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Rubella (German measles)

What is rubella?

Rubella is an infectious disease caused by a virus called the rubella virus. It is also called German measles, because the disease was first described in Germany. It is usually a very mild illness and causes no more trouble than a common cold. However, it has very serious consequences for a woman who gets infected in the first 3 months of her pregnancy. Her baby may be born with blindness, deafness and an abnormal heart. This is called congenital rubella.

What are the symptoms?

The patient usually feels unwell, has a slight fever, possibly a runny nose, and swollen glands behind the ears and in the neck.

A rash appears on the first or second day and consists of reddish-pink spots that appear first on the face and neck and then spread rapidly to the body, especially to the chest. The rash lasts for about 2 days, and by the fourth or fifth day all symptoms have faded away.

It is possible to have picked up the rubella virus and have no obvious symptoms. This applies to about one-quarter of all patients, who fortunately become immune from further infection.

How is it spread?

The disease is moderately infectious and is spread by droplets from the nose and throat. Once inside the body, the virus has an incubation period of about 14 days before it starts to cause symptoms (if at all).

What are the risks?

The main risk is to an unborn baby. A more common complication, especially in adults, is stiff, swollen joints (arthritis), which is usually short lived. Rarely (1 case in 5000) it carries a risk of encephalitis (inflammation of the brain).

What is the treatment?

Because rubella is such a mild disease, there is no specific treatment. However, patients should rest quietly until they feel well and take paracetamol for fever or aching joints.

School exclusion

The child is usually excluded until fully recovered or for at least 4 days from the onset of the rash.

What should you do?

Notify your doctor immediately if the patient has a convulsion.

Notify school authorities.

Contact any pregnant women who have been exposed to the patient.

If visiting the doctor, telephone beforehand in order to avoid exposure to pregnant women in the waiting room (if you think rubella is the diagnosis).

How can rubella be prevented?

The rubella vaccine should be given to all women before puberty. In Australia, it is routinely given to children between 12 and 15 months (combined with mumps and measles vaccines). It is also available for females (10 years) and is preferably given in the last year of primary school or the first year of high school. Older girls and women of child-bearing age who have not had rubella should be immunised at least 3 months before becoming pregnant. In Australia, most women aged 15 are immune and therefore protected from rubella. However, the only way to tell is to have a special blood test.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia