rubella

and Martina Feichter, medical editor and biologist

Sophie Matzik is a freelance writer for the medical team.

More about the experts

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Rubella is an acute and contagious viral infection. They can cause a typical red rash. In some people, however, the infection runs without symptoms. Rubella most commonly affects babies and toddlers. Rubella is much less common in adults. In most cases, an infection is without complications. However, during pregnancy it can be dangerous for the unborn child. Read everything you need to know about rubella here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. P35B06

Brief overview

Symptoms: initially cold-like symptoms, followed by the typical rubella rash: small, bright red spots that first appear behind the ears and then spread over the face to the whole body;
Cause: Viruses (so-called rubella viruses)
Contagion: via droplet infection; Two to three weeks pass between infection and the appearance of the first symptoms (incubation period)
Treatment: often not necessary; possibly measures to alleviate the symptoms (e.g. painkillers and fever reducers)
Danger: Rubella during pregnancy can be transmitted to the unborn child. There is a risk of serious damage to the child, especially in early pregnancy.
Prevention: rubella vaccination

Rubella: symptoms

Rubella symptoms can vary slightly in different people. In addition, many of them are not specific to the disease. This means that similar complaints can also appear with other diseases.

Up to 50 percent of all people who become infected with rubella show no symptoms at all. Then doctors speak of an asymptomatic course.

First symptoms of rubella

The first symptoms that usually occur with rubella are reminiscent of a common cold. These include, for example, a cough, runny nose and mild to moderate headache. In some cases there is also conjunctivitis. The eyes look red and can itch. Often these remain the only rubella symptoms. They are then usually not recognized as rubella.

Classic rubella symptoms

In addition to the signs of a cold, about half of all patients experience other symptoms. These include swollen, often painful lymph nodes in the neck and neck area (often in other parts of the body in adolescents and adults). This swelling occurs because the pathogens first multiply in the lymph nodes before they spread through the blood in the body. The lymph nodes behind the ears and neck may also be painful or itchy.

In some patients, rubella infection is accompanied by an increased body temperature (below 38 degrees Celsius).

Typical of rubella is a skin rash (exanthema) made up of small, light red, slightly raised spots. It doesn't itch, or at most it itches very slightly. The red spots do not fuse together like they do with measles. The rubella rash is often only faintly visible. It forms behind the ears first. In the course of a few hours, it spreads to the face, neck, arms and legs, and finally to the whole body. The rash will go away after one to three days.

Typical symptoms of rubella

Rubella infection usually begins with cold-like symptoms. Fields with small, bright red spots later form on the skin - the typical rubella rash.

In Germany rubella is sometimes referred to as "Rubeola". The term originally covers all skin conditions with a red rash. That is why it is misleading. In England, for example, the term is used for measles. In addition, scarlet fever is called "Rubeola scarlatinosa" in technical terms. Because of the possible misinterpretation, “Rubeola” is rarely used in German.

Rubella: complications

The rubella is usually mild and harmless. But they can also cause complications. The risk of this increases with age. That means: rubella in adults (and also adolescents) is more likely to have complications than in children.

Possible complications are:

Joint inflammation (arthritis): especially young women with rubella often develop swollen, painful joints
bronchitis
Otitis media
Inflammation of the brain (encephalitis)
Inflammation of the heart muscle (myocarditis)
Inflammation of the pericardium (pericarditis)

Rubella: contagion

Rubella infection occurs via droplet infection: When coughing, sneezing or kissing, infected people can transfer small droplets of saliva with the rubella virus to other people. The viruses enter the body through the mucous membrane of the upper respiratory tract (mouth, nose, throat). Infection is also possible through objects that are contaminated with the pathogens: For example, if you use the same cutlery as a sick person, you can also become infected.

The following applies: People who have not been vaccinated against rubella or have not yet had the disease can become infected. Rubella symptoms in spite of a vaccination or a previous infection hardly ever occur: Only if the vaccination or illness was a long time ago can you possibly become infected again with rubella. Such a reinfection is very rare. Those affected then usually show no and only very mild symptoms (such as rhinitis).

Rubella: incubation period

The time between infection with a pathogen and the onset of the first symptoms is called the incubation period. For rubella, it is between 14 and 21 days. Infected people are contagious about a week before to about a week after the appearance of the typical rash.

Even those who are infected with rubella viruses but show no symptoms (i.e. do not get sick) can transmit the pathogen to other people!

Rubella & Pregnancy

Rubella during pregnancy is very much feared: the pathogen can be transmitted from the mother to the unborn child via the placenta. Such a rubella infection in children in the womb is called rubella embryopathy. It can damage the child's organs so severely that they are born with significant disabilities. Miscarriage is also possible.

The stage of pregnancy is decisive: the damage that rubella can cause in children in the womb is more frequent and serious the earlier in pregnancy the infection occurs. All defects that a rubella infection can cause in the unborn child are summarized under the term "congenital rubella syndrome" (CRS).

Rubella in the 1st to 11th week of pregnancy

A rubella infection in the 1st to 11th week of pregnancy can cause particularly large and severe damage to the child. Rubella embryopathy can occur in different forms:

clinical triad (Gregg syndrome): organ malformations of the heart, eye and inner ear (such as heart defects, cataracts, hearing damage)
Extended Rubella Syndrome: jaundice, skin rash, reduced number of blood platelets (risk of bleeding!), anemia, inflammation of the heart muscles (myocarditis), pneumonia, encephalitis, bone diseases
Late-onset rubella syndrome: It only becomes noticeable from the 4th and 6th month of life: the babies no longer grow, develop a chronic rash and recurrent pneumonia. Mortality is high (especially with pneumonia).
Long-term effects in adolescence: hearing damage, diabetes mellitus, impaired hormone release, convulsions (epilepsy), progressive inflammation of the entire brain tissue (panencephalitis)

In addition to Gregg syndrome and extended Rubella syndrome, some unborn babies also show developmental disorders: For example, the head is noticeably small (microcephalus) and mental development is delayed.

Rubella in the 12th to 17th week of pregnancy

Rubella infection in the unborn child at this stage of pregnancy usually damages the inner ear: the little ones are born with a hearing loss (inner ear hearing loss).

Rubella after the 18th week of pregnancy

Rubella infection is less critical at this stage. The unborn child may develop a little more slowly than would be the case without an infection. As a rule, however, long-term consequences are not to be expected.

If a pregnant woman becomes infected with the rubella virus shortly before giving birth, the newborn may develop rubella.

Rubella: cause

Rubella is caused by a virus also known as rubella virus or rubella virus. The virus enters the body through the lining of the upper respiratory tract and multiplies mainly in the lymphatic tissue (such as the lymph nodes). From there, the rubella virus can get into the bloodstream (viraemia) and spread throughout the body in this way.

Rubella: examinations and diagnosis

A doctor should be consulted if rubella is suspected. Sometimes the disease can be accompanied by serious complications.

During the conversation, the doctor first collects all the important information in order to collect the patient's medical history (anamnesis). He asks the patient (in the case of children, the parents), for example:

How long has the rash existed?
Does the rash itch?
Is the body temperature increased?
Are you feeling tired?

The medical history is followed by a physical exam. Among other things, the doctor examines the rash and palpates the lymph nodes (for example on the neck and neck).

Rubella cannot be unequivocally determined based on the medical history and symptoms. Rashes and swollen lymph nodes can occur with many other conditions. Therefore laboratory tests should always be carried out if rubella is suspected:

In the case of a rubella infection, the specific defense substances (antibodies) formed by the body against the rubella virus can be detected in the blood. This works best five days after the onset of symptoms (fever and rash).

To be on the safe side, such an antibody test is carried out in pregnant women if the woman has not been vaccinated against rubella according to her vaccination certificate or has only received one of the two recommended rubella vaccination doses. The same applies if the vaccination status is unclear, i.e. you do not know whether the woman has ever had a rubella vaccination.

Up to five days after the rash starts, the doctor can send a throat swab or a urine sample to the laboratory to detect rubella viruses based on their genetic make-up. This is a simple, reliable method, especially with children, to reliably confirm a suspicion of rubella and to be able to advise pregnant contact persons (such as the pregnant mother) well.

Investigations on the unborn child

In pregnant women with suspected or proven rubella infection, the unborn child can also be examined. This happens as part of the prenatal diagnosis. An experienced doctor can take a sample of the placenta (chorionic villus sampling) or the amniotic fluid (amniocentesis). The laboratory tests whether the genetic material of the rubella virus can be detected in the sample.

From the 22nd week of pregnancy, it is also possible to take a blood sample of the unborn child from the umbilical cord with the help of a long, thin needle (umbilical cord puncture). This fetal blood can be examined for antibodies against rubella viruses or the genetic material of the pathogen.

Any suspicion of rubella as well as a proven infection must be reported by the attending physician to the responsible health department. He must also state the name of the patient. Deaths due to rubella are also notifiable.

Rubella: treatment

There is no treatment that can directly fight the rubella virus - i.e. no causal treatment. Only symptomatic treatment is possible: For example, if necessary, you can take antipyretic medication (such as ibuprofen or paracetaml) or calf compresses to lower the elevated temperature. In itself, however, a fever is desirable - it shows that the immune system is fighting the pathogen. Therefore, one should only lower a fever if absolutely necessary. It is best to discuss this with the attending physician.

The fever reducers ibuprofen and paracetamol have a pain-relieving effect at the same time. Ibuprofen also helps against inflammation. Both active ingredients are suitable for rubella patients so also for headaches and painful, inflamed joints.

Acetylsalicylic acid (ASA) is also a popular pain reliever and fever reliever. However, it must not be used in children and adolescents with febrile illnesses! Otherwise there is a risk that the rare but dangerous Reye's syndrome will develop.

If you have rubella, you should also drink enough fluids and rest. This supports the body in getting well.

Sick people should also stay away from other people as much as possible. This lowers the risk that they will pass the virus on. Contact with pregnant women in particular should be avoided: if they are not sufficiently immune to the pathogen, there are otherwise serious dangers for the unborn child.

Pregnant women who are not sufficiently immune to rubella and who have come into contact with a sick person should see a doctor quickly. Within the first three days after contact, he can inject the pregnant woman with finished antibodies against the pathogen. Later on, this so-called post-exposure prophylaxis no longer makes sense.

Rubella: disease course and prognosis

Rubella disease usually runs without problems. For children who have already been born, as well as adolescents and adults in general, it does not pose a great danger. With age, however, the risk of complications such as painful, inflamed joints, otitis media, bronchitis or myocarditis increases. Encephalitis is particularly feared. But it is one of the very rare rubella complications.

Rubella is usually mild in pregnant women too. The danger here is that the unborn child will also become infected. This can cause serious damage to the child, especially in the first few weeks of pregnancy.

Rubella vaccination

The best protection against rubella is a vaccination. The Standing Vaccination Commission (STIKO) at the Robert Koch Institute recommends rubella vaccination for all children, consisting of two doses of vaccine. It is given in combination with the vaccines against measles and mumps (measles-mumps-rubella vaccination, MMR vaccination).

The first dose of vaccine is recommended for children between 11 and 14 months of age (the earlier the better). The second dose of vaccine should be given between the ages of 15 and 23 months. There must be an interval of at least four weeks between the two vaccine doses.

The rubella vaccination is not only used to protect the person vaccinated against infection. The main aim is to prevent the rubella virus from spreading in the population. This also protects pregnant women who are not immune to the pathogens, as well as their unborn child.

Read more about the rubella vaccination and its possible side effects in the article Rubella vaccination.