Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus.
Epidemiology
- Transmission: Air droplets via nasopharyngeal secretions (respiratory route) (80% infectivity)
Aetiology
- Rubella

Clinical features
75% cases symptomatic
- Incubation period: 14-21 days
- Infective period: 7 days before & 5 days after appearance of rash
Children:
In children, rubella normally last two days
- Generalised maculopapular rash “blueberry muffin rash“: Face → Trunk → Extremities
- Febrile illness: Low fever of < 38.3 °C (101 °F)
- Posterior cervical lymphadenopathy
- Forchheimer spots (20% cases): Tiny red-coloured lesions in oropharynx or petechial haemorrhages on soft palate

Older children and adults:
- Additional symptoms:
- Swollen glands
- Coryza (cold-like symptoms)
- Arthritis/arthralgia (especially in young women)
- Rare problems:
- Brain inflammation
- Ear infection
Late-onset complications:
- Progressive rubella pancephalitis (PRP)
- Type I Diabetes mellitus
- Thyroiditis & hypothyroidism
Diagnosis
- Isolated in:
- Urin, blood, nasopharynx & CSF
- For 2 weeks after rash onset
- Urin, blood, nasopharynx & CSF
- Serology:
- Maternal: IgG & IgM titres
- Neonate (Umbilical cord blood): IgG titre

Differential diagnosis:
Other viral illnesses associated with rash
- Measles: Appears on 4th day over face and retroauricular in origin
- Chicken pox: Appears on 1st day of fever, with centripetal distribution and pleomorphic appearance like dewdrops on a rose petal.
- Erythema infectiosum: Rash on cheeks (slapped cheek appearance), and moves to trunk and extremities
- Erythema subitum: Macules/maculopapular rash
- Infectious mononucleosis: Associated with maculopapular rash
- Roseola

Management
- Maternal termination of pregnancy
- Unequivocal diagnosis of rubella in the first trimester of pregnancy is indicative
- Droplet precautions (7 days after rash onset)
- Prenatal counselling
- Rubella immunization
- All children and particularly all adolescent girls