Rubella, also known as German measles, is a contagious viral human disease caused by the rubella virus. Rubella transmission occurs primarily via respiratory droplets of infected persons. The incubation period of rubella ranges from 12 to 23 days. The initial symptoms of rubella are mild, including low-grade fever, malaise and upper respiratory symptoms. Up to 50% of infections are sub-clinical or asymptomatic. 14-17 days after exposure, the rubella rash develops on the face and then gradually spreads to the feet. Complications of rubella are rare, including arthritis, encephalitis and haemorrhage. When they occur, they show different patterns for different ages and sexes. Adult females are more likely to suffer rubella complications. People develop life-long immunity through natural recovery from the rubella infection.

Rubella can be passed on to the fetus during early pregnancy and can have serious consequences, such as fetal death, preterm delivery and congenital rubella syndrome (CRS). Infants with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction. There is no specific treatment for rubella but the disease is preventable by vaccination. Globally, over 100,000 babies are born with CRS each year. Prevention of CRS is the main objective of rubella vaccination. The first rubella vaccines were licensed in 1969 in the United States. In 1979, a more safe and effective vaccine (RA 27/3) became available, and previous vaccines were discontinued. Today, rubella vaccine is available either by itself, or in combination with measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV). A single dose gives more than 95% long-lasting immunity, which is similar to that induced by natural infection.

WHO recommends all countries to apply the well-established measles immunisation programmers to rubella vaccination. Routine immunisation is given to infants at 9 months, along with supplementary immunisation activities (SIAs) (partially funded by Gavi, the Vaccine Alliance) targeting different age groups. Up to date, large-scale rubella vaccination has practically eliminated rubella and CRS in many developed and in some developing countries. However, CRS rates are still relatively high in African and South-East Asian regions where vaccine coverage is low.

Model name: Rubella model (PHE)

WHO fact sheet on rubella
CDC page on rubella
Gavi page on rubella