Brief overview
- Symptoms: Initially cold-like symptoms, followed by the typical rubella rash: small, bright red spots that first appear behind the ears and then spread over the face to the entire body
- Course and prognosis: Usually mild, resolves after one week, complications rare
- Causes and risk factors: Rubella viruses, infection via droplet infection
- Diagnosis: Medical history, physical examination, antibody and PCR test
- Treatment: Often not necessary; possibly measures to alleviate symptoms such as pain or fever
- Prevention: Rubella vaccination
What is rubella?
Rubella is an infection with the rubella virus. The virus is transmitted from person to person via droplets. The disease is characterized by cold symptoms, elevated temperature and skin rash. A rubella vaccination, as well as an infection that has already been experienced, usually provides immunity.
In German-speaking countries, rubella is sometimes referred to as “rubeola”. The term originally encompasses all skin diseases with a red rash. Therefore, it is misleading. In English, the term is used for measles, for example. In addition, scarlet fever is called “rubeola scarlatinosa” in technical language. Because of the possible misinterpretation, “rubeola” is now rarely used in German.
Rubella: Incubation Period
The time between infection with a pathogen and the onset of the first symptoms is called the incubation period. For rubella, it is between 14 and 21 days. Infected people are already contagious about a week before to about a week after the appearance of the typical skin rash.
Even those who are infected with rubella virus but do not show any symptoms (i.e., do not get sick) may transmit the pathogens to other people!
What are the symptoms?
In about half of all patients, the signs of a cold are joined by other complaints. These include swollen, often painful lymph nodes in the neck and throat area, and in adolescents and adults often in other parts of the body as well. This swelling occurs because the pathogens first multiply in the lymph nodes before being distributed throughout the body via the blood. The lymph nodes behind the ears and in the neck sometimes hurt or itch.
In some patients, the rubella infection is accompanied by an increased body temperature (up to 38 degrees Celsius).
Rubella symptoms vary slightly from person to person. In addition, many of them are not specific to the disease. This means that similar symptoms are also seen in other diseases. When people become infected without showing symptoms, physicians speak of an asymptomatic course.
What is the course of rubella in children?
In children, a rubella infection is usually harmless. Only about every second child has any visible signs of the disease. If symptoms such as bright red spots, swelling of the lymph nodes or cold-like symptoms occur, they usually disappear completely after a week.
In adolescents and adults, the course of the disease is also usually mild in the case of a rubella infection. But the risk for more severe courses increases with age. This means that rubella in adults is more likely to progress with complications than in children.
Possible complications include:
- Bronchitis
- Otitis media (inflammation of the middle ear)
- Brain inflammation (encephalitis)
- inflammation of the heart muscle (myocarditis)
- Pericarditis (inflammation of the heart sac)
Rubella in pregnancy
Not having rubella immunity during pregnancy poses risks to the unborn child: the pathogen is transmitted from the mother to the unborn child via the placenta. Such a rubella infection in the womb is called rubella embryopathy. In severe cases, it damages the child’s organs to such an extent that it is born with considerable disabilities. Miscarriage is also possible.
The decisive factor is the stage of pregnancy: the damage caused by rubella in children in the womb is more frequent and more severe the earlier in pregnancy the infection occurs. All defects that a rubella infection causes in the unborn child are summarized under the term “congenital rubella syndrome” (CRS).
What causes rubella?
Rubella infection occurs via droplet infection: when infected people cough, sneeze or kiss, they transfer small saliva droplets containing the rubella viruses to other people. The viruses enter the body through the mucous membrane of the upper respiratory tract (mouth, nose, throat). Infection is also possible via objects contaminated with the pathogens: for example, if you use the same cutlery as someone who is ill.
The following applies: All people who have not been vaccinated against rubella or have not recovered from the disease run the risk of becoming infected. Rubella symptoms despite vaccination or having been through the infection almost never occur. Only if vaccination or illness occurred a very long time ago is it possible to become reinfected with rubella. However, such a reinfection is very rare. Those affected then usually show no or only very mild symptoms, such as a cold.
How is rubella detected?
- How long has the rash been there?
- Does the rash itch?
- Is the body temperature elevated?
- Do you feel listless?
The medical history is followed by a physical examination. Among other things, the doctor examines the rash and palpates the lymph nodes, such as those on the neck and throat.
Based on the medical history and symptoms, rubella cannot be determined beyond a doubt. Rash and swollen lymph nodes also occur in many other diseases. Therefore, additional laboratory tests are always performed when rubella is suspected:
In the blood, specific defense substances (antibodies) produced by the body against the rubella virus can be detected in the case of a rubella infection. This works best from five days after the onset of symptoms such as fever or rash.
Up to five days after the onset of the rash, it is possible to send a throat swab or urine sample to the laboratory to detect rubella viruses in it based on their genetic makeup (PCR test). This is a simple, reliable method, especially in children, to reliably confirm a suspicion of rubella and to provide good advice and protection for pregnant contacts.
Examinations of the unborn child
In pregnant women with suspected or proven rubella infection, it is possible to examine the unborn child. This is done as part of prenatal diagnostics. An experienced physician takes a sample of the placenta (chorionic villus sampling) or amniotic fluid (amniocentesis). In the laboratory, it is tested whether the genetic material of the rubella viruses can be detected in the sample.
A proven rubella infection must be reported to the appropriate authorities.
How is rubella treated?
There is no treatment that can directly combat the rubella virus – in other words, no causal treatment. Only symptomatic treatment is possible: This means, for example, taking fever-reducing medication such as ibuprofen or paracetamol as needed, or making calf compresses to lower the elevated temperature.
Home remedies have their limits. If the symptoms persist for a long period of time, do not get better or even get worse despite treatment, you should always consult a doctor.
The antipyretics ibuprofen and paracetamol have a pain-relieving effect at the same time. Ibuprofen also helps against inflammation. Both active ingredients are therefore also suitable for rubella patients with headaches as well as painful, inflamed joints.
If you have rubella, it is also a good idea to drink enough fluids and rest. This supports the body in getting better.
Pregnant women who are not sufficiently immune to rubella and have come into contact with someone who has the disease are advised to see a doctor quickly. Within the first three days after contact, it is possible to inject the pregnant woman with ready-made antibodies against the pathogen.
How can rubella infection be prevented?
The best protection against rubella is vaccination. The rubella vaccination serves not only to protect the vaccinated person from infection. Above all, it prevents the spread of the rubella viruses in the population. In this way, vaccinated women also protect pregnant women who are not immune to the pathogens, as well as their unborn child.
Read more about rubella vaccination and its possible side effects in the article Rubella Vaccination.
