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Rubella (German measles)

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Rubella is a viral infection which is sometimes called German measles. It is usually a mild illness. However it can cause serious harm to an unborn baby if a woman gets it during early pregnancy.

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Rubella is usually a mild illness. However it can cause serious harm to an unborn baby if a woman gets it during early pregnancy. For this reason it is strongly recommended that all children are immunised against rubella.

  • Rubella is a viral infection which is sometimes called German measles.
  • Rubella is now rare in countries such as Australia, but it is still a common cause of miscarriages and stillbirth, congenital blindness, deafness and heart problems in countries where immunisation is not available. (Congenital means present at birth).

How does rubella spread?

  • Rubella spreads by droplets from an infected person when that person coughs or sneezes.

How long does it takes to develop?

  • Rubella takes between 14 to 21 days (usually 16 to 18 days) to develop after contact with it.

How long is it infectious?

  • A person with rubella is most infectious when the rash is appearing, but can also be infectious for about 5 days before and for 5 to 6 days after the rash appears. 

Signs and symptoms

  • Between 25% and 50% of people who get a rubella infection either do not have any illness or they have a very mild illness which they do not know is rubella.
  • Children often only develop a rash and swollen glands in the neck, behind the ears and in the scalp at the back of the head, without being unwell.
  • Some children may feel unwell for one or more days before the rash comes. The glands in the neck and behind the ears will be swollen, and they may have signs of a 'cold'.
  • The rash usually begins on the face and spreads quickly. There are usually large numbers of fine red spots. The rash may be a little itchy, and it fades in about 3 days. The rash is not as bright red or patchy as measles.
  • Adults may feel unwell for up to 5 days with a mild temperature, a runny nose and headache. Up to 70% of adults who become unwell (women more than men) will have some soreness of joints, often in the hands and wrists, feet or knees.  

Diagnosis

  • The rash of rubella looks like the rash that is caused by many other viral infections.
  • A fine red rash with many swollen glands could be rubella, or it could be caused by many other viruses.
  • The only way to be sure that it is rubella is to do blood tests. To tell whether the infection has been recent, two blood tests will need to be done about 28 days apart to see if there is a change in the levels of rubella antibodies (proteins formed by the body to fight infections).
  • If a woman who is pregnant gets an illness with a rash that looks like rubella, she needs to be checked to see if it is rubella, because it could harm her unborn baby.

Health problems from rubella

  • Children who get rubella recover fully from the infection without any ongoing health problems except a very small number who have some joint pain for a while.
  • Some children who get febrile convulsions may have a convulsion triggered by the fever of rubella.
  • About 70% of adults who get rubella have joint pains which can last up to a month. Women get these more often than men.

Rubella during pregnancy

  • If women get rubella during the first 12 weeks of pregnancy, about 90% of the developing babies will be harmed by the virus.
    • This can include miscarriage, still birth, brain damage, deafness, vision problems, heart problems.
    • This is called Congenital Rubella Syndrome.
  • If they get rubella between 12 and 20 weeks there is less risk of harm to the baby, and virtually no risk after 20 weeks.
  • Generally pregnant women are checked early in their first pregnancy to see if they are immune to rubella.
    • If she is not immune it is recommended that she be immunised against rubella after her baby is delivered.
  • All pregnant women who are exposed to rubella need to consult their doctor urgently even if they have been immunised or have had an illness which was thought to be rubella.
    • There is a small risk that someone who has had an immunisation will not be fully protected from rubella, and several blood tests over several weeks will be needed to tell if the baby has been exposed to the virus.

What you can do

Preventing the spread of rubella

  • Keep the child away from any pregnant women even if that woman has been immunised.
  • Keep a child away from school, preschool or child care until well or for at least 4 days after the rash appears.

Rubella immunisation

  • The main aim of rubella immunisation is to prevent congenital rubella syndrome by stopping the spread of rubella in the community.
  • Two doses of rubella vaccine, combined with measles and mumps vaccines, in the form of MMR, are recommended for all children in Australia when they are 12 months old and 4 years old. See the topic 'Immunisation' for more information. This immunisation is free in Australia.
  • Even if a child has had an illness which may have been rubella, the child should be vaccinated against rubella because many infections cause similar rashes. If the child has already had rubella, the vaccine will not cause any problems.
  • Any woman of child-bearing age who has a blood test which shows she has not either had rubella or has not been effectively immunised against rubella should be immunised, and advised not to get pregnant for at least 28 days after immunisation.
    • Her doctor will probably advise that she have another blood test 2 months after the immunisation to see if the immunisation has given her enough protection.
  • Immunisation against rubella should be avoided during early pregnancy.
    • However none of the babies born to women who have been given the vaccine accidentally during pregnancy have had any damage from the vaccine.
    • Accidental vaccination during pregnancy is not a reason for termination of the pregnancy.
  • Female migrants to Australia, especially those from Asia, may need immunisation.

References

SA Health - 'Rubella (German Measles) - symptoms, treatment and prevention'.

Department of Health and Ageing, Australian Government. 'Australian Immunisation Handbook', 10th Edition' 2013.

Department of Health and Ageing, Australian Government. 'Immunisation: myths and realities'.

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

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