Rubella (German measles) in preschoolers

What is rubella?

Rubella, or German measles, is an infection which can cause a pinkish-red rash that first appears on the face and later spreads elsewhere on the body. Other symptoms that usually appear before the rash include a mild temperature, conjunctivitis and swollen lymph nodes (DH 2006: 343). The virus runs its course in about three days but up to half of people don't get any symptoms so they won't know that they've had it (Centers for Disease Control 2001).

Because most children in the UK receive the measles, mumps, and rubella (MMR) vaccine, it's now extremely rare here. In 2007 there were just 34 confirmed cases in the UK (HPA).

A child with rubella typically has a measles-like rash and a low fever, although it's possible for a child to have the virus without showing any symptoms. Rubella is commonly known as German measles or three-day measles, but it's actually not the same disease as measles, which is caused by a different virus.

If it's mild, why is it dangerous?

Rubella isn't dangerous to young children, but it can be devastating to unborn babies during the first trimester. In fact, the vaccine was developed primarily to protect women of childbearing age before they become pregnant.

A woman infected with rubella during her first trimester has an 85 per cent chance of having a baby with congenital rubella syndrome (CRS), which can lead to miscarriage, stillbirth, and severe birth defects, including deafness, blindness, and heart and brain defects.

Fortunately in the UK, the majority of women in their childbearing years are immune to the disease, either because they were vaccinated against it as a child or because they have already had the illness.

How do the symptoms develop?

The first sign in children is often an itchy rash, usually starting on the face and neck and later spreading to the rest of the body. The rash may look like pink or light red spots, which may merge to form evenly coloured patches. It typically lasts for two or three days.

Other symptoms include a low fever (38 degrees C/101 degrees F) that lasts about 24 hours; a stuffy or runny nose; red, inflamed eyes; and enlarged lymph nodes at the base of the skull, behind the ears, and at the back of the neck.

Most children with rubella recover quickly and completely. Adults who contract rubella sometimes suffer complications like arthritis and encephalitis (inflammation of the brain).

How does rubella spread?

While rubella isn't as contagious as measles or chicken pox, an unimmunized preschooler could become infected by inhaling droplets of saliva or mucus when an infected person sneezes or coughs.

A child with rubella is considered contagious from a week before the rash appears to a week after it goes away, although he's most contagious while he has the rash. If you're pregnant and were never immunised, it's important to stay away from an infected child until at least a week after his rash disappears.

Should I call the doctor if I think my preschooler has rubella?

Yes. In the UK, rubella is a notifiable disease (DH 2006: 344). This means that the Department of Health is keeping a record of the number of cases of rubella so that they can check how successful the immunisation programme has been. Plus, rubella is easily confused with other illnesses such as measles and scarlet fever, so the doctor will probably want to examine your child and take blood samples to confirm the diagnosis.

Call the doctor if your child's fever goes above 39 degrees C (103 degrees F) or if he has symptoms other than the fever and rash.

How should I treat rubella?

In the unlikely instance that your child contracts rubella, you won't need to do much because it's usually a very mild illness. Antibiotics won't work against rubella because it's caused by a virus, not by bacteria.

You may want to give your child some infant paracetamol or ibuprofen if the fever is making him uncomfortable. Never give aspirin to a child as it can trigger Reye's syndrome, a rare but potentially deadly illness.

How can I protect my child against rubella?

Make sure he receives the MMR vaccine. It's usually given at 12 to 15 months of age - and again between four and six years - as part of your child's scheduled immunisations. If your child is behind on any of his immunisations, check with his doctor about a makeup schedule.

Last reviewed: May 2008



DH. 2006. Rubella. Chapter 28 in Immunisation against infectious disease: The Green Book. London: Department of Health. [pdf file 115KB; Accessed May 2008]

HPA. Confirmed cases of Measles, Mumps and Rubella 1997-2007. Health Protection Agency. [Accessed October 2008]

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