Immunizations Rubella and Congenital Rubella Syndrome Childhood Infections By Vincent Iannelli, MD facebook Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. Learn about our editorial process Vincent Iannelli, MD Fact checked by Fact checked by Emily Swaim on March 01, 2021 linkedin Emily is a fact checker, editor, and writer who has expertise in psychology, health and lifestyle content. Learn about our editorial process Emily Swaim on March 01, 2021 Print DR P. MARAZZI/SCIENCE PHOTO LIBRARY / Getty Images Rubella is also known as 'German measles,' as German doctors in 1814 were the first to discover that it was actually a different disease from measles. It took another 100 years for experts to discover that rubella was caused by a virus, and it wasn't until 1941 that it was no longer thought of as a mild childhood disease. That was when rubella became linked with congenital rubella syndrome (CRS). Will Getting the MMR Vaccine While Pregnant Hurt the Fetus? Symptoms In general, rubella does cause very mild symptoms in most children. About 14 days (incubation period) after being exposed to someone else with rubella, children who aren't immune may develop a maculopapular (small spots) rash that starts on their face and then progresses down to their feet. The rash of rubella has some characteristic features that help to distinguish it from a measles rash, including that the rash is fainter, the spots don't join together like they do with measles, and these children generally don't have a high fever. The rash lasts about 3 days and may be more noticeable after your child gets overheated, especially after a hot bath or shower. Although rubella is only considered to be moderately contagious, it is when you have a rash that you are most contagious, spreading the virus via respiratory droplets and secretions. In addition to the rash, older children may develop swollen lymph nodes in the head and neck area. Swollen lymph nodes may appear up to a week before the rash appears and can linger for several weeks. As with many viral infections, adults with rubella can have more severe symptoms, including low-grade fever, malaise (not feeling well), and swollen lymph nodes. In rare cases, individuals may develop joint pain in the wrists, fingers, and knees (with or without swelling). Complications While rubella is typically a very mild disease, on rare occasions it can cause dangerous complications, especially in adults. Rubella complications can include low platelet counts and vascular damage leading to brain, gastrointestinal, and kidney bleeding. Around 1 in 6,000 people develop life-threatening encephalitis (swelling in the brain). Neuritis (inflammation of nerves in hands and feet) and orchitis (swelling in testicles) are also possible. Tragically, rubella complications are far from rare when a woman becomes infected early in her pregnancy, leading to congenital rubella syndrome. As the rubella virus can infect all of the organs of a developing baby, complications can include: Fetal deathPremature deliveryDeafnessVision abnormalities (cataracts, glaucoma, retinopathy, and microphthalmia)Congenital heart diseaseIntrauterine growth retardationMicrocephaly (in which a baby's head is smaller than expected)Developmental delaysBone alterationsLiver and spleen enlargement Children with congenital rubella syndrome are also more at risk for diabetes mellitus, autism, and progressive panencephalitis (a neurodegenerative disorder that can present years after the initial infection). Treatments There is no specific treatment or cure for rubella infections. For infants born with congenital rubella syndrome, treatments depend on the specific complications that the baby was born with, and they might include surgery for cataracts, hearing aids, etc. Outbreaks One of the biggest outbreaks of rubella and CRS in the United States occurred from 1964 to 1965 and resulted in: 12.5 million rubella virus infections20,000 infants born with CRS2,100 neonatal deaths This outbreak was not limited to the United States. It was a pandemic that had begun in Europe the previous year. As expected, cases of rubella and CRS quickly fell as the first vaccine was licensed in 1969. The rubella vaccine was later combined with the vaccines for mumps and measles in 1971 when the MMR vaccine was introduced. By 1986, there were only 55 cases of rubella in the United States. Coinciding with measles outbreaks, there were a number of rubella outbreaks in 1990-91, leading to at least 2,526 cases of rubella and 58 cases of CRS. A booster dose of MMR and rising vaccination levels helped to decrease rubella cases once again. While we don't see big outbreaks anymore, it is important to note that rubella isn't totally gone in the United States: 2013 - 9 cases of rubella and 1 case of CRS2015 - 5 cases of rubella and 1 case of CRS2017 - 7 cases of rubella and 5 cases of CRS As with other vaccine-preventable diseases, rubella and congenital rubella syndrome are also still big problems around the world. The Measles & Rubella Initiative (founded by WHO, UNICEF, and other organizations) estimates that over 100,000 babies are born with congenital rubella syndrome every year. The program says families in developing countries do not always have easy access to immunization services, putting their children at higher risk of developing CRS. Rubella and congenital rubella syndrome are still problems in some developed countries too. In 2004 and 2005, an unvaccinated religious community in the Netherlands developed a rubella outbreak with 387 cases. The outbreak spread to an affiliated religious community in Canada, causing at least 309 cases of rubella. Across both communities, there were 14 cases of CRS and 2 fetal deaths. There have also been large outbreaks in: Japan - in 2012 and 2013, a nationwide outbreak led to over 7,500 rubella cases and at least 10 cases of CRS.Romania - a 2012 rubella outbreak caused nearly 21,000 cases of rubella.Poland - a 2013 rubella outbreak caused over 38,500 cases of rubella. Although rubella is a vaccine-preventable disease, these cases continue to occur among mostly unvaccinated people when a vaccine is available. And as we repeatedly see, this can lead to an increase in neonatal deaths and cases of CRS. What You Need to Know About Rubella Other interesting facts about rubella include that: An ophthalmologist in Australia in 1941, Dr. Norman Gregg, first linked the rubella virus with congenital birth conditions.The incubation period of rubella can range from 12 to 23 days.Up to half of people with rubella don't have any symptoms or any obvious symptoms, although they can still be contagious to others.People with rubella may shed the virus, and be contagious, for up to 7 days before and after the rash starts.Antibody tests can determine if someone has rubella or if they are immune after vaccination.A single dose of MMR vaccine is about 95% protective against rubella.In 2004, rubella and CRS were eliminated in the United States. Since 2004, there have been fewer than 10 rubella cases and one CRS case per year. The elimination of rubella and congenital rubella syndrome in the United States has been a great vaccination success story. But rubella has not been completely eradicated across the globe, so infection is still possible. Evidence shows that every rubella case in the U.S. since 2012 has been contracted while the individual was outside the country. Vaccination is still incredibly important. Get Educated. Get Vaccinated. Stop the Outbreaks. Was this page helpful? Thanks for your feedback! Get expert tips to help your kids stay healthy and happy. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Center for Immunization and Respiratory Diseases. Congenital rubella syndrome. Updated April 28, 2020. Rubella virus infection, the congenital rubella syndrome, and the link to autism. College of Physicians of Philadelphia. Rubella. Updated February 7, 2019. Centers for Disease Control and Prevention. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2011. Updated January 20, 2012. World Health Organization. Rubella reported cases. Updated October 15, 2020. The Measles & Rubella Initiative. The problem. Updated September 8, 2020. Hahne S, Macey J, van Binnendijk R, et al. Rubella outbreak in the Netherlands, 2004-2005: high burden of congenital infection and spread to Canada. Pediatr Infect Dis J. 2009;28(9):795-800. doi:10.1097/INF.0b013e3181a3e2d5 Tanaka-Taya K, Satoh H, Arai S, et al. Nationwide rubella epidemic — Japan, 2013. Morb Mortal Wkly Rep MMWR. 2013;62(23):457-62. Additional Reading National Center for Immunization and Respiratory Diseases. Epidemiology and prevention of vaccine-preventable diseases: rubella. Updated December 16, 2020.