Last updated: May 31, 2023

Summarytoggle arrow icon

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. Complications of infection during pregnancy may cause congenital rubella syndrome with severe malformations (e.g., hearing loss, cataracts, heart defects, intellectual disabilities). The rubella vaccine is a combination vaccine that protects against measles, mumps, and rubella (MMR vaccine); the MMRV vaccine also protects against varicella. Immunization is recommended for all children, in addition to adults without evidence of immunity to measles, mumps, and/or rubella.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

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

Diagnosticstoggle arrow icon

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 diagnosestoggle arrow icon

  • Differential diagnoses of pediatric rashes

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Rubella is a nationally notifiable disease; report all cases to the appropriate health departments. [5]

Complicationstoggle arrow icon

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

Prognosistoggle arrow icon

  • 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.

Preventiontoggle arrow icon

Vaccination [6][7][8]

Administer a live attenuated rubella vaccine; (i.e., MMR vaccine, MMRV vaccine) according to the ACIP immunization schedule. See the following:

Evidence of immunity to rubella [9][10]

Exposure control [4][11]

For confirmed cases of rubella:

Women of reproductive age without evidence of immunity to rubella should be vaccinated prior to pregnancy to prevent congenital rubella syndrome. [12]

Referencestoggle arrow icon

  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. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021
  5. Chapter 14: Rubella. Updated: March 6, 2020. Accessed: May 5, 2023.
  6. Adult Immunization Schedule by Age Recommendations for Ages 19 Years or Older, United States, 2023. Updated: February 10, 2023. Accessed: March 24, 2023.
  7. CDC Adult Immunization Schedule by Medical Condition and Other Indication. . Accessed: June 20, 2022.
  8. Child and Adolescent Immunization Schedule. Recommendations for Ages 18 Years or Younger, United States, 2023. Updated: February 10, 2023. Accessed: March 24, 2023.
  9. Serology Testing for Rubella and Congenital Rubella Syndrome (CRS). Updated: April 12, 2023. Accessed: May 3, 2023.
  10. Isaac BM, Zucker JR, Giancotti FR, et al. Rubella Surveillance and Diagnostic Testing among a Low-Prevalence Population, New York City, 2012–2013. Clin Vaccine Immunol. 2017; 24 (9).doi: 10.1128/cvi.00102-17 . | Open in Read by QxMD
  11. Rubella (German Measles, Three-Day Measles) - For Healthcare Professionals. Updated: March 31, 2016. Accessed: March 18, 2017.
  12. Chapter 15: Congenital Rubella Syndrome. Updated: April 28, 2020. Accessed: May 5, 2023.
  13. Yetman R, Hormann M. Pediatrics PreTest Self-Assessment And Review, 14th Edition. McGraw-Hill Education ; 2016

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