Rubella
Introduction
Rubella (also known as German measles) is a viral infection that used to be common in children. Rubella is usually a mild infection.
Symptoms of rubella include:
- a distinctive red-pink skin rash
- swollen glands (nodes)
- cold-like symptoms such as a sore head and runny nose
Read more about the symptoms of rubella.
Rubella and pregnancy
The only time that rubella becomes a serious concern is if a pregnant woman catches the infection during the first 16 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)
- deafness
- heart abnormalities
- brain damage
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. There was only one recorded case during 2007 (the last year for which data are available) in the UK.
Read more about the complications of rubella.
The MMR vaccine
Children are immunised against rubella as part of their routine childhood immunisation programme.
This is done with the MMR vaccine which is given in early childhood. Read more about the MMR vaccine and preventing rubella.
When to see your GP
You should always contact your GP if you suspect that you or your child have rubella.
Do not visit your GP surgery. Telephone them instead as there may be pregnant women in the waiting room.
Treating rubella
Rubella does not usually require medical treatment as the symptoms will normally pass within 7-10 days.
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.
Read more about treating rubella.
What causes rubella?
Rubella is caused by the rubella virus, which is spread in much the same way as a cold or the flu.
Rubella is spread 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.
If you inhale an infected droplet you can become infected. It can take 2-3 weeks for symptoms to develop but you will only be infectious to other people for one week before symptoms appear, and for up to six days after the rash has started.
Anyone with rubella should stay away from school or work for six days after the rash starts to avoid infecting others. It’s also important to avoid contact with pregnant women.
Once a person has had rubella they should develop a life-long immunity against further infection.
Read more about the causes of rubella.
Who is affected
Rubella is now very rare in England and Wales. There were only 12 reported cases during 2010 in England and Wales.
Most of the cases occurred in people who were born in countries that do not offer routine immunisation against rubella.
There can occasionally be large outbreaks of cases. One of these occurred in 1996 when there were close to 4,000 cases in England and Wales. This is why children should be vaccinated against it.
Also, making sure children are routinely vaccinated helps to protect pregnant women and their babies.
Advice for pregnant women
If you are pregnant and you think you may have been in close contact with someone with rubella then contact your GP.
They will be able to refer you for tests to see if you have contracted rubella (which is unlikely, but it is important to take precautions).
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Symptoms
The symptoms of rubella take 2-3 weeks to develop after someone is infected with the rubella virus. This time is called the incubation period.
During the incubation period some people may have a slightly raised temperature, conjunctivitis or feel like they are getting a cold.
Some of the main symptoms of the rubella virus, when it develops, are described below.
A distinctive red-pink rash
The rubella rash is a distinctive red-pink colour. The rash appears as spots, which may be slightly itchy. It usually starts behind the ears, before spreading around the head and neck. It may then spread to the trunk (abdomen and chest), legs and arms. The rash usually lasts for 3-7 days.
Swollen lymph nodes
Swelling usually appears behind the ears, below your skull at the back of your head, and in your neck. Swollen lymph nodes (glands) can be painful. Sometimes they appear before the rash, and can last for a week after the rash has disappeared.
A high temperature
A high temperature (fever) of 38ºC (100.4ºF) or more is a symptom of rubella which, although more common in children, can be more severe in adults. Your temperature may remain high for several days.
Cold-like symptoms
Cold-like symptoms, such as a runny nose, watery eyes, sore throat and cough, are common in rubella, particularly in adults.
When to seek medical advice
You should always contact your GP if you suspect that you or your child have rubella.
Do not visit your GP surgery. Telephone them instead as there may be pregnant women in the waiting room.
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 that they can track the spread of infection in case there is a sudden outbreak of cases.
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Causes
Rubella is caused by the rubella virus. The virus is spread 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.
If you inhale an infected droplet of moisture, you can get rubella. This can easily happen through face-to-face contact with someone who is infected, or from just being together in the same room.
Once you have had rubella then you normally develop a life-long immunity against further infection.
Congenital rubella syndrome
If a pregnant woman who does not have immunity to rubella (either due to previous infection or vaccination) catches the rubella virus, then the virus can be passed on to her unborn baby.
The virus can disrupt the development of the baby, causing a series of birth defects that are known as congenital rubella syndrome (CRS).
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 risks.
If a woman catches rubella during the first 10 weeks of pregnancy then the chance of her baby being affected by CRS is as high as 90% and the baby is likely to experience multiple birth defects.
If a woman catches rubella between the 11th and 16th week of pregnancy then the risk of CRS occurring drops to around 10-20% and it is likely that CRS will only result in a single birth defect.
Birth defects are rare if an infection occurs after the 16th week. The most commonly reported birth defect (at least in the past when rubella was more common) caused by infection in later pregnancy is deafness.
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Diagnosis
If you suspect that you or your child has rubella, phone your GP surgery, or call NHS Direct on 0845 4647 straight away for advice.
Do not visit your GP surgery without calling them first. If you do, you will put any pregnant women who may be there at risk of catching the rubella infection.
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 other viral infections often have similar symptoms, so a blood test is the only way to confirm a diagnosis.
Blood test
A sample of blood will be taken from a vein in your arm 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 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 immunised against it.
- If neither antibody is present, you do not have rubella and you have not been immunised against it.
Diagnosis in pregnant women
If you are pregnant and have some of the symptoms of rubella, your GP may want to test you for the infection to rule it out early on.
This is because of the risk of birth defects developing if rubella infection occurs in early pregnancy.
You should see your GP if you have had face-to-face contact with someone who has rubella, or if you have spent more than 15 minutes in the same room as someone who has rubella. If you have not previously been immunised against the infection, your GP may wish to do further tests.
If testing shows that you have rubella you will be referred to a doctor who specialises in conditions that can affect unborn babies (an obstetrician).
The obstetrician will use tests such as an ultrasound scan and amniocentesis to check if your baby does have congenital rubella syndrome (CRS). They may be able to determine the type and extent of the birth defects they may be born with.
You will also be offered counselling so you can make an informed decision about whether you wish to proceed with the pregnancy.
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Treatment
There is no specific treatment for the rubella infection. The condition is usually mild and will improve without any treatment. Symptoms usually disappear within 7-10 days.
Phone your GP surgery or call NHS Direct Wales (0845 4647) 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.
If you have rubella, you should:
- stay off work for six days from the start of the rash
- keep your child off school for six days from the start of their rash (if they have rubella)
- avoid any contact with pregnant women for at least a week after the start of the rash
Self-help treatment
The rash itself does not need any treatment. It will usually disappear within a week. To relieve the other symptoms caused by rubella, follow the advice below.
Paracetamol or ibuprofen
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. Your pharmacist can advise you.
Do not give aspirin to children under 16 years old.
Controlling a temperature
If your child has a high temperature, try to reduce it by keeping them cool. A cool (but not cold) compress, such as a damp flannel, can be used.
Drink plenty of fluids
If you child has a high temperature, make sure that they drink plenty of fluid because they may be at risk of dehydration. If you or your child have a cough, a lack of fluid will make it worse.
Cough
Cough medicines will be of little help if you or your child have a cough. Instead, putting a bowl of water in the room will increase the humidity and can help to relieve a cough. Alternatively, if the radiators are on, putting a wet towel on the radiator will release more water into the air.
Ensure that your child drinks plenty of fluids. Giving them warm liquids to drink may help to relax their airways, loosen mucus and soothe a cough. However, avoid giving your child overly sugary drinks as this can damage their teeth. Honey should not be given to babies under 12 months.
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Complications
If a pregnant woman catches rubella, it can result in a miscarriage (the loss of the pregnancy during the first 23 weeks) or stillbirth (where a baby is born after the 24th week of pregnancy without any sign of life).
However, this is now rare since the MMR vaccination was introduced.
The rubella infection can also pass to the unborn baby and cause birth defects, known as congenital rubella syndrome (CRS).
Congenital rubella syndrome (CRS)
Congenital rubella syndrome (CRS) can cause the following problems in unborn babies:
- cataracts (cloudy patches in the lens of the eye) and other eye defects
- deafness
- 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
- damage to the brain, liver, lungs or bone marrow
Children born with CRS can develop symptoms later in their lives as well. These include:
- pneumonia – an infection of the lungs
- type 1 diabetes – a long-term condition that is caused by too much glucose in the blood
- overactive 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
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Prevention
The best way to avoid catching rubella is to be immunised with the measles, mumps and rubella (MMR) vaccine.
Advice for parents
The MMR vaccine is part of the routine childhood immunisation programme. One dose is given to a child at around 13 months of age. 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 also 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 wear off over time, it is important that your immunity level is checked by your GP before every pregnancy.
If the test shows that you have very few or no rubella antibodies, you will be offered the MMR vaccine to protect you against rubella. You can have the MMR vaccine before you become pregnant, but not 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 already pregnant, you will be offered a rubella immunity 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 breast-feeding 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 up to six days after the rash first starts. To limit the risk of infecting other people, follow the advice below.
- if you have rubella, stay off work for six days after the start of the rash
- if your child has rubella, keep them off school for this period as well
- avoid all contact with pregnant women for at least a week from the start of the rash
Exposure to others
If you come into contact with someone who has rubella, you only need to contact your GP if you then go on to develop symptoms or if you are pregnant.
‘Contact’ includes any face-to-face contact, or being in the same room for more than 15 minutes.
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