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Rubella
Last reviewed: 04.07.2025
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Rubella (German measles), also known in English-speaking countries, is an acute viral disease characterized by swollen lymph nodes, skin rash, headache, and runny nose.
ICD-10 codes
- B06. Rubella (German measles).
- B06.0. Rubella with neurological complications.
- B06.8. Rubella with other complications.
- B06.9. Rubella without complications.
Epidemiology of rubella
Rubella is very rare in England. In 2010, only 12 cases were recorded. However, in countries where routine immunisation against rubella is not carried out, the disease is a much larger problem.
Rubella most often affects children aged 5-15 years. Rubella is also common in adults, but after 40 years of age such cases are rare.
The source of the infectious agent is patients, including those with an erased and atypical course of the disease, persons with asymptomatic infection and virus carriers. The virus is excreted from the mucus of the upper respiratory tract 1-2 weeks before the rash appears and for 3 weeks after the rash appears. In children with congenital rubella, the pathogen can be excreted from the body with urine, sputum, feces up to 2 years after birth.
The main route of transmission of the pathogen is airborne. Viremia developing with rubella causes intrauterine transmission from mother to fetus, as well as the probability of parenteral transmission of the pathogen. The spread of the pathogen through care items has no practical significance.
[ What causes rubella?
Rubella is caused by an RNA virus belonging to the togavirus family, which causes a person to become covered with a small red rash. Infection occurs through airborne droplets or direct contact with the carrier. When a pregnant woman is infected, the virus enters the fetus through the placenta.
The rubella virion is spherical, 60-70 nm in diameter, and consists of an outer membrane and a nucleocapsid. The genome is formed by a non-segmented +RNA molecule. The virion is antigenically homogeneous.
Rubella virus is sensitive to chemical agents. It is inactivated by ether, chloroform, formalin. At a temperature of 56 °C it dies after 30 minutes, at 100 °C - after 2 minutes, when exposed to ultraviolet radiation - after 30 seconds. In the presence of protein in the environment, the resistance of the virus increases. At low temperatures, the virus retains biological activity well. The optimal pH for the virus is 6.8-8.1.
What is the pathogenesis of rubella?
The site of primary virus replication is unknown, but already during the incubation period, viremia develops, and the virus is released into the environment with exhaled aerosol, urine and feces. The virus enters the body through the mucous membranes of the upper respiratory tract. Subsequently, the virus multiplies in the lymph nodes (this process is accompanied by polyadenopathy), as well as in the skin epithelium, leading to the appearance of a rash. The virus penetrates the BBB and placenta. As a result of the activation of interferon production, the formation of cellular and humoral immunity, the circulation of the virus stops, and recovery occurs. However, in pregnant women and children with congenital rubella, the virus can exist in the body for a long time.
Rubella during pregnancy
Despite the fact that this disease is called "mild", it can be seriously dangerous for pregnant women if a woman "picks up" the infection during the first 16 weeks. The rubella virus penetrates the fetus through the placenta and disrupts the normal intrauterine development of the baby. The degree of damage to the fetus depends on the gestational period. Most often, the virus affects the child's vision, which can lead to cataracts. It is also dangerous for the baby's hearing, because the virus can provoke its complete loss. Rubella usually does not require treatment, after 7-10 days all symptoms completely disappear. Doctors recommend that patients adhere to bed rest and take ibuprofen or paracetamol to relieve pain.
What are the symptoms of rubella?
The incubation period of rubella lasts 14-21 days, then comes the prodromal period lasting 1-5 days, which is usually characterized by fever, malaise, lymphadenopathy, in adults it usually proceeds mildly, and in adolescents it may be absent. Swelling and soreness of the occipital, postauricular and posterior cervical lymph nodes are characteristic. Pharyngeal symptoms of rubella appear.
The first symptom is usually a rash. Typical symptoms of rubella are fever (very rarely above 38 degrees), runny nose, headache, enlarged lymph nodes and rash.
Rubella rarely has complications. Symptoms of rubella may include benign polyarthritis affecting small and medium joints, thrombocytopenic purpura.
The rash is similar to measles, but is less widespread and disappears more quickly. It appears on the face and neck and quickly spreads to the trunk and limbs. Redness of the face may be observed. On the 2nd day, it becomes scarlet fever-like (spotted) with a reddish blush. Petechial elements on the soft palate (Forschheimer spots) turn into red spots. The rash lasts for 3-5 days.
General symptoms of rubella in children may be absent or mild and include malaise and sometimes arthralgia. In adults, general symptoms are usually mild, although fever, weakness, headache, joint stiffness, transient arthritis, and mild rhinitis may occur. Fever usually resolves on the second day of the rash.
Encephalitis is rare, occurring during large outbreaks among the military. This complication is typical, but can be fatal. Thrombocytopenic purpura and otitis media are rare.
How is rubella diagnosed?
The diagnosis of rubella is established on the basis of clinical and epidemiological data and blood picture.
Rubella can be suspected in a patient with characteristic adenopathy and rash. Laboratory diagnostics of rubella is necessary only in pregnant women, patients with encephalitis and newborns. An increase in the antibody titer by 4 or more times between the acute phase and the convalescence phase confirms the diagnosis.
Specific diagnostics of rubella is based on the use of RSK, RTGA, ELISA and RIF in paired sera. Determination of specific antibodies belonging to the IgM class is carried out no later than the 12th day after contact with the source of infection.
In differential diagnosis, measles, scarlet fever, secondary syphilis, drug reactions, infectious erythema, infectious mononucleosis, ECHO, and coxsackie infection should be taken into account. Infections caused by enteroviruses and parvoviruses B19 (infectious erythema) may be clinically indistinguishable. Rubella differs from measles by its milder course, faster disappearance of the rash, milder and shorter general symptoms, absence of Koplik spots, photophobia, and cough. Even observation for one day shows that scarlet fever is accompanied by more pronounced symptoms and pharyngitis than rubella. In secondary syphilis, the lymph nodes are painless and the rash is usually expressed on the palms and soles. Laboratory diagnosis of syphilis is usually easy. Infectious mononucleosis is characterized by a more severe sore throat, a longer and more severe malaise, and the presence of atypical mononuclear cells in the blood smear, and the presence of antibodies to the Epstein-Barr virus.
What do need to examine?
What tests are needed?
How is rubella treated?
Rubella is treated without any medications. There is no specific therapy for encephalitis.
How is rubella prevented?
Having had rubella once, a person acquires lifelong immunity. However, due to the high danger that rubella poses to pregnant women, WHO recommends preventive vaccination.
Patients are isolated at home for 5 days from the moment of the rash. Disinfection and isolation of contact children are not carried out. Rubella is prevented by vaccination, the measles, mumps and rubella vaccination is carried out in Russia since 1997.
Vaccination against rubella with a live vaccine is routine. Immunization of individuals over 15 years of age results in immunity in more than 95% of those vaccinated and no cases of viral transmission have been proven. Rubella vaccination is recommended for children and all others in post-pubertal age, especially individuals in organized groups - students, military personnel, health care workers, immigrants and those working with young children. Vaccination should not be performed in individuals with impaired immune systems. Routine vaccination is recommended for all susceptible women immediately after delivery. Women of childbearing age are screened for rubella antibodies and all seronegatives are immunized. However, such vaccination should not be performed unless there is certainty that pregnancy will not occur within at least 28 days after vaccination: the vaccine virus can infect the fetus during early pregnancy. Congenital rubella syndrome has not been described; the risk of fetal harm is estimated at up to 3%. Rubella vaccine is contraindicated during pregnancy. After vaccination against rubella, fever, rash, lymphadenopathy, polyneuropathy, arthralgia and arthritis are rare in children; joint pain and swelling can sometimes occur in adults, especially in women.