Rubella

Rubella, also known as German Measles, is a highly contagious disease caused by the rubella virus. It was once a common childhood disease, but due to routine vaccination programs, the risk of getting rubella in Canada is now very low.

Getting rubella is most dangerous in early pregnancy as it can cause miscarriage or stillbirth. Pregnant individuals who get rubella have a 90% chance of passing the virus to their developing baby who may then be born with severe birth defects such as:

  • cataracts
  • deafness
  • heart defects
  • lifelong mental and physical disabilities

This is called Congenital Rubella Syndrome (CRS), which happens in 9 out of 10 babies born to individuals who are infected with rubella in the first 3 months of pregnancy. The risk of CRS is low likely due to routine vaccination and low transmission of the virus.

Vaccination makes it unlikely for children, pregnant individuals, and others to get rubella. Most cases in Canada are travel-related since rubella vaccination is not routine across the world.

 

Rubella is spread by an infected person through:

  • Direct contact, such as kissing or sharing food or drinks
  • Respiratory droplets that come out of their nose or mouth when breathing, coughing, sneezing or talking

People can spread rubella to others about one week before they develop the common symptom of a rash, which is often before they know they are sick, and for the first four days after the rash appears.

Symptoms appear between 14 and 21 days after infection, but some people, especially children, may not show any symptoms.

Rubella is usually not severe, and can cause:

  • a rash, which may be itchy, that starts on the face and spreads to the rest of the body (lasts about three days)
  • a low-grade fever (under 39°C)
  • nausea
  • redness, swelling, and pain of the lining of the eye (conjunctivitis)
  • swollen glands behind the ears and neck
  • cold-like symptoms before the rash appears (e.g. headache, weakness, runny nose, red eyes)
  • aching or swollen joints

Getting rubella can sometimes cause serious problems, including:

  • swelling of the brain (encephalitis)
  • internal bleeding (thrombocytopenia)
  • viral infection of the brain leading to brain problems (progressive rubella panencephalitis)

The rubella vaccine is given in two doses as part of vaccination against measles, mumps, and varicella. Over 97% of individuals develop immunity against rubella after one dose of vaccine.

See the MMR and MMRV vaccine fact sheet for more information.

Note: Under Ontario’s Immunization of School Pupils Act, parents/caregivers are required to report their child’s vaccination or a valid exemption. Visit toronto.ca/studentvaccines for details and to report vaccinations.

 

Individuals should stay home from work, school, daycare, and public places for one week (seven days) after the rash appears.

To help stop the spread of rubella:

If you or your child develop symptoms, call a health care provider immediately to book an appointment that avoids exposing others to the infection.

 

Health care providers diagnose rubella based on:

  • symptoms
  • vaccination history
  • potential exposure to the virus based on recent outbreaks
  • travel history to regions where the disease is common

Diagnosis is confirmed using laboratory testing. Rubella tests are available, using blood, urine or nasal swabs, to confirm diagnosis or immunity. Testing to confirm immunity after vaccination is not usually recommended. If you have proof of vaccination, history of a laboratory confirmed infection or laboratory confirmed immunity, you are considered immune to rubella.

There is currently no treatment for rubella. Mild infections usually get better on their own, and by drinking plenty of fluids and eating healthy foods to help fight the infection. Health care providers may prescribe medication to reduce fever.

 

If you are not immune to rubella and have been exposed, post-exposure vaccination does not prevent infection or reduce the risk of severe illness. However, anyone who is at risk of getting rubella and has been exposed should be vaccinated to reduce the risk of infection from further exposures. If you are pregnant and have been exposed to rubella, contact a health care provider immediately.

 

Rubella needs to be reported to Toronto Public Health by schools and child care centres.

Health care providers must also report rubella, congenital rubella infection, and congenital rubella syndrome to Toronto Public Health.