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Rubella Content Supplied by NHS Choices
Introduction

Rubella (german measles) is a viral infection that's now rare in the UK. It's usually a mild condition that gets better without treatment in 7 to 10 days.

Symptoms of rubella include:

  • a red-pink skin rash made up of small spots
  • swollen glands around the head and neck
  • a high temperature (fever)
  • cold-like symptoms such as a cough and runny nose
  • aching and painful joints - more common in adults

The symptoms of rubella usually only last a few days, but your glands may be swollen for several weeks.

Read more about the symptoms of rubella.

When to see your GP

You should always contact your GP or NHS 111 if you suspect rubella.

Don't visit your GP surgery without phoning first, as arrangements may need to be made to reduce the risk of infecting others.

If you're pregnant and develop a rash or come into contact with someone who has a rash, contact your GP or midwife immediately.

Read more about diagnosing rubella.

Rubella and pregnancy

Rubella usually only becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of her pregnancy.

This is because the rubella virus can disrupt the development of the baby and cause a wide range of health problems, including:

The birth defects caused by the rubella virus are known as congenital rubella syndrome (CRS).

Since the introduction of the mumps, measles and rubella (MMR) vaccine, CRS is now very rare in the UK.

Read more about the complications of rubella.

How it spreads

Rubella is caused by a type of virus called a togavirus. It's spread in a similar way to a cold or flu, through droplets of moisture from the nose or throat of someone who's infected. These droplets are released into the air when someone coughs, sneezes or talks.

You can become infected if you come into contact with the droplets from an infected person, although it can take two to three weeks for symptoms to develop.

If you have rubella, you'll be infectious to other people from one week before symptoms develop, and for up to four days after the rash first appeared.

You should stay away from school or work for four days after the rash starts to avoid infecting others, and try to avoid contact with pregnant women during this time.

Who's affected

Rubella is rare in the UK nowadays. Most cases occur in people who came to the UK from countries that don't offer routine immunisation against rubella.

However, there can occasionally be large outbreaks of rubella in the UK. One of these occurred in 1996, when there were almost 4,000 cases in England and Wales. There were 12 confirmed cases of rubella in England and Wales in 2013.

Treating rubella

There's no specific treatment for rubella, but symptoms normally pass within 7 to 10 days. If you or your child are finding the symptoms uncomfortable, you can treat some of these at home while you wait for the infection to pass.

For example, paracetamol or ibuprofen can be used to reduce the fever and treat any aches or pains. Liquid infant paracetamol can be used for young children. Aspirin shouldn't be given to children under the age of 16 years.

Read more about treating rubella.

Preventing rubella

The best way to prevent rubella is to be immunised with the MMR vaccine. Children are offered this vaccine as part of the routine childhood immunisation programme.

It's given in two doses - the first when the child is one year old, followed by a second booster dose before they start school, at three years and four months.

Routine vaccination is important because it reduces the risk of large outbreaks and helps protect pregnant women and their babies.

The MMR vaccine can also be given to older children and adults who haven't been fully immunised before.

Contact your GP if you're uncertain whether you or your child are up-to-date with vaccinations.

If you're thinking of getting pregnant and you're not sure whether you've had two doses of the MMR vaccine, it's a good idea to check with your GP practice. If your records show you haven't had two doses of MMR or there's no record, ask for the vaccinations.

Read more about preventing rubella.

Information about you

If you or your child has rubella, your clinical team will pass information about you/your child on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.

Find out more about the register.

Symptoms of rubella

The symptoms of rubella usually take two to three weeks to develop after infection. This time is called the incubation period.

Some infected people won't develop any symptoms, but in those who do, a rash and swelling around the neck and head are common signs of the condition.

A red-pink rash

The rubella rash is typically a red-pink colour. It consists of a number of small spots, which may be slightly itchy.

The rash usually starts behind the ears before spreading around the head and neck. It may then spread to the chest and tummy (the trunk), and legs and arms. In most cases the rash disappears by itself within three to five days.

Swollen lymph glands

Lymph nodes, or glands, are small lumps of tissue found throughout the body. They contain white blood cells that help fight bacteria, viruses and anything else that causes infection.

If you have rubella, the glands will usually swell behind the ears, below your skull at the back of your head, and in your neck. In some cases this swelling can be painful.

These lymph glands sometimes start to swell before the rash appears, and the swelling can last for several weeks after the rash has gone.

Other symptoms

As well as a rash and swollen lymph glands, people with rubella may also develop other symptoms, including:

  • a high temperature (fever) - it is usually mild (less than 39C or 102.2F) but can be more severe in adults
  • cold-like symptoms - such as a runny nose, watery eyes, sore throat and cough
  • slightly sore and red eyes (conjunctivitis)
  • aching and painful joints
  • loss of appetite
  • tiredness

These symptoms may develop shortly before the rash and usually last for a few days.

Seeking medical advice

You should always contact your GP surgery or NHS 111 straight away if you suspect rubella. While the condition is usually mild, it's important for a doctor to confirm the diagnosis as the symptoms could be caused by a more serious illness.

If you're pregnant and develop a rash, or come into contact with someone who has a rash, contact your GP or midwife immediately.

It's also important that any cases of rubella are reported to the relevant local health authorities so they can track the spread of infection in case there's a sudden outbreak of cases.

Don't visit your GP surgery without phoning first, as arrangements may need to be made to reduce the risk of infecting others. In particular, contact with pregnant women should be avoided if possible - rubella can cause serious problems in an unborn baby, although this is rare nowadays.

Read about diagnosing rubella.

Diagnosing rubella

If you suspect rubella, phone your GP surgery or NHS 111 straight away for advice.

Don't visit your GP surgery without phoning first, as arrangements may need to be made to reduce the risk of spreading any infection to other people.

Contact with pregnant women should be avoided as rubella can cause serious problems in an unborn baby, although this is very rare nowadays.

Your GP should be able to arrange a time for you to visit that won't put other people at risk.

You should keep your child away from school - or yourself away from work - until you've seen your GP.

Your GP may suspect rubella from the symptoms, but as other viral infections often have similar symptoms, testing a sample of saliva or blood is the only way to confirm a diagnosis.

Saliva and blood tests

If rubella is suspected, a sample of saliva from your mouth or blood taken from a vein in your arm can be taken and tested for certain antibodies.

Antibodies are proteins your body produces to destroy disease-carrying organisms and toxins. If you have rubella or you've had it in the past, your saliva or blood will test positive for certain antibodies:

  • IgM antibody - this will be present if you have a new rubella infection
  • IgG antibody - this will be present if you've had the rubella infection in the past, or you've been vaccinated against it

If neither antibody is present, you don't have rubella and you haven't been immunised against it.

Diagnosis in pregnancy

If you're pregnant, you should contact your GP or midwife as soon as possible if:

  • you come into contact with someone who has rubella
  • you have a rash or come into contact with anyone who has a rash
  • you have symptoms of rubella

It's unlikely you have rubella in these circumstances, but a blood test may be necessary to check for the condition.

In the rare cases where testing shows you do have rubella, you'll be referred to a doctor who specialises in conditions that can affect unborn babies (obstetrician). You may be offered further tests, such as an ultrasound scan, to check for any signs of problems in your baby.

You'll also be offered counselling so you can make an informed decision about whether you wish to continue with the pregnancy if serious problems are found.

Antibodies
Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.
Treating rubella

There's no specific treatment for rubella. The condition is usually mild and improves without treatment within 7 to 10 days.

Phone your GP surgery or NHS 111 for advice if you suspect rubella. Don't visit your GP surgery unless you're advised to do so.

Treating your symptoms

If the symptoms of rubella are causing discomfort for you or your child, there are some things you can do while you wait for the infection to pass.

Controlling fever and relieving pain

If necessary, paracetamol or ibuprofen can be used to reduce a high temperature (fever) and treat any aches or pains.

Liquid infant paracetamol can be used for young children. Aspirin shouldn't be given to children under 16 years old.

Speak to your pharmacist if you're not sure which medications are suitable for your child.

If your child's high temperature is causing them distress, you can also try to reduce it by keeping them cool. A cool, but not cold, compress - such as a damp flannel held to their forehead - can help.

Drink plenty of fluids

If your child has a high temperature, make sure they drink plenty of fluid as they may be at risk of dehydration. Keeping hydrated will also help reduce discomfort caused by coughing.

Treating cold-like symptoms

If you have cold-like symptoms such as a runny nose, sore throat or a cough, there are a number of things you can do to feel more comfortable.

For example, steam inhalation may offer some relief from a cough. This involves sitting with your head over a bowl of hot water. Place a towel over your head, close your eyes and breathe deeply, while trying not to get the hot steam in your eyes.

Steam inhalation isn't advised for children because of the risk of scalding, but it might help your child if they sit in a hot, steamy bathroom. Alternatively, putting a wet towel on a warm radiator will release more water into the air.

Giving your child warm drinks, particularly ones containing lemon or honey, may also help to relax their airways, loosen mucus and soothe a cough. Honey shouldn't be given to babies under 12 months.

Avoiding the spread of infection

While you have rubella, it's important to reduce the risk of spreading the infection to other people.

If you or your child have the condition, you should avoid work or school for four days from when you first developed the rubella rash.

In rare cases, rubella can cause serious problems in an unborn baby, so you should also try to avoid contact with pregnant women for four days from the start of the rash.

Complications of rubella

Serious complications of rubella are rare, particularly since the measles, mumps and rubella (MMR) vaccine was introduced.

However, in the small number of cases where an infection develops in pregnancy, there's a serious risk to the unborn baby.

If a pregnant woman catches rubella, the infection can be passed to her baby. This can result in problems such as miscarriage and a range of birth defects known as congenital rubella syndrome.

Congenital rubella syndrome

Congenital rubella syndrome (CRS) occurs when the virus that causes rubella disrupts the development of an unborn baby. It's very rare in the UK nowadays, with only eight cases reported between 2002 and 2011.

The risk of CRS affecting the baby and the extent of the birth defects it causes depends on how early in the pregnancy the mother is infected.

The earlier in the pregnancy, the greater the risk:

  • infection in first 10 weeks - the risk of CRS is as high as 90% and the baby is likely to have multiple birth defects
  • infection in 11th to 16th weeks - the risk of CRS drops to around 10 to 20% and it's likely affected babies will have fewer birth defects
  • infection in 17th to 20th weeks - CRS is very rare, with deafness the only problem reported

There isn't thought to be any risk of CRS developing if you're infected with rubella after the 20th week of pregnancy.

If a pregnant woman does become infected with rubella during the first 20 weeks of pregnancy, there's no treatment known to be effective in preventing CRS.

Problems caused by CRS

CRS can cause the following problems in babies:

  • eye defects such as cataracts (cloudy patches in the lens of the eye)
  • deafness
  • congenital heart disease - where the heart doesn't develop in the right way
  • a small head compared with the rest of the body, as the brain isn't fully developed
  • a slower than normal growth rate in the womb
  • damage to the brain, liver, lungs or bone marrow

Children born with CRS can develop problems later in their lives as well. These include:

  • type 1 diabetes - a lifelong condition that causes a person's blood sugar level to become too high
  • overactive thyroid or underactive thyroid - the thyroid gland produces hormones to control the body's growth and metabolism
  • swelling inside the brain - this causes a loss of mental and movement functions

Occasionally, hearing problems aren't obvious at birth, but are detected as the child gets older.

Preventing rubella

The best way to avoid catching rubella is to be immunised with the measles, mumps and rubella (MMR) vaccine.

The MMR vaccine is part of the routine childhood immunisation programme. The first dose is given to a child when they're one year old, with a second booster dose given before the start of school, at 3 years and 4 months.

Contact your GP if you're uncertain whether your child's vaccinations are up-to-date. It's possible to have the MMR vaccination at any age.

If you suspect your immunisation isn't up-to-date and you're at risk of catching mumps, measles or rubella, your GP may recommend the MMR vaccine. For example, this may be necessary if there's an outbreak of measles or you're a woman planning to get pregnant.

If you're already immunised, having the MMR vaccine again won't cause you any harm.

Planning a pregnancy

It's a good idea to check that you're fully protected against rubella if you're planning to have a baby.

If you're not sure whether you've had two doses of the MMR vaccine, you can get your GP practice to check your vaccination history. If your records show you haven't had both doses or there is no record, ask to have the vaccinations.

Because MMR vaccination could cause a risk to your baby in pregnancy, you should avoid becoming pregnant for one month after having it. This means you'll need a reliable method of contraception.

During pregnancy

You can't have the MMR vaccine when you're pregnant as it could pose a risk for your baby.

If you're currently pregnant and have not had, or don't know if you've had, two doses of MMR, ask your GP practice to check your records.

If you haven't had two doses of the MMR vaccine or there's no record available, you should ask for the vaccine when you go for your six-week postnatal check-up after your baby is born.

Limiting the spread of infection

Someone who has the rubella virus is infectious for one week before symptoms appear and around four days after the rash first develops.

If you or your child have rubella, you should limit the risk of infecting other people by staying off work or school for four days after you develop the rash.

You should also try to avoid contact with pregnant women for at least four days from the start of the rash.

Antibodies
Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.
 
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