• Clinical science

Rubella (German measles)


Rubella, or German measles, is an infectious disease that is caused by the rubella virus. Since the introduction of the measles, mumps, and rubella (MMR) vaccine, it is a relatively rare condition. Rubella is transmitted via airborne droplets and has a mild clinical course. The clinical presentation begins with nonspecific flu-like symptoms and post-auricular and/or suboccipital lymphadenopathy. An exanthem phase may overlap or follow; this phase is characterized by a rash that typically starts behind the ears and progresses distally, developing into a generalized maculopapular rash. Rubella is usually self-limiting and involves symptomatic treatment. Immunization with a live, attenuated vaccine, in association with the measles and mumps vaccine, is highly recommended. The first dose is administered between 12–15 months of age and the second dose between 4–6 years of age. Complications of infection during pregnancy may cause congenital rubella syndrome with severe malformations (e.g., hearing loss, cataracts, heart defects, intellectual disabilities).


  • A rare disease in the US following the implementation of the MMR vaccine


Epidemiological data refers to the US, unless otherwise specified.



Clinical features

Patients with rubella infection are asymptomatic in ∼ 50% of cases. Young children have a far milder course than older children and adults; the latter group often presents with prodromal symptoms, other systemic complaints (e.g., arthritis), and a longer duration of infection.

Prodromal phase

Exanthem phase

  • Duration: lasts 2–3 days
  • Findings
    • Fine, nonconfluent, pink maculopapular rash
      • Begins at the head, primarily behind the ears, extends to the trunk and extremities, sparing palms and soles
      • Rash may be itchy in adults
    • Polyarthritis



Although rubella infection may be considered a clinical diagnosis; , laboratory confirmation is necessary for certain patient groups to assess the risk of complications such as e.g., congenital rubella in pregnant women or encephalitis.


Differential diagnoses

  • Differential diagnoses of pediatric rashes

The differential diagnoses listed here are not exhaustive.





We list the most important complications. The selection is not exhaustive.


The disease usually has a benign course and the exanthem disappears rapidly. Joint pain may persist for several weeks; arthralgia may persist up to a month in adults.




Women of child-bearing age, without vaccination or unclear vaccine status, should be vaccinated prior to pregnancy!

Precautions during infection

  • Patients with rubella infection should be isolated for 7 days after the onset of the rash.
  • Precautions regarding droplet transmission should be taken.

Reporting requirements

  • Rubella cases should be reported to the CDC or to the National Center for Immunization and Respiratory Diseases (NCIRD) within 24 hours of confirmation.