Rubella (German Measles)

Symptoms

Typical symptoms of rubella are a mild rash, swollen and tender glands (especially behind the ear, at the back of the neck, and under the skull), and a slight fever. In addition, some adolescent girls and adult women develop joint pain (arthritis), especially in the small joints of the hands.

• Swollen glands in the neck area are common with many viral infections. However, with rubella, the glands that are most affected are those located behind the ear and at the back of the head. The degree to which they become swollen and tender is unique to rubella.
• Sometimes a rash is the only symptom of rubella that young children develop.
• Older children and teenagers may have fever, eye pain, sore throat, and body aches. They may or may not develop a rash.
• Symptoms of rubella, especially pain and swelling at the joints, may be more severe in adults than in children. Joint pain (more commonly seen in women) may take as long as a month to go away.

The rash associated with rubella is mild, starts on the face, and spreads to the neck, the chest, and the rest of the body. It may first appear as a mild blush before it develops into a more pinpoint rash with distinctive spots. Rubella infection without a rash is also common. Even if you do not have a rash, you are still contagious.

Complications, such as infection of the brain (encephalitis), can develop from rubella. Encephalitis from rubella is very rare but serious. About 1 out of 5 people who get this complication die.

A fetus that becomes infected with rubella during the first trimester is at risk for miscarriage, fetal death, and birth defects.² Up to 90% of fetuses exposed to rubella during the first 11 weeks of pregnancy develop congenital rubella syndrome (CRS).² This syndrome can result in serious birth defects. Hearing impairment is the most common, although cataracts and glaucoma, other eye problems, heart defects, brain problems, mental and physical retardation (stunted growth), and bone disease may also occur.

Other viral illnesses and conditions can cause symptoms and rashes similar to rubella. For this reason, rubella may be confused with:

• Mild cases of scarlet fever, an illness that most often occurs in children between the ages of 2 and 10 who have recently had strep throat.
• Measles, also called rubeola or red measles.
• Fifth disease (parvovirus B19), a contagious and usually mild viral illness that is common in children.
• Roseola, a mild viral illness that affects young children. It often starts with a sudden high fever of 103°F (39.4°C) to 105°F (40.6°C) that lasts 2 to 3 days.
• Infectious mononucleosis, a viral illness usually caused by the Epstein-Barr virus. Mono most commonly develops in young adults between the ages of 15 and 24.
• Allergic reactions to medicines.
• Some stomach and intestinal viral infections, such as stomach flu (gastroenteritis).

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Author:	Amy Fackler, MA Debby Golonka, MPH	Last Updated: October 2, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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