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Rubella in Adult
Other Resources UpToDate PubMed

Rubella in Adult

Contributors: Rajini Murthy MD, Susan Burgin MD
Other Resources UpToDate PubMed


Rubella (German measles) is caused by the rubella virus, which is an RNA virus in the Togaviridae family. Transmission is through the respiratory route. Its incubation period is 14-21 days. A prodrome of irritability, malaise, mild conjunctivitis, headache, fever, adenopathy, and minimal respiratory symptoms may appear 1-7 days prior to the cutaneous eruption. An exanthematous eruption starts on the face, spreads caudally, becomes generalized in 24 hours, and then typically disappears within 3 days. The palms and soles are typically, but not always, spared. This rash may be absent in as many as 25% of cases.

Infection in the United States is rare, owing to widespread vaccination. There is a higher incidence in confined populations such as military bases and schools. The disease is more common in the spring and summer. Arthralgias and mild arthritis, splenomegaly, thrombocytopenia, and testicular pain are sometimes seen. Encephalitis occurs in 1 out of 6000 cases. Pain on lateral or upward eye movement is common in this disorder. Thrombocytopenic purpura is also a rare complication.

Even in the immunocompromised host, rubella is usually a benign illness. The major impact of rubella is on the fetus of a pregnant patient and is one of the TORCH (toxoplasmosis, other [syphilis, varicella zoster, parvovirus B19], rubella, cytomegalovirus, and herpes simplex) diseases. These disorders can cause fetal heart and eye malformations, cataracts, deafness, intellectual disability, thrombocytopenic purpura, hepatosplenomegaly, intrauterine growth retardation, interstitial pneumonia, myocarditis, myocardial necrosis, and metaphyseal bone lesions.


B06.9 – Rubella without complication

36653000 – Rubella

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Last Reviewed:03/19/2023
Last Updated:04/03/2023
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Patient Information for Rubella in Adult
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Contributors: Medical staff writer


German measles (rubella) is caused by the rubella virus and spreads among humans through contact with fluids in the respiratory tract. The development (incubation) period of German measles is 14-21 days before starting to feel ill, and a rash accompanied by fever appears 1-7 days later. German measles occurs more commonly in the spring and summer months. Even in a person with a weak immune system, German measles is usually a mild illness. However, if a pregnant person becomes infected, German measles can cause severe damage to the unborn baby.

Who’s At Risk

German measles is rare in the United States due to required vaccination, usually given twice before children start attending school. There is a higher incidence of German measles in people who are in confined situations such as military bases and schools. Most infections seen in the US occur in young adults who have not been vaccinated. German measles is commonly seen in disadvantaged people, migrant workers, and new immigrants.

Signs & Symptoms

  • Your child may develop irritability, fatigue, headache, fever, and minor respiratory symptoms 1-7 days before the rash appears. Areas in the neck and other areas (lymph nodes) may become swollen.
  • Children may have pain when trying to move their eyes side to side (lateral movement) or upward.
  • Pink, flat spots begin to appear on the face. Within one day, the rash fades from the face and spreads to the torso (trunk) and arms and legs (extremities). The pink, flat spots (macules) merge together on the trunk but remain separated (discrete) on the extremities.
  • Peeling often occurs later in the rash areas.
  • The rash may itch, and it is usually gone in about 3 days. As many as 25% of outbreaks may have no rash.
  • The affected child is contagious to others from a week before to a week after the rash appears.

Self-Care Guidelines

German measles is generally mild, and an affected child can be cared for at home.
  • To relieve discomfort and fever, give the child acetaminophen (Tylenol) or ibuprofen.
  • Avoid contact between the child and anyone who might be pregnant. If there is contact, tell the patient to call their doctor for advice.

When to Seek Medical Care

If your child has a fever over 102 degrees Fahrenheit or if the child appears very ill, call the doctor.


Tests might be done, if needed, to confirm the diagnosis.


Bolognia, Jean L., ed. Dermatology, pp.1259-12602. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2041. New York: McGraw-Hill, 2003.
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Rubella in Adult
A medical illustration showing key findings of Rubella (Prodome)
Clinical image of Rubella - imageId=915460. Click to open in gallery.  caption: 'A close-up of pink macules, papules, and patches on the thigh.'
A close-up of pink macules, papules, and patches on the thigh.
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