Rubella

Rubella is a contagious viral disease that is associated with a characteristic skin rash.

The virus usually occurs in children but it can also affect adults.

Most cases of rubella are mild. In almost half of all people infected, no symptoms occur.

People who have recovered from the illness or who have been fully vaccinated have life-long immunity against the rubella virus.

Rubella is dangerous if contracted by a pregnant woman who has never had the virus and has not been vaccinated. The virus can be passed on to the unborn child, which increases the risk of serious complications.

The first symptoms of rubella appear two to three weeks after the person contracts the virus.

General symptoms

Non-specific signs of illness occur first:

• lymph node swelling, primarily in the neck and behind the ears
• headache
• high temperature between 38 and 39 degrees Celsius
• conjunctivitis
• rhinitis (sneezing, itchiness, and a blocked or runny nose)

Development of the characteristic skin rash

In 50% to 80% of people with rubella, a characteristic skin rash occurs, consisting of small reddish spots.

The rash starts on the face and spreads over the entire body. The spots clear up on their own after one to three days.

Rubella is caused by an infection with the rubella virus. This virus only occurs in humans and is usually spread by droplet infection.

When this happens, tiny droplets containing the virus are released into the air when people speak, sneeze or cough, for example. These droplets may then be inhaled by other people.

When does a person become contagious and how long does this last?

People who contract rubella are contagious from a week before until around a week after the rash appears. If babies become infected before birth, the virus may continue to be shed from their respiratory tract secretions and urine for up to one year and so they remain contagious for this period.

Rubella is a notifiable disease in Germany. 18 cases of rubella were registered in 2020.

The most recent case in an unborn baby was reported in 2015.

Vaccination greatly reduces the number of rubella cases worldwide.

Most people who contract rubella only experience mild symptoms. Around half of all those infected remain entirely symptom-free.

Most children with rubella only develop a skin rash, which clears up on its own after a few days.

Adults often experience joint pain and joint inflammation alongside general symptoms.

Children who contract rubella before birth often have to deal with the effects of the disease for the rest of their lives.

Rubella in unborn babies

When unborn babies contract rubella and become seriously ill, medical practitioners refer to this as congenital rubella, also known as congenital rubella syndrome (CRS).

Whether and to what extent complications are likely to occur depends on the point during the pregnancy at which the expectant mother contracts the virus:

• In weeks 1 to 12 of the pregnancy, it is very likely that the child will suffer severe complications.
• In weeks 13 to 16 of the pregnancy, this risk is slightly reduced.
• From week 20 of the pregnancy onwards, an infection has barely any effects on the child.

A rubella infection in unborn children typically results in:

• miscarriage and premature birth
• heart defects, cataracts, inner ear deafness (also known as Gregg’s triad of symptoms)
• small head
• mental impairments
• blood count changes
• inflammation of the brain, myocardium (heart muscle), or liver

There is a vaccine that protects against rubella. The Standing Committee on Vaccination in Germany (Ständige Impfkommission, STIKO) recommends different vaccination schedules for different age groups.

Vaccine recommendations for children

Children should receive the first dose of the rubella vaccine at the age of 11 to 14 months. A second dose is then required at the age of 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 together with the vaccines against measles and mumps (MMR vaccine) or as part of the 4-in-1 MMRV vaccine, which also protects against chickenpox.

Vaccine recommendations for adults

Provided they were not vaccinated as children, all women aged between 15 and 45 should receive two rubella vaccine doses at an interval of at least 4 weeks to prevent a rubella infection during a possible pregnancy. Men should also receive at least one dose of the vaccine, particularly if they work in community facilities and come in contact with children or pregnant women.

Answers to frequently asked questions about the rubella vaccine can be found on the website of the Robert Koch Institute (RKI).

Rubella cannot be diagnosed on the basis of the rash alone.

To make a definitive diagnosis, evidence of the virus is required. Doctors therefore take a swab sample from the back of the throat, as well as a urine or blood sample, and send these to a laboratory for diagnosis.

A PCR test can detect the virus’s genetic material directly from the throat swab and urine sample. In the blood sample, antibodies against the virus can be detected, which provide evidence of a rubella infection.

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 who are planning a pregnancy 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 to ensure sufficient immunity against the virus.

There is no specific treatment to target the rubella virus.

If symptoms such as high temperature and pain occur, they can be relieved with medication.

To prevent the virus from spreading, it is important to take precautionary measures:

Measures for the acutely ill

The priority is to prevent pregnant women from contracting the rubella virus. Therefore, anyone infected with the virus should stay home for one week after the rash and avoid contact with anyone who is unvaccinated.

Measures for non-pregnant contacts

Anyone who lives or works with a person with an acute infection, is in kindergarten or school with them, or otherwise spends time with them 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 it can prevent or minimize infection in the first 72 hours after contact. No special measures are needed for close contacts with sufficient immunization protection.  

Measures for pregnant contacts

Pregnant women who have come into contact with a person infected with rubella should see their doctor to have their immunization protection checked.

In certain cases, it may be possible to take antibodies against rubella as a precautionary measure. This type of post-exposure vaccine may reduce the viral load and render the symptoms less severe if an infection does occur. However, it cannot reliably prevent the infection from passing to the unborn baby.

Pregnant women without sufficient immunization protection should avoid community facilities until there is no longer a risk of infection. Preventive treatment with antibodies is not recommended in this case.