Rubella (German measles)

Commonly known as German measles or 3-day measles

Rubella is a viral illness that commonly causes fever and a skin rash. It mostly affects school-age children and is usually a mild disease. However if rubella occurs during pregnancy, it can have severe harmful effects for an unborn baby. It can also lead to miscarriage.

Key points

  1. Rubella (also called German measles) is a different disease to measles (also called English measles).
  2. It is spread through the air when someone swallows or breathes the cough or sneeze droplets from an infected person.
  3. In most people, the symptoms of rubella are mild, such as fever, skin rash, headache and joint pain. In many cases there are no symptoms at all.
  4. If a pregnant woman contracts rubella, her baby is at risk of severe and permanent birth defects, such such as deafness, blindness, heart defects and brain damage, or death.
  5. Vaccination with the combination measles, mumps and rubella (MMR) vaccine is the best way to protect against rubella. There is no rubella-only vaccine available in New Zealand. 
  6. Pregnant women should not be given the MMR vaccine. If you are planning a pregnancy, ask your midwife or doctor if you need to be vaccinated against rubella so that your baby is protected. When you have been vaccinated, you should avoid getting pregnant for at least a month afterwards.

What causes rubella?

Rubella is caused by the rubella virus, which is spread through the air when someone swallows or breathes the cough or sneeze droplets from an infected person. If you become infected, you are most contagious when the rash is erupting. However, you could still spread the disease from 7 days before the rash appears to 7 days afterwards.

You should avoid childcare facilities, school, work or other public places until you are well or for 7 days after the appearance of the rash.

What are the symptoms of rubella?

The main symptom of rubella is a red or pink spotty rash. The rash takes 2–3 weeks to appear after getting rubella. It usually starts behind your ears and spreads to your head, neck and body. The rash can be hard to see on dark skin, but might feel rough or bumpy. It lasts up to 5 days (the average is 3 days). It may or may not be itchy. As the rash fades, the affected skin may shed in flakes. See examples of rubella rash.

Rubella can also cause other symptoms such as:

  • aching fingers, wrists or knees
  • a high temperature of 38ºC or above
  • coughs
  • sneezing and a runny nose
  • headaches
  • a sore throat
  • sore, red eyes.

For some people there will be no symptoms at all. Because the symptoms are so mild, it can be hard to diagnose correctly. The only way to confirm an infection is with a blood test or special swab test.

What are the risks of having rubella while pregnant?

If a pregnant woman contracts rubella, especially during the first 3 months of pregnancy, the infection can pass to the unborn baby. This can cause severe abnormalities (referred to as congenital rubella syndrome). This can affect almost any part of the baby's developing body and may include cataracts, deafness, heart abnormalities, intellectual disability and behavioural problems. In some cases, miscarriage will occur. 

  • Pregnant women are checked for rubella immunity via a blood test in early pregnancy. This is part of the antenatal blood tests. Even if the blood test from a previous pregnancy showed immunity to rubella, the test must be repeated at each pregnancy.
  • If you think you might be pregnant and your immunity has not been tested, check with your doctor or practice nurse.

Pregnant women should not receive the MMR vaccine during pregnancy, even if blood tests show they are not immune. They should receive the MMR vaccine after delivery. 

If you pregnant and believe you’ve been exposed to rubella, see your doctor immediately.

Planning a pregnancy

If you are planning a pregnancy, it's best to make sure you have immunity to rubella before you become pregnant. Check whether you need to be vaccinated against rubella. When you have been vaccinated, avoid getting pregnant for a month after your last MMR vaccination. Read more about the MMR vaccine.

Who is at risk of getting rubella?

Rubella is now uncommon in New Zealand, thanks to effective immunisation. However cases do still occur and anyone who hasn’t been vaccinated against rubella is at risk. The following groups of women are most likely to be non-immune to rubella:

  • women born outside of New Zealand in countries here vaccination against rubella may not be widespread (especially in Asia, the Pacific Islands, sub-Saharan Africa and South America) who entered New Zealand after the age of routine vaccination
  • women over the age of 35 years.

People travelling outside New Zealand to countries where rubella is still common (or where an outbreak is occurring) are at higher risk of infection and should ensure they are fully vaccinated against rubella before their trip.

How is rubella treated?

There are no specific treatments for rubella and symptoms usually go away after a few days. There are things you can do to ease your symptoms, such as:

  • using pain relief, such as paracetamol to reduce pain and discomfort
  • keeping yourself hydrated and having enough fluids to avoid dehydration.

Why is vaccination so important?

Vaccination with the MMR vaccine is the best way to protect against rubella and prevent its spread. In New Zealand, this vaccine is part of the childhood immunisation schedule and is free for all children at ages 15 months and 4 years. It may also be free for those who have not previously been vaccinated or whose immunisation history is unknown. Most people who receive 2 doses of MMR attain long-term protection against rubella.

Even though rubella poses the most risk to pregnant women, boys should also be vaccinated. This is because the speed that rubella can spread in the community depends on the number of people who are not immunised. The infection will not spread if enough people are immunised. This is called herd immunity.

How can I prevent the spread of rubella?

If you have rubella, to prevent others catching the disease from you stay at home when you are ill – generally this will be for at least a week after your rash develops. It is especially important to avoid contact with anyone you know who may be in the early stages of pregnancy.

Rubella is a notifiable disease. This means that if you are found to have rubella, your doctor will notify the Public Health Service so that they can try to trace the source and reduce the risk of outbreaks.

Learn more 

Rubella Immunisation Advisory Centre (IMAC), NZ
Diseases we immunise against Royal New Zealand Plunket Society
Rubella DermNet NZ
Rubella Ministry of Health, NZ

References

Rubella Immunisation Handbook, NZ, 2017

Reviewed by

Dr Li-Wern Yim is a travel doctor with a background in general practice. She studied medicine at the University of Otago, and has a postgraduate diploma in travel medicine (Otago). She also studied tropical medicine in Uganda and Tanzania, and holds a diploma from the London School of Hygiene & Tropical Medicine. She currently works in clinical travel medicine in Auckland.

Credits: Health Navigator Editorial Team. Reviewed By: Dr Li-Wern Yim, Travel Doctor Last reviewed: 22 Jan 2020