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Immune system

Rubella (also called German measles) is a mild disease but can, in about 1 in 6000 cases, lead to encephalitis (inflammation of the brain).

Rubella is particularly dangerous if contracted during the first 8 to 10 weeks of pregnancy, causing damage in up to 90% of unborn babies (called congenital rubella syndrome), resulting in death or blindness, deafness, heart, brain, liver and lung damage.

The policy to immunise all children in the UK against rubella has, since the introduction of the immunisation policy in 1988, produced a dramatic fall in the number of cases of rubella. This has also had a dramatic effect in protecting adult women from exposure to the disease. As a result, cases of congenital rubella syndrome are now rare in the UK. Before rubella vaccine became available, an estimated 200-300 babies were born each year with congenital rubella syndrome in the UK. Between 2000 and 2007 there were 11 cases of congenital rubella syndrome born in England and Wales, of whom 8 were infected abroad.


Rubella is caused by a virus. It is spread through the airborne droplets produced when coughing and sneezing by someone infected with the virus. The incubation period, that is the time taken for the disease to develop after being infected with the virus, is about 14 to 21 days. Individuals are infectious from one week before symptoms first appear to four days after the appearance of the rash.


The symptoms of rubella start like a bad cold with a high temperature, cough, sore eyes and runny nose. A red rash appears most usually behind the ears, on the face and neck, but only lasts for a short time and may easily go unnoticed. Glands may swell before the appearance of the rash.


In the UK, most children are routinely vaccinated against rubella with a vaccine known as MMR which also protects against mumps and measles. Children are given the vaccine between 12 and 18 months of age and then given a booster between 4 and 5 years. Infants under 12 months of age travelling to countries where rubella is still a problem should also be vaccinated with MMR. As the vaccine is less effective when given early, these children will need two further doses of the vaccine at the recommended ages to ensure that they are adequately protected. There is no evidence that MMR vaccination harms an unborn baby. However, as a precaution, MMR vaccine should not be given to women who are pregnant and if given to a non-pregnant woman, adequate contraceptive measures must be used for at least a month.

When to see your pharmacist

You can obtain paracetamol from your local pharmacy without the need for a prescription to help reduce your child’s temperature following immunisation. Always check the label of medicines to make sure that you are not giving your child too much paracetamol if giving more than one type of medicine. Aspirin should not be used in children under 16 years of age to lower high temperatures or for pain relief.

When to see your doctor

After MMR vaccination, your child may feel grizzly but if crying is prolonged or there is a persistent rash or fever, you should see your doctor. Swelling might occur at the injection site but is not normally any larger than the size of a 10p coin, any larger swelling should be checked by your doctor.

If you are thinking of starting a family and you are not sure whether you have been immunised against rubella, see your doctor before you get pregnant. A simple test can be carried out to check if you have immunity.

Protecting your child, your family and others against rubella

The most effective way of protecting your child and others against rubella is to have your child vaccinated with the MMR vaccine. The childhood immunisation programme provides direct protection against mumps, measles, rubella, diphtheria, whopping cough and the risks of bacterial meningitis caused by pneumococcal bacteria, meningococcal type C and Hib. By providing immunity against mumps and measles, the immunisation programme also helps provide protection against viral meningitis. The risks of all of the diseases covered by the immunisation programme are far, far greater than any risks associated with the vaccines themselves. It is essential that all children are vaccinated at the appropriate times. Vaccination of children also helps reduce the spread of infection to adults.

There has been much publicity about giving a single vaccine for each disease separately, rather than giving the combined triple vaccine (MMR) to protect against all three diseases, because of a misunderstanding that MMR may cause bowel disease or autism. The conclusion of experts from all over the world, including the World Health Organization, is that there is no link between the MMR vaccine and bowel disease or autism. The World Health Organization advises against using separate vaccines for the simple reason that doing so would leave children at risk and offer no benefits. No country in the world recommends giving MMR as three separate vaccines. Giving the vaccines separately may be harmful because it leaves children open to the risk of catching measles, mumps or rubella. By having them all at once, your child is protected against all three diseases as soon as they have had the MMR injection.

Living with rubella

If someone in your family does develop rubella try to keep them apart from others for at least 5 days after the appearance of the rash. This means keeping young children off from school for 5 days, or staying away for 5 days from work or other places where there is close contact with other people. If you have been at work, you should tell your human resources department to allow them to tell members of staff who may be pregnant.

The practice of holding ‘parties’, deliberately to infect others to build their immunity without vaccination, is positively discouraged by the health authorities as it can pose a serious health risk.

To reduce the spread of the virus, encourage all members of the family to use disposable tissues when sneezing or coughing, and to wash their hands regularly throughout the day, not just after going to the toilet.

To ease symptoms, drink plenty of water. A cold flannel applied to the forehead will help lower temperature. Do not overdo things but try and get as much sleep and rest as possible to help the body recover.

It is common for children to develop a mild fever and rash after the immunisation and generally feel a bit grizzly. The recommended dose of paracetamol is advised if the child develops a temperature.

Useful Tips
  • If your child develops a fever after childhood immunisation for MMR, sponging with cool water can help get reduce their temperature
  • Make sure your baby or child drinks lots of fluids

Reviewed on 27 May 2011