Last updated: March 23, 2021

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Rubella, or German measles, is an infectious disease that is caused by the rubella virus. Since the introduction of the measles, mumps, and rubella (MMR) vaccine, it is a relatively rare condition. Rubella is transmitted via airborne droplets and has a mild clinical course. The clinical presentation begins with nonspecific flu-like symptoms and post-auricular and/or suboccipital lymphadenopathy. An exanthem phase may overlap or follow; this phase is characterized by a rash that typically starts behind the ears and progresses distally, developing into a generalized maculopapular rash. Rubella is usually self-limiting and involves symptomatic treatment. Immunization with a live, attenuated vaccine, in association with the measles and mumps vaccine, is highly recommended. The first dose is administered between 12–15 months of age and the second dose between 4–6 years of age. Complications of infection during pregnancy may cause congenital rubella syndrome with severe malformations (e.g., hearing loss, cataracts, heart defects, intellectual disabilities).

  • A rare disease in the US following the implementation of the MMR vaccine

Epidemiological data refers to the US, unless otherwise specified.

Patients with rubella infection are asymptomatic in ∼ 50% of cases. Young children have a far milder course than older children and adults; the latter group often presents with prodromal symptoms, other systemic complaints (e.g., arthritis), and a longer duration of infection.

Prodromal phase

Exanthem phase

  • Duration: lasts 2–3 days
  • Findings
    • Fine, nonconfluent, pink maculopapular rash
      • Begins at the head, primarily behind the ears, extends to the trunk and extremities, sparing palms and soles
      • Rash may be itchy in adults
    • Polyarthritis

Although rubella infection may be considered a clinical diagnosis; , laboratory confirmation is necessary for certain patient groups to assess the risk of complications such as e.g., congenital rubella in pregnant women or encephalitis.

  • Differential diagnoses of pediatric rashes

The differential diagnoses listed here are not exhaustive.

We list the most important complications. The selection is not exhaustive.

The disease usually has a benign course and the exanthem disappears rapidly. Joint pain may persist for several weeks; arthralgia may persist up to a month in adults.

Immunization [3][5][6]

Women of child-bearing age, without vaccination or unclear vaccine status, should be vaccinated prior to pregnancy!

Precautions during infection

  • Patients with rubella infection should be isolated for 7 days after the onset of the rash.
  • Precautions regarding droplet transmission should be taken.

Reporting regulations

  • Rubella cases need to be reported to the CDC or to the National Center for Immunization and Respiratory Diseases (NCIRD) within 24 hours of confirmation.
  1. Walker PJ, Siddell SG, Lefkowitz EJ, et al. Changes to virus taxonomy and the International Code of Virus Classification and Nomenclature ratified by the International Committee on Taxonomy of Viruses (2019). Arch Virol. 2019; 164 (9): p.2417-2429. doi: 10.1007/s00705-019-04306-w . | Open in Read by QxMD
  2. Rubella (German Measles, Three-Day Measles) - Serologic Testing for Rubella and CRS in Low Prevalence Setting. Updated: March 31, 2016. Accessed: March 18, 2017.
  3. Manual for the Surveillance of Vaccine-Preventable Diseases - Chapter 14: Rubella. Updated: April 1, 2014. Accessed: March 18, 2017.
  4. Rubella (German Measles, Three-Day Measles) - RNA Detection. Updated: March 31, 2016. Accessed: March 18, 2017.
  5. Rubella (German Measles, Three-Day Measles) - Rubella Vaccination. Updated: July 11, 2016. Accessed: March 18, 2017.
  6. MMR Vaccine Questions and Answers . Updated: May 3, 2004. Accessed: March 18, 2017.
  7. Yetman R, Hormann M. Pediatrics PreTest Self-Assessment And Review, 14th Edition. McGraw-Hill Education ; 2016
  8. Rubella (German Measles, Three-Day Measles) - For Healthcare Professionals. Updated: March 31, 2016. Accessed: March 18, 2017.

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