Rubella (also known as german measles) is a viral infection that used to be common in children. It is usually a mild condition that gets better without treatment in seven to 10 days.
Symptoms of rubella include:
a red-pink skin rash made up of small spots
swollen glands around the head and neck
a high temperature (fever)
cold-like symptoms such as a cough and runny nose
aching and painful joints (more common in adults)
The symptoms of rubella usually only last a few days, but your glands may be swollen for several weeks..
When to see your GP
You should always contact your GP if you suspect that you or your child has rubella.
Do not visit your GP surgery without phoning first, as arrangements may need to be made to reduce the risk of infecting others.
Rubella and pregnancy
The main time that rubella becomes a serious concern is if a pregnant woman catches the infection during the first 20 weeks of her pregnancy.
This is because the rubella virus can disrupt the development of the baby and cause a wide range of health problems, such as:
eye problems, such as cataracts (cloudy patches on the lens of the eye)
The birth defects caused by the rubella virus are known as congenital rubella syndrome (CRS).
Since the introduction of the mumps, measles and rubella (MMR) vaccine, CRS is now very rare in the UK, with only eight cases reported between 2002 and 2011.
How it spreads
Rubella is caused by a type of virus called a togavirus. It is spread in a similar way to a cold or flu, through droplets of moisture from the nose or throat of someone who is infected. These droplets are released into the air when someone coughs, sneezes or talks.
You can become infected if you come into contact with the droplets from an infected person, although it can take two to three weeks for symptoms to develop.
If you have rubella, you will be infectious to other people from one week before symptoms develop, and for up to four days after the rash first appeared.
You should stay away from school or work for six days after the rash starts to avoid infecting others and try to avoid contact with pregnant women during this time.
Who is affected
Rubella is rare in the UK nowadays. Most cases occur in people who came to the UK from countries that do not offer routine immunisation against rubella.
However, there can occasionally be large outbreaks of rubella in the UK. One of these occurred in 1996 when there were close to 4,000 cases in England and Wales.
During 2012, there were around 65 confirmed cases of rubella in England and Wales, an increase from only six cases in 2011.
There is no specific treatment for rubella, but symptoms will normally pass within seven to 10 days. If you or your child are finding the symptoms uncomfortable, you can treat some of these at home while you wait for the infection to pass.
For example, paracetamol or ibuprofen can be used to reduce the fever and treat any aches or pains. Liquid infant paracetamol can be used for young children. Aspirin should not be given to children under 16 years old.
The best way to prevent rubella is to be immunised with the MMR vaccine.
Children are offered this vaccine as part of their routine childhood immunisation programme. It is given in two doses, one when they are 12-13 months old and a booster when they are three to five years old.
Routine vaccination is important because it reduces the risk of large outbreaks and helps to protect pregnant women and their babies.
The MMR vaccine can also be given to older children and adults who have not been fully immunised before.
Contact your GP if you are uncertain about whether you or your child’s vaccinations are up to date.
A red-pink rash is a common symptom of rubella
Advice for pregnant women
Contact your GP if you are pregnant and you think you may have been in close contact with someone with rubella.
They will be able to refer you for tests to see if you have contracted rubella, although this is unlikely.
Symptoms of rubella
The symptoms of rubella usually take two to three weeks to develop after infection. This time is called the incubation period.
Some infected people will not develop any symptoms, but in those who do, a rash and swelling around the neck and head are common signs of the condition.
A red-pink rash
The rubella rash is typically a red-pink colour. It consists of a number of small spots, which may be slightly itchy.
The rash usually starts behind the ears, before spreading around the head and neck. It may then spread to the trunk (chest and tummy), legs and arms.
In most cases, the rash will disappear by itself within three to five days.
Swollen lymph glands
Lymph nodes, or glands, are small lumps of tissue found throughout the body. They contain white blood cells that help fight bacteria, viruses and anything else that causes infection.
If you have rubella, the glands behind the ears, below your skull at the back of your head, and in your neck usually swell. In some cases, this swelling can be painful.
These lymph glands sometimes start to swell before the rash appears and the swelling can last for several weeks after the rash has gone.
As well as a rash and swollen lymph glands, people with rubella may also develop other symptoms, including:
a high temperature (fever), which is usually mild (less than 39C or 102.2F), but can be more severe in adults
cold-like symptoms, such as a runny nose, watery eyes, sore throat and cough
slightly sore and red eyes (conjunctivitis)
aching and painful joints
loss of appetite
These symptoms may develop shortly before the rash and usually last for a few days.
Seeking medical advice
You should always contact your GP if you suspect that you or your child have rubella.
While the condition is usually mild, it is important that the diagnosis is confirmed by a doctor as the symptoms could be due to a more serious illness. It is also important that any cases of rubella are reported to the relevant local health authorities so they can track the spread of infection in case there is a sudden outbreak of cases.
Do not visit your GP surgery without phoning first as arrangements may need to be made to reduce the risk of infecting others. In particular, contact with pregnant women should be avoided if possible because rubella can cause serious problems in an unborn baby (although this is rare nowadays).
If you suspect that you or your child have rubella, phone your GP surgery 111 straight away for advice.
Do not visit your GP surgery without phoning first, as arrangements may need to be made to reduce the risk of spreading any infection to other people. In particular, contact with pregnant women should be avoided if possible because rubella can cause serious problems in an unborn baby (although this is very rare nowadays).
Your GP should be able to arrange a time for you to visit that won't put other people at risk, or they may come out to visit you or your child.
You should keep your child away from school (or yourself away from work) until you have seen your GP.
Your GP may suspect that you have rubella from your symptoms, but as other viral infections often have similar symptoms, testing a sample of saliva or blood is the only way to confirm a diagnosis.
Saliva and blood tests
If rubella is suspected, a sample of saliva from your mouth or a sample of blood from a vein in your arm can be taken and tested for certain antibodies.
Antibodies are proteins that your body produces to destroy disease-carrying organisms and toxins. If you have rubella or you have had it in the past, your saliva or blood will test positive for certain antibodies, which are listed below:
The IgM antibody will be present if you have a new rubella infection.
The IgG antibody will be present if you have had the rubella infection in the past, or you have been vaccinated against it.
If neither antibody is present, you do not have rubella and you have not been immunised against it.
Diagnosis in pregnancy
If you are pregnant, a blood test to check if you are immune to rubella will usually be carried out as part of your antenatal care. This is because a rubella infection in early pregnancy carries a risk of causing serious problems in your baby.
Most women are immune to rubella, and rubella infections during pregnancy are very rare in the UK. However, if the test shows you are not immune to the condition, you will be offered advice about avoiding the infection and what to do if you think you may be infected.
If you are not immune to rubella, you should contact your GP or midwife as soon as possible if:
you have had face-to-face contact with someone who has rubella
you have spent more than 15 minutes in the same room as someone who has rubella
you have symptoms of rubella
It is unlikely that you have rubella in these circumstances, but a further blood test may be necessary to check for the condition.
In the rare cases where testing shows that you do have rubella, you will be referred to a doctor who specialises in conditions that can affect unborn babies (an obstetrician).
The obstetrician may carry out tests such as an ultrasound scan and amniocentesis to check for any signs of problems in your baby.
You will also be offered counselling so you can make an informed decision about whether you wish to proceed with the pregnancy if serious problems are found.
There is no specific treatment for rubella. The condition is usually mild and improves without treatment within seven to 10 days.
Phone your GP surgery 111 for advice if you think that you or your child have rubella. Do not visit your GP surgery unless you are advised to do so.
Treating your symptoms
If the symptoms of rubella are causing discomfort for you or your child, there are some things you can do to treat these while you wait for the infection to pass.
Controlling fever and relieving pain
If necessary, paracetamol or ibuprofen can be used to reduce a high temperature (fever) and treat any aches or pains. Liquid infant paracetamol can be used for young children. Aspirin should not be given to children under 16 years old.
Speak to your pharmacist if you are not sure which medications are suitable for your child.
If your child's high temperature is causing them distress, you can also try to reduce it by keeping them cool. A cool (but not cold) compress, such as a damp flannel held to their forehead, can help.
Drink plenty of fluids
If your child has a high temperature, make sure they drink plenty of fluid because they may be at risk of dehydration. Keeping hydrated will also help reduce discomfort caused by coughing.
Treating cold-like symptoms
If you have cold-like symptoms such as a runny nose, sore throat or a cough, there are a number of things you can do to feel more comfortable.
For example, steam inhalation may offer some relief from a cough. This involves sitting with your head over a bowl of hot water. Place a towel over your head, close your eyes and breathe deeply, while trying not to get the hot steam in your eyes.
Steam inhalation is not advised for children because of the risk of scalding, but it might help your child if they sit in a hot, steamy bathroom. Alternatively, putting a wet towel on a warm radiator will release more water into the air.
Giving your child warm drinks, particularly ones containing lemon or honey, may also help to relax their airways, loosen mucus and soothe a cough. However, honey should not be given to babies under 12 months.
Avoiding the spread of infection
While you have rubella, it is important to reduce the risk of spreading the infection to other people.
If you or your child have the condition, you should avoid work or school for six days from when you first developed the rubella rash.
In rare cases, rubella can cause serious problems in an unborn baby, so you should also try to avoid contact with pregnant women for six days from the start of the rash.
Complications of rubella
Serious complications of rubella are rare, particularly since the measles, mumps and rubella (MMR) vaccine was introduced.
In the small number of cases where an infection develops in pregnancy, however, there is a serious risk to the unborn baby.
If a pregnant woman catches rubella, the infection can be passed to her baby. This can result in problems such as miscarriage (the loss of the pregnancy during the first 23 weeks) and a range of birth defects known as congenital rubella syndrome (CRS).
Congenital rubella syndrome (CRS)
CRS occurs when the virus that causes rubella disrupts the development of an unborn baby. It is very rare in the UK nowadays, with only eight cases reported between 2002 and 2011.
The risk of CRS affecting the baby and the extent of the birth defects it causes depends on how early in the pregnancy the mother is infected. The earlier in the pregnancy, the greater the risk.
The risks are:
infection in first 10 weeks – the risk of CRS is as high as 90% and the baby is likely to have multiple birth defects
infection in 11th-16th weeks – the risk of CRS drops to around 10-20% and it is likely that affected babies will have fewer birth defects
infection in 17th-20th weeks – CRS is very rare, with deafness the only problem reported
There is not thought to be any risk of CRS developing if you are infected with rubella after the 20th week of pregnancy.
If a pregnant woman does become infected with rubella during the first 20 weeks of pregnancy, there is no treatment that is known to be effective in preventing CRS.
Problems caused by CRS
CRS can cause the following problems in babies:
cataracts (cloudy patches in the lens of the eye) and other eye defects
congenital heart disease (where the heart does not develop in the right way)
a small head compared with the rest of the body, as the brain is not fully developed
a slower than normal growth rate in the womb
damage to the brain, liver, lungs or bone marrow
Children born with CRS can develop problems later in their lives as well. These include:
type 1 diabetes – a long-term condition that is caused by too much glucose in the blood
overactive thyroid or underactive thyroid – the thyroid gland produces hormones to control the body’s growth and metabolism
swelling inside the brain – this causes a loss of mental and movement functions
Occasionally, hearing problems are not obvious at birth, but are detected as the child gets older.
The best way to avoid catching rubella is to be immunised with the measles, mumps and rubella (MMR) vaccine.
The MMR vaccine is part of the routine childhood immunisation programme. One dose is usually given to a child when they are 12-13 months old. A second booster dose is given before they start school, usually between three and five years old.
Contact your GP if you are uncertain about whether your child’s vaccinations are up to date.
It is possible to have the MMR vaccination at any age. If you suspect that your immunisation is not up to date and you are at risk of catching mumps, measles or rubella, your GP may recommend that you have the MMR vaccine. For example, this may be necessary if there is an outbreak of measles, or if you are a woman planning to get pregnant (see below).
If you are already immunised, having the MMR vaccine again will not cause you any harm.
Planning a pregnancy
If you are considering trying for a baby, ask your GP to test your immunity to rubella before you become pregnant. As immunity to rubella can sometimes wear off over time (even if you have had the MMR vaccine), it is important that your immunity level is checked by your GP before every pregnancy.
If the test shows you may not be immune to rubella, you will be offered the MMR vaccine to protect you against rubella. You can have the MMR vaccine before you become pregnant, but it is not recommended during pregnancy. After having the MMR vaccine, you should take care to avoid becoming pregnant for one month.
If you are pregnant
If you are pregnant, you will be offered a rubella immunity blood test by your GP or midwife as part of your antenatal care. Most women are immune and no further action is required.
If you are not immune to rubella, try to avoid anyone who has the rubella virus. Inform your GP if you come into contact with anyone who has the rubella virus.
You can receive the MMR vaccination after giving birth to protect you against rubella in the future. The MMR vaccine can be given to breastfeeding mothers without any risk to their baby.
Limiting the spread of infection
Someone who has the rubella virus is infectious for one week before symptoms appear and for around four days after the rash first develops.
If you or your child have rubella, you should limit the risk of infecting other people by staying off work or school for six days after you develop the rash.
You should also try to avoid contact with pregnant women for at least six days from the start of the rash.
Vaccination before travelling
Although rubella is uncommon in the UK, the condition is more widespread in some other parts of the world, such as areas of Africa, Asia and South America.
You should contact your GP before travelling to areas with high rates of rubella if you are unsure whether you have been fully immunised against the condition.
In some cases, having the MMR vaccine before travelling may be recommended.