Conditions · Pediatrics and neonatology
Rubella and congenital rubella syndrome !
A mild viral rash illness in children, but in early pregnancy it can cause deafness, cataracts and heart defects in the baby. Vaccines prevent it.
Updated 2026-11-01
Structures involved
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Microorganisms that cause it
Why it happens
What it is
Rubella (German measles) is a mild, contagious viral infection caused by the rubella virus (genus Rubivirus), with rash, fever and enlarged lymph nodes. Its importance is congenital rubella syndrome (CRS): infection in early pregnancy can cause miscarriage, stillbirth or a baby with deafness, eye defects and heart defects.
Who gets it
It remains the leading vaccine-preventable cause of birth defects worldwide, with many thousands of babies born with CRS each year in countries with low vaccine coverage. The Americas, including Colombia, were declared free of endemic rubella and CRS in 2015 after mass vaccination, but imported cases remain possible, so surveillance of fever with rash and high vaccine coverage are maintained. Rubella and CRS are notifiable diseases in Colombia.
Causes
- Rubella virus, an RNA virus (family Matonaviridae)
- Spread by respiratory droplets from infected people, including those without symptoms
- Transplacental spread to the fetus during maternal viraemia
- Infants with CRS shed the virus for many months and can infect others
Risk factors
- No vaccination or incomplete vaccination
- Non-immune women of childbearing age
- Infection in the first 12 weeks of pregnancy (highest risk of CRS)
- Travel to or contact with people from countries with ongoing transmission
- Crowded settings with low vaccine coverage
Pathophysiology
The virus replicates in the upper respiratory tract and regional lymph nodes, then spreads in the blood; the rash appears as the immune response begins. In pregnancy the virus crosses the placenta and infects fetal tissues, slowing cell division and damaging small blood vessels while organs are forming. This explains why risk and severity are greatest in the first trimester and fall after about 16–20 weeks, and why the eye, inner ear, heart and brain are most affected.
Classification
- Postnatal (acquired) rubella
- Congenital rubella infection without defects
- Congenital rubella syndrome (CRS)
Symptoms and signs
- Mild fever, sore throat and runny nose
- Pink maculopapular rash that starts on the face and spreads down, lasting about 3 days
- Tender lymph nodes behind the ears, at the back of the head and in the neck
- Joint pain and swelling, mainly in adolescent and adult women
- About half of infections cause no symptoms
- CRS: sensorineural deafness, cataracts, congenital heart disease (patent ductus arteriosus, pulmonary artery stenosis), microcephaly and developmental delay, 'blueberry muffin' rash, low birth weight, hepatosplenomegaly
Diagnosis
- Clinical
- Fever with rash and posterior auricular or suboccipital lymph nodes suggests rubella, but the picture overlaps with measles and other rash illnesses, so laboratory confirmation is needed and every case of fever with rash is reported to public health surveillance.
- Tests
- Rubella-specific IgM serology, a rise in IgG between paired samples, or RT-PCR of throat swab or urine. In pregnancy: IgM, IgG avidity and specialist counselling. In suspected CRS: infant IgM, persistent IgG beyond the expected maternal antibody decline, or RT-PCR of throat swab or urine.
- Imaging
- Not needed for acquired rubella. For CRS: echocardiography, eye examination, hearing screening (otoacoustic emissions or brainstem response) and cranial ultrasound.
Differential diagnosis
- Measles
- Parvovirus B19 (erythema infectiosum)
- Roseola (human herpesvirus 6)
- Dengue, Zika and chikungunya
- Scarlet fever, enteroviral rash, drug eruption
- Other congenital TORCH infections (cytomegalovirus, toxoplasmosis, syphilis)
Goal of treatment
Relieve symptoms of acquired rubella, prevent spread (especially to pregnant women), and detect and treat the defects of congenital rubella syndrome early with multidisciplinary follow-up.
Treatment
- Conservative
- Acquired rubella: supportive care with rest, fluids and antipyretic and analgesic medicines; no specific antiviral exists.
- Follow-up
- Isolation: droplet precautions and staying away from school or work for about 7 days after rash onset; infants with CRS need contact precautions for up to a year.
- Medical
- CRS: specialist care for heart defects (e.g. PDA closure), cataract surgery, hearing aids or cochlear implants, and early developmental intervention.
- Follow-up
- Nursing priorities: check rubella immunity in women before pregnancy, keep non-immune pregnant staff away from cases, report cases, and follow growth, hearing and vision in CRS.
Complications
- Arthritis and arthralgia (adult women)
- Thrombocytopenic purpura
- Encephalitis (rare)
- In pregnancy: miscarriage, stillbirth and CRS
- CRS long term: deafness, blindness, intellectual disability, diabetes and thyroid disease, progressive rubella panencephalitis (rare)
Prognosis
Acquired rubella is usually mild and self-limited. In CRS, heart defects and cataracts can often be repaired, but deafness and brain damage are permanent and need lifelong support.
Prevention
- Measles–rubella or MMR vaccine in the routine childhood schedule (two doses)
- Verify immunity and vaccinate non-immune women before pregnancy; the live vaccine is not given during pregnancy
- Surveillance and notification of every case of fever with rash
- Isolation of cases and contact tracing
Test yourself
Think of the answer, then tap the question to see it.
What is the classic triad of congenital rubella syndrome?
Sensorineural deafness, cataracts and congenital heart disease (e.g. patent ductus arteriosus).
When during pregnancy is rubella infection most dangerous to the fetus?
In the first trimester, especially the first 12 weeks.
Which lymph nodes are typically enlarged in rubella?
Postauricular, suboccipital and posterior cervical nodes.
Why is the rubella vaccine not given during pregnancy?
It is a live attenuated vaccine.
Which test confirms acute rubella?
Rubella-specific IgM serology or RT-PCR.
Related conditions
- Congenital (TORCH) infections: syphilis, toxoplasmosis, CMV and Zika
- Measles
- Patent ductus arteriosus
- Cataract
- Hearing loss (conductive and sensorineural, including sudden hearing loss)
- Erythema infectiosum (fifth disease, parvovirus B19)
- Roseola infantum (exanthem subitum)
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Rubella (World Health Organization, 2024); Congenital rubella: MedlinePlus Medical Encyclopedia (MedlinePlus (U.S. National Library of Medicine), 2024); About Rubella | Rubella | CDC (Centers for Disease Control and Prevention, 2024).
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