Rubella Summary

Definition

  • RNA virus (Togaviridae family)
  • Also known as German measles
  • Life-long immunity after infection/vaccine
  • Rare since MMR vaccine

Transmission

  • Direct contact & droplet spread
  • Incubation: 12-23 days
  • Contagious: 7d before to 5-7d after rash

Clinical Features

  • No specific features - lab confirmation needed
  • Rash: face→body, pink/red, 3-5 days
  • Lymphadenopathy (suboccipital)
  • Arthritis (70% women)

Pregnancy Risk

  • Miscarriage, stillbirth
  • Congenital Rubella Syndrome
  • 90% transmission early pregnancy
  • Eye/heart/CNS defects, hearing loss

Management

  • Notify Health Protection Team
  • Notifiable disease
  • Oral fluid testing
  • Supportive care only
  • Isolate 5 days after rash

Prevention

  • MMR vaccination
  • Avoid contact with pregnant women
  • Infection control measures

Rubella (German Measles)

Viral infection caused by RNA virus in Togaviridae family

Introduction

Rubella (also known as German measles) is a viral infection by a single‐stranded ribonucleic acid (RNA) virus in the family Togaviridae. Once infected or immunised, most people develop life-long immunity to rubella. On rare occasions reinfection can occur, but the clinical significance of this is not clear.

Vaccination Impact

Since the measles mumps rubella (MMR) vaccine was introduced, rubella infection has become uncommon in the UK.

Transmission

Transmission Routes

  • Direct contact with an infected person
  • Droplet spread from nasopharyngeal secretions

Viral Replication

  • Replicates in respiratory mucosa and local lymph nodes
  • Spread hematologically to rest of body
  • Can spread to placenta and fetus in pregnant women

Infectious Period

  • Incubation period: 12-23 days after exposure
  • Most infectious when rash is erupting
  • Contagious from 7 days before to 5-7 days after rash appears

Clinical Features

Important Note

There are no clinical features specific to rubella infection — diagnosis cannot be made on clinical features alone, laboratory confirmation is required.

When present, clinical features develop 2–3 weeks after exposure and include:

Rash (50-80% of cases)

  • Starts on face and neck before spreading
  • Pink or light red, maculopapular
  • Transient (usually present for 3-5 days)

Lymphadenopathy

  • May precede the rash
  • Lasts for 2 weeks after rash resolves
  • Suboccipital, postauricular, cervical nodes affected

Arthritis/Arthralgia

  • More common in adults
  • Occurs in up to 70% of women with rubella

Other Features

  • Forchheimer spots (20% of patients)
  • Low-grade fever (<39°C)
  • Headache, malaise, nausea
  • Mild upper respiratory symptoms
  • Non-purulent conjunctivitis

Differential Diagnosis

Parvovirus B19

  • Causes erythema infectiosum (fifth disease)
  • Bright red "slapped cheek" rash
  • Red, lacy rash on body
  • In adults: rash, fever, joint inflammation
  • Harmful effects on fetus

Measles

  • Similar rash distribution
  • More severe rash and symptoms
  • More severe viremia symptoms

Other Viral Infections

  • Herpesvirus type 6 (roseola infantum)
  • Enterovirus, adenovirus, cytomegalovirus
  • HIV, hepatitis, echovirus, coxsackievirus
  • Tropical viruses (if recent travel)

Other Conditions

  • Scarlet fever
  • Brucellosis, Kawasaki disease
  • Syphilis, toxoplasmosis
  • Drug reactions

Management

Immediate Action Required

Contact the local Health Protection Team (HPT) immediately. Rubella is a notifiable disease.

Immediate oral fluid sample may be requested

Positive samples may undergo further testing for confirmation and genotyping

Samples may also be tested for other infections with similar features (e.g., measles)

Patient Advice

Self-Care Measures

  • Rubella is usually mild and self-limiting
  • Typically resolves within a week
  • No specific treatment available
  • Rest and drink adequate fluids
  • Take paracetamol or ibuprofen for symptomatic relief

Infection Control

  • Stay away from school/work for at least 5 days after rash development
  • Avoid contact with pregnant women
  • Cover mouth and nose with disposable tissue
  • Wash hands after using or disposing of tissues

Complications

Pregnancy Complications

Rubella can cause serious complications in pregnancy including miscarriage, stillbirth and severe birth defects known as Congenital Rubella Syndrome (CRS).

Congenital Rubella Syndrome (CRS)

  • 90% chance of transmission if infection early in pregnancy
  • Severity varies by pregnancy stage
  • Multiple defects most likely if infection during first 16 weeks
  • Eye defects (cataracts)
  • Hearing impairment
  • Cardiac abnormalities (PDA, pulmonary artery stenosis)
  • CNS defects (microencephaly, mental retardation)
  • Intrauterine growth restriction
  • Autism, endocrine abnormalities

Other Complications

  • Arthritis and arthralgia (adult women)
  • Rarely severe or persistent
  • Bleeding disorders (thrombocytopenia - 1 in 3000)
  • Encephalitis (1 in 6000 cases)
  • Other neurological complications:
    • Myelitis
    • Optic neuritis
    • Peripheral neuritis
    • Guillain-Barre syndrome