunization to a client who is 24 hours postpartum
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