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27 Jul 2017 dr. Rini Siallagan Articles 128

Rubella, also known as ‘’German Measles“ is a contagious viral infection that causes a fever and a rash amongst other symptoms. Generally, children may develop mild symptoms that they’re unaware of being infected by the rubella virus.

However, rubella infection is a serious health risk for pregnant women. If a pregnant woman is infected with rubella, especially in the first trimester, she may miscarry the fetus or the fetus may suffer from severe birth defects.

Rubella is caused by a virus. It is spread in the same way as the common cold, through tiny droplets produced by sneezing or coughing. It also spreads through indirect contact, for instance sharing the same spoon or plate with an infected person or by touching our nose, eyes, and mouth after touching an infected person.
Rubella has a long incubation period of around 12 – 23 days, which means that the patient will start showing symptoms around 12 – 23 days after they are infected. People who contract the virus are infectious for up to 10 days before symptoms even appear.


The main symptom of rubella is a rash characterized by itchy red spots, which starts to appear on the head and neck. The rash will appear on days 14-21 after infection, with the most common on days 17 & 18 after exposure.

Generally, the rash is accompanied by prodrome sign such as fever, swollen glands, body aches and fatigue. These warning signs last from days 1 to 5 before the rash appears. When the rash appears, usually the fever resolves.

The rash may be itchy and  tends to spread down from the head to the trunk of the body..  The rash also disappears from the head to the trunk as it resolves. The rash normally will last about 3-5 days before disappear. Other signs and symptoms of rubella infection are headaches, redness on eyes, and a runny nose or flu like syndrome. About 50 percent of infected people show no symptoms but they can surely still transmit the virus.

Complications that may appear:

The most common complication of rubella infection is the inflammation of the joints (arthritis) that usually goes away on its own. Ear infections may happen to children under 4 years old. There are some rare but very serious complications such as bleeding due to the low platelets and infection of brain (encephalitis).

Another serious complication can occur when rubella infects pregnant women. Pregnant women contracting rubella (especially in the first trimester) may cause miscarriage or birth defects.  This is why Rubella antibodies is sometimes screened for in pregnant women or women planning to have babies. Birth defects caused by rubella are termed Congenital Rubella Syndrome (CRS) which includes:

1. Common Presentation of CRS:

  • Deafness

  • Cataracts and blindness

  • Heart defects

  • Intellectual disabilities

  • Liver and spleen damage

  • Low birth weight

  • Skin rash at birth

2. Less Common Presentation of CRS:

  • Glaucoma causing blindness

  • Brain damage

  • Thyroid and other hormone problems

  • Inflammation of the lungs

Treatment and Prevention

As with most viral infections including measles and mumps, there is no specific cure or treatment for this disease. The therapy is targetted based on the symptoms such as analgesics to manage the pain, and antipruritic to manage the itchiness.

Prevention of rubella by vaccination is recommended for all children and for all couples that are planning for a family, before the woman is pregnant. Once a woman is pregnant it will be too late for her to receive vaccination as the vaccine contains a live (but weakened) virus that may also harm the fetus.