Rubella (German Measles) Overview

Rubella (also known as German Measles or Three-Day Measles) is a respiratory viral infection that exhibits mild respiratory symptoms and low-grade fever, followed by a rash lasting about 3 days. In adults, symptoms can also include aches in joints.

Rubella Symptoms

In addition to rash and fever, other symptoms may include chronically swollen lymph nodes (lymphadenopathy), malaise, or conjunctivitis. Joint pain (arthralgia) and arthritis can occur in up to 30% of infected adult and adolescent females.

In children there may be no significant respiratory symptoms before the onset of rubella, and the illness is not easily diagnosed since the rash may be mild and mimic other conditions. Many cases of rubella infections (est. 20–50%) exhibit no clinical symptoms.

The incubation period for rubella is 12–23 days. Persons with rubella are most infectious when the rash is erupting, but can shed virus from 7 days before to 5–7 days after rash onset.

Dangers and Complications of Rubella

Up to 85% of infants infected with rubella in the first trimester of pregnancy will suffer birth defects and/or neurologic abnormalities, such as blindness, mental retardation and heart defects. The condition is known as congenital rubella syndrome or CRS.

The last major epidemic of rubella in the United States occurred in 1964 and 1965 when millions of rubella cases led to 20,000 cases of infants born with CRS. Following vaccine licensure in 1969, rubella incidence declined rapidly. Each year from 1992 through 2000, fewer than 500 cases were reported; each year since 2001, fewer than 25 cases have been reported—a 99.8% decline compared with the pre-vaccine era.

In general, complications occur more frequently in adult women, who may experience arthritis or arthralgia, often affecting the fingers, wrists and knees. These joint symptoms rarely last for more than a month after appearance of the rash. Rare complications are thrombocytopenic purpura, encephalitis, neuritis, and orchitis.

Rubella Vaccine

The rubella vaccine is a live attenuated (weakened) virus. Although it is available as a single preparation, it is recommended that in most cases rubella vaccine be given as part of the MMR vaccine (protecting against measles, mumps, and rubella). MMR is recommended at 12-15 months (not earlier) and a second dose when the child is 4-6 years old (before kindergarten or 1st grade).

Rubella vaccination is particularly important for non-immune women who may become pregnant because of the risk for serious birth defects if they acquire the disease during pregnancy is great.

The MMR vaccine should not be given during pregnancy, and conception should be avoided for one month after vaccination.

Travel and Rubella

Although more than half of all the World Health Organization member countries now use rubella vaccine, rubella still remains a common disease in many parts of the world.

The risk of exposure to rubella outside the United States can be high, so all travelers leaving the United States should be immune to rubella. Acceptable presumptive evidence of immunity to rubella for international travelers includes:

• Documentation of receipt of one or more doses of a rubella-containing vaccine on or after the first birthday, or
• Laboratory evidence of rubella immunity (a positive IgG antibody serologic test)

Birth before 1957 provides only presumptive evidence of rubella immunity and does not guarantee that a person is immune. Therefore, the Advisory Committee on Immunization Practices (ACIP) recommends that birth before 1957 not be accepted as evidence of rubella immunity for women who might become pregnant. A clinical diagnosis of rubella is unreliable and should not be considered in assessing immune status, because many rash illnesses can mimic rubella infection and many rubella infections are unrecognized.

Source: CDC