Rubella in Children

Rubella is an infection caused by the rubella virus, and many parents know it as German measles or 3-day measles. It spreads through the air when an infected person coughs or sneezes. In children, it is usually mild, with a pink rash, tender swollen glands behind the ears, and a slight fever of 102°F or lower, and about 25-50% of people infected never feel sick at all. Rubella is now rare in the United States. Endemic rubella was declared eliminated in 2004, and fewer than 10 cases are reported each year, nearly all linked to international travel.

Yes. German measles is an older common name for rubella, and 3-day measles is another. Each name refers to the same infection caused by the rubella virus. The name has nothing to do with Germany as a source of the illness. German physicians first described rubella in the mid-18th century, and their description is where the name came from.

No. Rubella and measles are different infections caused by different viruses, and rubella is much milder. They also unfold differently. Measles starts with 2-4 days of fever, cough, runny nose, and red watery eyes before any rash appears, and the measles rash then lasts 5-6 days. With rubella, the rash is often the first noticeable sign, and the fever usually stays mild. Because measles and rubella rashes can look similar, laboratory testing is needed to confirm the infection.

Rubella spreads through the air. When an infected person coughs or sneezes, droplets from their nose and throat spread the virus to people nearby. A person with rubella is contagious from 7 days before the rash appears through 7 days after, so your child can spread the virus before you know they have it. People with no symptoms at all spread it too, which is why a child with confirmed rubella stays home for 7 days after the rash first appears.

The rubella rash is made of flat pink spots and small bumps. It starts on the face and covers the rest of the body within about 24 hours, then fades over about 3 days in the order it appeared, so the face often clears while the trunk and limbs are still covered. On brown and black skin, the pink color is much harder to see, and the fine bumpy texture may be the clearest sign, so try running your fingertips over your child's face and trunk. The rash usually comes with 2 other symptoms. Tender swollen glands behind the ears and at the back of the neck often start before the rash, and tiny red spots on the roof of the mouth appear 1-5 days ahead of it in about 20% of cases.

At 12-15 months and again at 4-6 years, usually before starting school. A single dose of MMR is 97% effective against rubella, and 2 doses give close to lifelong protection. Some children receive the measles, mumps, rubella, and varicella (chickenpox) vaccine instead, known as MMRV, which is recommended for children 12 months through 12 years. A baby 6-11 months old traveling internationally should get 1 dose of MMR before the trip, then 2 more doses after their first birthday.

Yes. Rubella infection during pregnancy can cause miscarriage or stillbirth, and it can cause congenital rubella syndrome (the group of birth defects caused by rubella infection before birth). The level of risk depends on timing. Infection in the first 12 weeks of pregnancy causes birth defects in up to 85% of babies, falling to about 50% at 13-16 weeks and about 25% during the second half of the second trimester. Deafness is the most common effect and is sometimes the only one, and there is no cure for congenital rubella syndrome. Anyone who is pregnant and has been around a child with rubella should call their own doctor right away for a blood test if they do not know whether they are immune.