Rubella is typically mild in children. However, if an unvaccinated pregnant woman becomes infected with rubella, there can be serious consequences for the unborn child, such as fetal deformities or miscarriage. Vaccination protects against the disease. Since a woman cannot be vaccinated against rubella during pregnancy, vaccination must be performed prior to pregnancy. 

At a glance

  • Rubella is typically mild in children. 
  • A distinctive skin rash indicates rubella. 
  • Unvaccinated pregnant women can transmit the virus to their unborn babies.  
  • As a result, miscarriage and deformities can occur. 
  • A vaccination against the infection offers protection. 
  • By vaccinating a very high percentage of people (95% of the population), the virus can lose its ability to survive and replicate because it requires people who are not immune. 

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Rubella: mother with infant on her arm nuzzling the curve of her neck. The infant has a red spotty rash all down its back.

What is rubella?

Rubella is a viral disease that can affect not only children but also adults. The disease is usually mild and even asymptomatic in almost half of cases. A skin rash with red spots that begins on the face and spreads to the entire body is typical. 

The disease is dangerous particularly in unvaccinated pregnant women. The maternal blood can infect the unborn child with the virus. As a result, miscarriage and deformities can occur.  

What are the symptoms of rubella?

The first symptoms are seen 2 to 3 weeks after infection with the virus. A skin rash with small red spots is a typical sign of the disease but is only seen in 50 to 80% of those infected. There are two different types of the disease.

Der für Röteln typische Hautausschlag mit feinen rötlichen Flecken tritt nur bei 50 bis 80 Prozent der Erkrankten auf.

Rubella in children and adults

General signs of illness are seen first:  

  • characteristic lymph node swelling, primarily in the neck and behind the ears 
  • headache 
  • low fever 
  • conjunctivitis 
  • rhinitis (sneezing, itchiness, and a blocked or runny nose) 

Then the distinctive skin rash develops: 

  • small red spots 
  • starting in the face and spreading over the entire body 
  • the spots disappear after 1 to 3 days 

Rubella in unborn babies (= congenital rubella syndrome, CRS)

Unborn babies can become infected with rubella in their mother’s womb. The most severe damage is seen in babies whose mothers became infected with the virus in the first trimester of pregnancy. The risk for damage decreases slightly in the 13th to 16th week of gestation. After the 20th week of gestation, an infection barely has any consequences. 

Typical effects of a rubella infection in unborn children: 

  • miscarriage and premature birth 
  • Gregg triad: heart defects, cataracts, deafness 
  • small head 
  • mental impairments 
  • blood count changes  
  • inflammation of the brain, myocardium, or liver 

What causes rubella?

Rubella is caused by the rubella virus and only occurs in humans. Therefore, the virus can only be passed from human to human.

Important: People with a rubella infection are contagious a week before the onset of the skin rash and remain contagious for an additional week after the rash. Children who become infected in the womb and are born with rubella can shed the virus for an entire year and can infect close contacts. 

How common is rubella?

Rubella is considered one of the childhood diseases. In countries that do not vaccinate against the virus, 80 to 90% of children become infected with rubella. Vaccination greatly reduces the number of rubella cases worldwide. North and South America are already considered free of rubella. 

Approximately 20 to 40 cases of rubella are seen in Germany each year. Rubella in unborn babies is rare, with the last case having been reported in 2013. The goal is to eliminate rubella with systematic vaccination. To achieve this goal, 95% of the world’s population needs to be immune, e.g. by means of vaccination. 

How does rubella develop?

As a rule, patients with rubella have only mild symptoms, with approximately half of those infected being completely asymptomatic. 

Children sometimes only have a skin rash for a few days, while adults often additionally report general malaise and painful joint inflammation. Children infected with rubella in the womb often have to deal with the effects of the disease for their entire lives. 

How can rubella be prevented?

There is a vaccine that protects against rubella. The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the following: 

Vaccination for children

Children should receive the first dose of the rubella vaccine at the age of 11 to 14 months followed by a second dose at 15 to 23 months. The minimum amount of time between the first and second vaccination is 4 weeks. The second dose provides lifelong protection without the need for a booster. The rubella vaccine is administered as part of a combination vaccine (measles, mumps, rubella), sometimes also together with the varicella vaccine. 

Bei Kindern sind zwei Impfungen erforderlich. Sie sollten im Alter von 11 bis 14 Monaten zum ersten Mal gegen Röteln geimpft werden, danach ist eine zweite Impfung im Alter von 15 bis 23 Monaten erforderlich.

Vaccination for adults

All women of childbearing age should receive 2 doses of the rubella vaccine at least 4 weeks apart to prevent severe rubella infection in unborn babies. Men should also receive at least one dose of the vaccine, particularly when they work in community facilities and come in contact with children and/or pregnant women. 

Important: Pregnant women cannot be vaccinated against rubella because it is a live vaccine, i.e., a vaccine containing virus that is capable of replicating and could therefore harm a fetus. However, an accidentally administered vaccine is not a reason for pregnancy termination. All known cases of an accidentally administered rubella vaccine have not resulted in any harm to the child.  

For answers to frequently asked questions regarding the rubella vaccine, visit the website of the Robert Koch Institute.

How do vaccinations work?

The video below explains how a vaccination works.

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How is rubella diagnosed?

Since it is extremely important to identify close contacts in the case of a rubella infection, doctors should perform diagnostic testing to detect the virus in the case of suspicion of a rubella infection. Clinical pathologists can detect the virus directly in a throat swab or a urine sample or indirectly based on antibodies in a blood sample.  

The virus can also be detected in an unborn baby. However, it is difficult to extract a sample without putting the baby at risk. Therefore, doctors only perform this procedure when absolutely necessary.  

Sometimes women of childbearing age are not sure whether they have already been vaccinated against rubella or have already been infected. They can have blood drawn and tested to determine whether enough antibodies are present for immunity.

How is a rubella infection treated?

Treatment measures for a confirmed rubella infection depend on the individual case.  

Treating the acutely ill

There is no treatment specifically for the rubella virus. Fever-reducing, anti-inflammatory drugs can be used to treat fever and joint pain. Since the course of the disease is usually mild, no further measures are needed. 

Important: The virus must not be transmitted to any pregnant women. Therefore, anyone infected with the virus should stay home for one week after the rash and avoid contact with anyone who is unvaccinated. 

Treatment of contacts

Anyone who lives or works with a person with an acute infection or is together with them in a kindergarten or school or otherwise spends time with an infected person has an increased risk of infection. Close contacts without sufficient immunization protection should immediately get vaccinated. This is referred to as a containment vaccination because vaccination within 72 hours of contact can prevent or minimize infection. No special measures are needed for close contacts with sufficient immunization protection.  

Attending or working at a community facility

Anyone living together with an infected person can only enter community facilities if they had sufficient immunization protection prior to the time of possible infection. Otherwise, they may not enter the community facility for 3 weeks. Pregnant women without sufficient immunization protection should not enter community facilities with confirmed rubella infection for 3 weeks. 

Treatment of pregnant women

Pregnant women who had contact with a person with rubella should see their doctor to have their immunization protection checked. Antibodies against rubella that appear after contact with an infected person cannot reliably prevent infection of an unborn baby. However, it is possible to determine if an unborn baby is in fact infected with the virus.  

  • Robert Koch-Institut (RKI). Infektionskrankheiten A-Z: Röteln. Aufgerufen am 25.03.2020.  
  • Robert Koch-Institut (RKI). RKI-Ratgeber: Röteln. Aufgerufen am 25.03.2020.  
  • Weltgesundheitsorganisation (WHO). Eliminierung von Masern und Röteln. Aufgerufen am 28.03.2020.  
  • Weltgesundheitsorganisation (WHO). Rubella. Aufgerufen am 29.03.2020.  

Reviewed by the German Society for Pediatric Infectiology (Deutsche Gesellschaft für Pädiatrische Infektiologie e.V.).

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