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Rubella (German measles)

What is rubella (German measles)?

Rubella is a mild viral infection that usually lasts three days. Rubella is very rare in the United States because of routine vaccination. While rubella is mild in children, infection during the first trimester of pregnancy can cause fetal death, premature delivery, or serious birth defects known as congenital rubella syndrome. 

Signs and symptoms

  • Red or pink rash that appears first on the face, then spreads downward over the body. 
  • Swollen glands, usually at the base of the skull and behind the ears.
  • Mild or no fever.
  • Joint aches or pain (more common in adults).
  • 20-50% of infected individuals will not have symptoms.

Incubation period

14-21 days, usually 16-18 days

Contagious period and spread

  • Contagious period: Seven days before to 14 days after the rash onset. However, children are most contagious from three to four days before the rash starts until seven days after the rash. 
  • Spread through respiratory (droplet) route: Contact with large droplets and respiratory secretions that form when a child talks, coughs, or sneezes.

Public health reporting requirements

  • Report the infection to a staff member designated by the child care program or school for decision-making and action related to the care of ill children. 
  • Schools and child care facilities should report the infection to the local or state health department within one day of diagnosis.
  • Schools and child care facilities should work with state or local public health agencies to notify parents/guardians about a case of rubella in the facility.
  • Suspect rubella cases should be referred to a health care provider. 

Control of spread

  • Review vaccination status of all children and staff.
  • Unvaccinated or non-immune children and staff should be excluded from group settings if there is an outbreak. 
  • Exposed pregnant staff, especially those in the first trimester, should contact their health care provider to find out if they are immune to rubella.

Vaccination

Routine child/adolescent recommendations:

  • The rubella vaccine (contained in the measle, mumps, rubella [MMR] vaccine) is routinely given at 12-15 months of age, with a second dose recommended at age 4-6 years.

Colorado school-required vaccines: 

Adult/other recommendations:

Treatment

There is no specific medicine to treat rubella or make the disease go away faster. In many cases, symptoms are mild. For others, mild symptoms can be managed with bed rest and medicines for fever, such as acetaminophen.

Exclusion

  • Exclude any children with rubella for seven days after onset of rash.
  • For outbreaks, exclude exposed children and staff who have not been immunized (or, if older than 4-6 years, received fewer than two doses of MMR vaccine) or lack evidence of rubella immunity by laboratory methods until they become immunized, or until the local health department determines it is safe for them to return. This may be more than three weeks. 

Role of teachers, caregivers, and family

  • Encourage routine vaccination. Review and ensure all children have received the rubella-containing vaccine according to current immunization recommendations.
  • Report the infection to the local or state health department. If the health professional who makes the diagnosis does not inform the local health department that the infected child is a participant in a child care program or school, this could delay controlling the spread.
  • Report the infection to the staff member designated by the child care program or school for decision-making and action related to the care of ill children. That person will work with public health to alert possibly exposed family and staff members and parents of unimmunized children to watch for symptoms and notify the health consultant.