Symptoms:

• About 25% to 50% of people who get infected with rubella will not experience any symptoms.
• Young children who get infected with rubella typically have mild symptoms.
• If children do have symptoms, a red rash is generally the first sign. The rash usually begins on the face then spreads to the rest of the body.
• Most adults who get rubella usually have a mild illness, with low-grade fever, sore throat, and a rash that starts on the face and spreads to the rest of the body.
• Some adults may also have a headache, pink eye, and general discomfort before the rash appears.

Complications:

The most serious complication from rubella infection is the harm it can cause a pregnant person’s developing baby. Serious birth defects are more common if a pregnant person is infected early in their pregnancy, especially in the first trimester. These severe birth defects are known as congenital rubella syndrome (CRS) and may result in infants being born with one or more of the following conditions:

• Heart problems
• Loss of hearing and eyesight
• Intellectual disability
• Liver or spleen damage
• Low birth weight

If you think you or someone in your family may have symptoms or been exposed to rubella, contact your health care provider.

Rubella spreads when an infected person coughs or sneezes. A person with rubella may spread the disease to others up to one week before the rash appears and remain contagious up to 7 days after.

If a pregnant person is infected with rubella, they can pass it on to their developing baby. See Pregnancy and Rubella page to learn more.

Rubella vaccination is the best way to prevent getting rubella. One dose of the MMR or MMRV vaccine is about 97% effective at preventing rubella.

• There are two types of rubella-containing vaccines
• Measles-mumps-rubella (MMR) vaccine for persons aged 12 months and older.
• Measles-mumps-rubella-varicella (MMRV) for persons aged 12 months to 12 years.

Learn more about who should get the MMR and MMRV vaccine.

There are many places to get the MMR or MMRV vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.

If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:

• Eligible for or are enrolled in Medi-Cal
• American Indian or Alaskan Native
• Uninsured (do not have health insurance)
• Underinsured (private health insurance does not cover the full cost of vaccines)

Click to see if your child is eligible to receive VFC vaccines: English | Spanish

Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• LACDPH Vaccine Preventable Disease Control Program website for patients and their families to get more information on vaccines.

You can also dial 2-1-1 for a list of free or low cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults. Learn more about specific vaccine information for different age groups:

• Vaccines for Infants and Children (LACDPH)
• Vaccines for Adolescents and Teens (LACDPH)
• Vaccines for Adults (LACDPH)

• Rubella and Pregnancy (March of Dimes)
• Rubella: Questions and Answers (Immunize.org)
• Vaccine-Preventable Diseases: Rubella (CDC)
• Travelers' Health: Travel Vaccines (CDC)
• What is Rubella (German Measles) (National Foundation for Infectious Diseases)
• Rubella (German Measles) (Johns Hopkins)
• Paying for Vaccines (LAC DPH)
• Child and Adolescent Vaccine Assessment Tool (CDC)
• The Adult Vaccine Assessment Tool (CDC)

Consider rubella in unvaccinated patients who recently traveled internationally or a person who was exposed to a confirmed rubella case. Rubella presents nonspecifically with the following symptoms:

• Maculopapular rash (fainter than a measles rash) that starts on the face and progresses from head to feet, becomes generalized in 24 hours and lasts a median of 3 days.
• Other symptoms such as a low-grade fever, headache, conjunctivitis, rhinitis, and lymphadenopathy may occur 1 – 5 days before the rash.

Rubella is a mild viral illness, but it's very infectious and can lead to Congenital Rubella Syndrome (CRS), which can cause structural birth defects affecting the eyes and heart. When rubella infection occurs during pregnancy, especially during the first trimester, complications include miscarriages, and fetal deaths/stillbirths. At birth, infants may have signs and symptoms of CRS, including:

• Hearing loss
• Cataracts
• Heart defects
• Cognitive disabilities
• Intrauterine growth retardation (IUGR)
• Liver and spleen damage
• Bone abnormalities

CRS was eliminated from the United States in 2004, but cases can still be imported by a pregnant person who contracts rubella in an endemic country. Although rare, CRS can occur when a susceptible pregnant person acquires a mild or asymptomatic rubella infection early in pregnancy, and fetal anomalies are later noted on ultrasound or at birth. Maternal infection beyond 18 weeks gestation may result in congenital rubella infection (CRI) only and not signs and symptoms of CRS.

Universal childhood vaccine is important to eliminate community transmission of rubella and thus prevent acquisition during early pregnancy.

• Clinical diagnosis of CRS and acute cases of rubella should be verified with laboratory testing.
• Serology Testing Recommendations for CRS
• Rubella IgM - Test suspected infants as close to birth as possible and again at 1 month of age if the initial IgM test is negative.
• Rubella IgG - The presence of rubella IgG in an infant after the decline of maternal antibodies (9 months of age) and the absence of vaccination or exposure to rubella will confirm CRS.
• Molecular Testing:
• Rubella RT PCR –throat or nasopharyngeal swab, urine specimens, and cerebrospinal fluid (CSF) from a neonate are used to confirm suspected CRS cases.
• Throat swabs are the preferred sample types for detecting rubella RNA in CRS cases.
• Use viral transport media to collect NP and throat swabs.
• CRS surveillance and case confirmation algorithm can be found in the CDC’s Birth Defects Surveillance Toolkit (page 84).

If a commercial lab cannot perform testing, please call the Los Angeles County Department of Public Health Vaccine-Preventable Disease Control (VPDC) Program at 213-351-7800 to arrange testing through the Public Health Laboratory (PHL). See below for instructions.

• Specimen Storage: Store specimens refrigerated at 2-8°C until transportation to PHL or commercial lab can be arranged. Transport refrigerated specimens on cold packs to the laboratory as soon as possible.

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that persons who do not have presumptive evidence of immunity should get vaccinated. Vaccination is the best way to prevent rubella and complications, such as CRS, from disease.

• MMR and MMRV vaccines are both safe and highly effective vaccines to protect against rubella.
• In immunocompetent individuals, 1 dose of a rubella-containing vaccine is 97% effective against rubella.
• Healthcare personnel should have documented evidence of immunity against rubella.

MMR and MMRV Vaccine Recommendations

Proper vaccine storage and handling practices play an important role. For general recommendations and guidance access the Vaccine Storage and Handling Toolkit.

Please contact the County of Los Angeles Dept. of Public Health Vaccine-Preventable Disease Control Program to report a case or obtain technical assistance with specimen collection or completion of forms for the reporting of rubella or CRS. Consultation is required before sending specimens to the Public Health Laboratory.

Report suspected or confirmed rubella cases within 7 calendar days from identification by electronic transmission (email or digital fax) or telephone (IAW Title 17, California Code of Regulations (CCR), Section 2500).

Documents to include:

• Confidential Morbidity Report (CMR) Form (Confirmed)
• Related Patient Medical Records
• Immunization Records

CRS cases should also be reported to the Vaccine Preventable Disease Control Program within 7 calendar days from identification. Submit the following documentation:

• CRS Reporting Form
• Maternal medical history, including vaccination records, travel history, and prenatal screening
• Infant medical history
• Laboratory results

Weekday Telephone (8:30 AM to 5:00 PM): 213-351-7800
After Hours: Call 213-974-1234
Email: vpdc@ph.lacounty.gov
Fax: 213-351-2782

Click here for more information on reporting a Vaccine Adverse Event.

• Rubella Quicksheet (CDPH)
• Congenital Rubella Syndrome (CRS) (CDC)
• Testing Pregnant Patients (CDC)
• Testing for Measles, Mumps, Rubella and Varicella (CDC)
• ACIP Vaccine Recommendations for MMR | MMRV (CDC)
• MMR Vaccine Information Statement (CDC)
• MMRV Vaccine Information Statement (CDC)
• Standing Orders for Administering MMR Adults | Children and Teens (Immunize.org)
• Rubella: Questions and Answers (Immunize.org)
• Vaccine Facts (LAC DPH)
• Los Angeles Health Alert Network (LAHAN) (LAC DPH)
• Centers For Disease Control and Prevention (CDC) Rubella Trainings
• You Call the Shots
• The Pink Book Webinar Series