What is rubella?

Rubella virus is an infectious disease caused by rubella virus. The rubella disease is therefore also called rubella. Rubella is one of the classic childhood diseases, like measles , mumps and chickenpox . Rubella is highly contagious. Those who are not vaccinated are usually infected in childhood. Rubella is particularly common in winter and spring.

Because of the vaccination, rubella cases have decreased significantly worldwide. The World Health Organization (WHO) counted only 10,000 cases in 2016 (year 2000: 670,000). Rubella is most common in western Pacific, Southeast Asian and African countries. In Germany only a few people are infected with the rubella virus. Many are immune to rubella.

Usually rubella progresses without complications. Many do not even notice that they have contracted the disease. However, this harmless course does not apply to pregnant women . If expectant mothers become infected, they can transmit the virus to their unborn child. Rubella during pregnancy can have serious consequences for the unborn child. Serious malformations in the child (e.g. deafness, intellectual disabilities, heart defects) or miscarriages are possible. Due to the rubella vaccination, however, these complications have become significantly less common today.

Rubella: symptoms

Only about half of patients develop rubella symptoms. And when they do, they are usually mild. The other half has no visible signs of the infectious disease. Rubella usually begins with uncharacteristic symptoms that can also occur with other diseases. The first signs of rubella are similar to those of a cold (flu-like infection).

Rubella in babies, toddlers and children

• headache
• slight fever
• inflamed airway mucous membranes
• sometimes mild conjunctivitis : the eyes redden and itchy occurs.
• swollen, painful lymph nodes, especially on the neck and behind the ears
• Rash on the skin that is typical of rubella: The small spots appear on the face first. From there they spread over the entire body to the arms and legs. Severe itching does not occur with rubella rash. The rash lasts for about two to three days.

After about a week, the symptoms of rubella subside. Anyone who has gone through the disease has lifelong immunity. So he can't get infected a second time.

Rubella in adults and adolescents

Rubella in adults can be more severe than in babies and children. The following symptoms and complications are possible:

• headache
• Loss of appetite
• slight inflammation of the conjunctiva and eyelids
• Runny nose: the nose is blocked or runny
• to cough
• swollen lymph nodes in other areas of the body, not just behind the ears and neck
• Joint inflammation with swollen, painful joints - especially in young women

The older a person is when they develop rubella, the more often complications arise: inflammation of the middle ear, brain, heart muscle, pericardium and bronchitis are possible.

Rubella: airborne infection

The infection with rubella usually happens via droplet infection, i.e. when coughing, sneezing or speaking. If other people in the area inhale the rubella virus droplets, they can become infected. The rubella pathogen penetrates the body via the mucous membranes of the upper respiratory tract, multiplies and ultimately leads to the onset of the disease. It takes about two to three weeks for the first symptoms to show up, if at all.

Women who become infected with rubella during pregnancy can transmit the virus to their unborn baby. This is extremely dangerous for the child. Outside the human body, the rubella virus does not survive long. Therefore, transmission of rubella by other means than air is rare.

Rubella: The course of the disease is usually mild, but not always

The time between infection with the rubella virus and the onset of the disease is two to three weeks . That's how long the incubation period is for rubella. Most of the time the disease is mild and many even develop no symptoms at all. But not always. With increasing age, the course of rubella is often more severe. Then the risk of complications from rubella is increased. For example, joint, middle ear or heart muscle inflammation can occur. Even with rubella during pregnancy, complications occur in the unborn child, most commonly malformations or a miscarriage.

Rubella - duration and how long is it contagious?

Rubella lasts about a week, by which time all symptoms have usually subsided. Anyone who has contracted rubella is contagious about a week before the rash appears and a week afterwards - and therefore a danger to others. Even people who don't develop rubella symptoms and don't notice the disease can infect others.

Children who have been infected with rubella in the womb (rubella embryopathy) excrete the virus in large quantities through the respiratory tract and urine until they are one year old.

Anyone who has survived rubella once is protected from the disease for life - they are immune and will not get it a second time.

Rubella - complications are possible

The course of rubella is not always mild and harmless. This is especially true for adults and pregnant women. Rubella can cause the following complications:

• Joint inflammation and joint pain , especially in the finger, hand or knee joints. The joints feel stiff and hurt when they are exerted. Such joint inflammations occur almost only in young women and heal on their own after a few weeks.
• bronchitis
• Ear infection
• Myocarditis , pericarditis
• Lack of blood platelets: The consequences are bleeding from the skin, mucous membranes or from the blood vessels
• Inflammation of the brain, which is very rare

Complications in babies infected with rubella in the womb (rubella embryopathy) include:

• Eye damage
• deafness
• Heart defect
• Brain damage
• Damage to the liver, spleen and bone marrow

Rubella vaccination

The Standing Vaccination Commission (STIKO) of the Robert Koch Institute (RKI) has recommended rubella vaccination for all children since 1991. There used to be a single vaccine that only offered protection against rubella. This rubella vaccine has not been available since 2012. Today, doctors use a combination vaccine that prevents measles and mumps at the same timeand rubella protects. It is abbreviated as the MMR vaccine. It is one of the live vaccines. These contain small amounts of reproductive pathogens. However, they are so weakened that they do not trigger the disease on their own. For several years there has also been a quadruple vaccine that provides additional protection against chickenpox (varicella). Your child is protected from four infectious diseases with just a few syringes.

Rubella vaccination: when and how often?

In order to achieve the bests possible immunity against rubella, the STIKO recommends two vaccinations according to the following vaccination schedule:

• The first vaccination should be given to babies between the ages of eleven and 14 months. If parents plan to give their child to a community facility (e.g. daycare) before it is 11 months old, the first vaccination is possible as early as nine months.

• The second rubella vaccination takes place at the earliest four weeks after the first vaccination, i.e. between 15 and 23 months of age.

Overall, both girls and boys should be vaccinated, because pregnant women can be infected by either sex.

In addition, the following vaccination recommendations apply to certain groups of people:

• Unvaccinated children and adolescents should catch up with rubella as soon as possible (two doses of vaccine).
• Employees in health care (e.g. pediatrics, obstetrics, pregnant women) or in community facilities (e.g. daycare centers, schools) who have contact with pregnant women, infants or small children should have a one-time vaccination if they were not vaccinated against rubella in childhood or if the vaccination status is unclear is.
• Women of childbearing potential  should definitely be vaccinated twice before their first pregnancy. A vaccination against rubella during pregnancy is not possible. As a precaution, there should be at least one month between vaccination and pregnancy because of the live vaccine. Anyone who has not been vaccinated or has only been vaccinated once or for whom the vaccination status is unclear should definitely get the vaccination before they become pregnant. However, if women accidentally get vaccinated during pregnancy because they do not yet know about the offspring in their wombs, this is not a reason for an abortion. Damage to the embryo from the vaccination is not yet known.

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