An Overview of Rubella

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Rubella is a viral illness that is particularly dangerous to pregnant women and fetuses. If contracted in early pregnancy, the likelihood of miscarriage or birth defects is high. Rubella is uncommon in the United States due to widespread vaccination.

Rubella is often called German measles or three-day measles. In March 2005 the Centers for Disease Control and Prevention (CDC) announced the elimination of congenital rubella syndrome (CRS) in the United States. By that time, vaccination reached more than 95% of school-aged children and about 91% of the entire U.S. population.

Before vaccinations were routinely given to kids, rubella was primarily a childhood disease. The last epidemic in the United States was from 1964–1965 and had an estimated 12.5 million cases. The CDC considers rubella eliminated in the U.S. since 2004.

Doctor holding a newborn baby sick with rubella

andriano_cz / Getty Images


Outside of the effects that rubella has on pregnancy and congenital rubella syndrome, it manifests as a very mild illness in most patients. About half of all infected individuals will not show any signs or symptoms at all, despite being infectious in many cases. Children are more likely than adults to not show symptoms.

The most common sign of rubella is a maculopapular rash that begins on the face about two weeks after infection and spreads down from there.

One to five days before the onset of the rash (known as the prodromal period) is a mild flu-like condition that shows up with low-grade fever, malaise, swollen lymph nodes, and an upper respiratory infection with a sore throat, cough, and runny nose.

Pink eye (conjunctivitis) is a common symptom that goes along with the flu-like illness before the rash appears. In adults, the pink eye might accompany a headache. About 70% of teenagers and adult women who contract rubella can develop arthritis.

In very rare cases, rubella can cause bleeding problems or brain infections (meningitis or encephalitis).


Rubella is an RNA virus of the genus Rubivirus within the Togaviridae family. It is transmitted through droplets and contact with an infected person. An infected person is contagious up to one to two weeks before symptoms appear. There are no animals (nonhumans) who carry the virus.

Rubella is very rare in the United States because of robust vaccination programs, but it is more common in other countries. Rubella and congenital rubella syndrome show up most in the U.S. from foreign-born youths coming from countries that do not have the same vaccination programs.

The most common cause of rubella for residents of the United States occurs when an unvaccinated person travels internationally. Pregnant women are most at risk and should not travel internationally unless they are vaccinated against the rubella virus.

The CDC recommends vaccinations for all children and for women who intend to become pregnant. The vaccine used is the measles, mumps, rubella (MMR) vaccine.

Women of childbearing age should not get pregnant within four weeks of receiving the vaccine. An unvaccinated pregnant woman should wait until after birth to get the MMR vaccine and should avoid traveling internationally.


Rubella diagnosis is complicated. There is no solid, easy, and quick blood test to identify a rubella infection. If there is a potential for exposure of rubella to a nonimmune pregnant female, it is very important to seek a practitioner for testing. There are several different tests that might be ordered, including a culture of nasal and throat specimens, but that can be difficult to obtain.

Testing for rubella changes as the disease progresses. Certain blood tests (such as an IgM) are most effective if taken at least four days after the onset of rash. Your healthcare provider will be able to order the right type of blood tests.


There is no antiviral treatment for rubella. Because of the severe effects the infection can have on a fetus, if a nonimmune pregnant female is exposed to rubella, healthcare providers may offer termination of the pregnancy. If that is not an option, the practitioner might recommend two doses of immune globulin injection within 72 hours (3 days) of exposure. Immune globulin injection is used to decrease symptoms, although it is not likely to stop them. Newborns with congenital rubella syndrome have been born to women treated with immune globulin therapy.

Treatment is mostly supportive. Fever and pain relievers can be used to alleviate symptoms.

Congenital Rubella Syndrome

When a pregnant woman is infected with rubella, she is in danger of miscarriage or stillbirth, and her developing fetus is in danger of being born with severe birth defects known as congenital rubella syndrome. The possibility of birth defects is higher earlier in the pregnancy. It is especially dangerous during the first trimester.

These congenital birth defects are lifelong and can be any of the following:

  • Low birth weight
  • Rash
  • Deafness
  • Cataracts or glaucoma
  • Heart defects
  • Intellectual disabilities
  • Liver or spleen damage
  • Brain damage
  • Hormonal conditions
  • Respiratory inflammation

There is no cure for congenital rubella syndrome. Each of the potential complications must be treated individually.

A Word From Verywell

The most important thing to understand about rubella is the role of vaccination to reduce the chance of infection. The United States was able to nearly eradicate rubella through a robust and consistent vaccination program. Other countries are still working to achieve that type of success.

It is extremely important to continue to vaccinate kids otherwise we could see an increase in childhood diseases like rubella. Because most of the non-immunized people in the United States today are childbearing age, an outbreak could result in a high instance of congenital rubella syndrome.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Rod Brouhard, EMT-P
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.