Rubella (German measles)
On its own, rubella is one of the mildest of the rash illnesses. A child who has it barely feels ill: a slight temperature, some pale spots for three days…
On this page
On its own, rubella is one of the mildest of the rash illnesses. A child who has it barely feels ill: a slight temperature, some pale spots for three days, and within a week it is over. The whole seriousness of this disease lies somewhere else. If a woman catches it in the first three months of pregnancy, the virus reaches the baby and damages exactly what is being built at that moment: hearing, heart, eyes. So what follows is less about how to get through the rash than about keeping the virus away from anyone who is pregnant.
How it shows itself
Two to three weeks pass between catching rubella and the rash, and throughout that time the person looks perfectly well. Then come the features it is usually recognised by:
- a fine pink rash: it starts on the face and behind the ears and within a day moves down to the neck, trunk and arms. The spots do not merge into solid patches, they last about three days and go without leaving any peeling;
- enlarged, tender glands behind the ears and at the back of the neck, along the hairline. This is the most characteristic sign of rubella: it often turns up before the rash and outlasts it;
- a slight temperature, a little nasal discharge, a mild cough, reddish eyes, headache;
- joint pain in the fingers, wrists and knees. Uncommon in children; in adult women it is frequent and is usually the most unpleasant part of the illness, settling over a few weeks.
And the most important point in this section: in roughly half of cases rubella runs with no rash at all, or so quietly that it is taken for a mild cold. An uncomfortable conclusion follows from that — a pregnant woman can catch it from someone who does not know they are ill and who is not at fault in any way.
How it differs from measles
Rubella and measles are confused constantly, online included, yet they are different illnesses: different viruses, a different course and an entirely different danger. The same vaccine protects against both, but that does not make them one disease.
The difference shows in how ill the person is. With measles someone is plainly unwell: a high temperature for several days, a troublesome cough, a streaming nose, red eyes that hurt in the light, and only then, while the temperature is still high, the rash appears — vivid, merging into patches, lasting about a week and leaving brownish marks and peeling behind. Next to that, rubella looks like nothing much: a low temperature, a tolerable general state, a pale rash lasting three days.
Even so, the two cannot be told apart reliably by eye, particularly early on. If you or your child have a rash with a temperature, the diagnosis is confirmed by a blood test or a swab — and this is not a formality: measles is more dangerous and calls for different steps, and whether it is rubella decides whether pregnant contacts need to be rung round.
Before going in to be seen, phone ahead and mention the rash. You will most likely be asked not to sit in the general waiting area, or offered a phone conversation first: there may be a pregnant woman in the corridor.
Why it is dangerous to an unborn baby
If a woman catches rubella during pregnancy, the virus crosses the placenta and interferes with how the baby's organs are forming. This is called congenital rubella syndrome, and it is made up of very specific things:
- deafness — the commonest consequence and sometimes the only one; the baby may be born looking healthy, with the hearing loss found later;
- heart defects needing surgery;
- cataract and other damage to the eyes, up to blindness;
- damage to the brain with delayed development, low birth weight, an enlarged liver and spleen.
It can also end in loss of the pregnancy or in stillbirth.
Timing is decisive. The greatest risk is in the earliest weeks, while the heart, eyes and inner ear are being formed: infection during that period affects most babies. After that the risk falls quickly, and infection later than week twenty is thought to carry practically no risk to the baby.
And here is the reason this page exists at all: there is no treatment that reliably protects the baby once a pregnant woman has been infected. The only thing that works is not catching it, which means having protection in place beforehand.
Pregnancy: what to do the same day
If you are pregnant and you develop a rash, or you have been near someone with rubella or suspected rubella, contact your doctor or midwife the same day, without waiting for an appointment and without checking first whether it settles on its own. This is not about urgent treatment but about timing: the blood test is worth doing at a particular point after the contact, and days lost cannot be made up afterwards.
What happens next: blood is taken for antibodies, to establish two things — whether you already had protection and whether there are signs of a recent infection. If you have been vaccinated or have had the illness, there is almost certainly nothing to worry about. If there is no protection, the pregnancy will be watched more closely, and the conversation about what that means and what the options are is one the doctor has with the stage of pregnancy in mind.
Do not put the call off because the rash looks trivial, and do not turn up to be seen without warning. And if there was a contact but no rash, call anyway: rubella often runs without one.
How not to pass it on
The virus travels through the air in coughs, sneezes and speech, and also on objects that saliva has reached. A person becomes infectious about a week before the rash appears — that is, while nothing is yet visible — and stays infectious for roughly a week afterwards.
- Stay at home: no nursery, school or work for at least five days from the day the rash appears.
- Keep away from anyone who is pregnant until the infectious period is over. If contact has already happened, tell her straight away: what matters to her is getting the blood test in time, not finding out a month later.
- Wash your hands with soap, cover your mouth with a tissue when coughing and throw used tissues away.
- Do not share crockery, towels or bedding with the household.
The vaccine
Rubella is one of those illnesses a vaccine removes almost entirely. There is usually no separate vaccine for it: the protection comes inside the combined vaccine, along with measles and mumps. It is given according to the national immunisation schedule, in two doses — the first in the first or second year of life, the second later. Exact timings differ from country to country and should be checked against your own country's schedule. Two doses give protection that lasts for many years.
What adults should know:
- if you are planning a pregnancy, check your rubella protection in advance — it is an ordinary blood test for antibodies. If there is none, the vaccine is given before conception;
- this vaccine is not given during pregnancy, because it is a live one. For a period after vaccination pregnancy is not attempted; your doctor will say how long;
- if a lack of protection comes to light during pregnancy, the vaccine is given straight after the birth to settle the matter for the future; breastfeeding is no obstacle;
- having had rubella also leaves protection, but a memory of "I had something like that as a child" does not count as proof: several infections produce a similar rash. Only a blood test answers this reliably.
Getting through it, and when a doctor is needed urgently
There is no treatment aimed at the virus itself, and none is needed: the illness clears in about a week on its own. The usual things help — rest, plenty to drink, something for fever and pain if there is discomfort or the joints ache. For children, children's paracetamol and ibuprofen at a dose worked out by weight are suitable; aspirin is not given to children and adolescents. Antibiotics do nothing against a virus.
Complications of rubella are rare, but they exist, and their signs are worth knowing. See a doctor urgently, and if things worsen quickly call an ambulance (in Europe, the single number 112), if there is:
- bruising without any knocks, pinpoint spots that do not fade under pressure, bleeding gums, nosebleeds, blood in the urine or stool — this is how a fall in platelets shows itself;
- severe headache, unusual drowsiness or confusion, a convulsion, a stiff neck, discomfort in bright light, vomiting — signs of inflammation of the brain and its coverings;
- in a child, listlessness, refusing drinks, being difficult to wake.
A doctor is also needed the same day if the rash lasts longer than a week, the temperature is high and not settling, or the joints hurt and swell enough to get in the way of daily life.
Online consultation
Remotely it is easy to settle the commonest question: what this rash is, whether it looks like rubella or measles and what to do next — which test to arrange and where to go so that you do not end up sitting in a shared waiting room with a rash. Pregnancy is a separate matter: a doctor will say which tests are needed after a contact and at what point they are done, and will help make sense of an antibody result you already have. Online is also a convenient place to plan vaccination before conception and to work out whether you are protected. The signs in the list above are not assessed remotely — with those, be seen straight away or call an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Rubella (German measles)
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Rubella (German measles)
Discuss your symptoms and possible next steps for Rubella (German measles) with a doctor online.
