Rubella (German Measles)

About This Disease

Rubella is a rash illness caused by a virus. The illness is usually mild, but if it occurs during the first 3 months of pregnancy, it can cause serious birth defects.

Signs and Symptoms

The symptoms include rash, mild fever, body and joint aches, headache, runny nose and red eyes. Painful swelling of the lymph nodes at the back of the neck often appears before the skin rash. The rash, which lasts for 3 days or less, usually starts on the face and spreads from head to foot. Up to half of the people who get the disease may have few or no symptoms. The symptoms can start 12 to 23 days following exposure to the rubella virus. A person is contagious from 7 days before, to 7 days after the onset of rash.


You get rubella by exposure to airborne droplets from the nose or throat of a person infected with rubella virus. Rubella can also be spread by direct contact. A person with rubella should not go to school or work for 7 days after onset of rash. Persons with active rubella should remain isolated for the duration of the contagious period.


Having the disease once protects you from getting rubella again.

Risk in Hawaii


The best way to keep from getting rubella is to get the MMR vaccine.

All children should receive at least one dose of rubella vaccine, as a combination measles, mumps, rubella vaccine (MMR) at or after 12 months of age. Vaccination is required for all children before enrollment in school and preschool programs and colleges in Hawaii. Unprotected adults born in 1957 or later and all women of childbearing age who are not pregnant should receive one dose of the MMR vaccine.

All women of childbearing age should be vaccinated for rubella before getting pregnant. Rubella is especially serious if a woman becomes infected in the first 3 months of pregnancy because it fetal death or a variety of birth defects, including deafness, eye problems, heart defects, liver and spleen damage and mental retardation. Abnormalities in the fetus caused by rubella infection are called congenital rubella syndrome (CRS). CRS occurs in up to 90% of infants born to women infected during the first trimester of pregnancy. A woman who is not sure of her immune status should consult her doctor.

People with a life threatening allergic reaction to a previous dose of MMR vaccine or its components (gelatin and neomycin) and pregnant women should not receive the MMR vaccine. Persons who have immune system problems or who are ill should consult with their doctor before being vaccinated.

Additional Resources

Information for Clinicians