VACCINE-PREVENTABLE DISEASE SECTION
Rubella Clinical Information
Report suspected rubella cases
Clinical presentation
If you suspect rubella in a patient:
Rubella clinical case definition (children/adults):
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Call MDH immediately at 651-201-5414 or tollfree at 1-877-676-5414 to report.
Collect specimens for RT-PCR and serologic
testing.
Laboratory testing
Refer to the Lab Testing for Rubella at the MDHPublic Health Laboratory
(http://www.health.state.mn.us/divs/idepc/disease
s/rubella/hcp/labtesting.html) for specimen
collection instructions and requirements.
Epidemiology of rubella
Rubella was once common in the U.S. with about
50,000-60,000 cases (primarily in young children)
reported annually. The last major epidemic in the
U.S. occurred during 1964-1965, with about 12.5
million cases, resulting in 2,000 cases of
encephalitis, 11,250 therapeutic or spontaneous
abortions, 2,100 neonatal deaths, and 20,000
infants born with congenital rubella syndrome.
Following vaccine licensure in 1969, reported
rubella cases decreased dramatically. Rubella was
declared eliminated from the U.S. and the Americas
in 2004 and 2015, respectively. Elimination means
endemic transmission is no longer occurring, but
sporadic cases can be imported from areas where
rubella is still common. Continued success in
maintaining rubella elimination depends upon
keeping vaccination rates high.
Globally, an estimated 110,000 babies are born with
congenital rubella syndrome every year, mostly in
South East Asia and Africa.
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Acute onset of generalized maculopapular rash
Fever higher than 99°F (37.2°C)
Arthritis, lymphadenopathy or conjunctivitis
Up to 50 percent of rubella infections may be
subclinical. In children, rash is usually the first sign
of disease and prodrome is rare. In older children
and adults, there is usually a 1 to 5 day prodrome
with low-grade fever, malaise, lymphadenopathy,
and upper respiratory symptoms preceding the
rash. Testalgia or orchitis may be present in post
pubertal males. Forschheimer spots may be noted
on the soft palate but are not diagnostic for rubella.
The rash usually occurs initially on the face and then
progresses downwards towards the trunk and
extremities. It lasts about 3 days, is fainter than
measles rash and does not coalesce. It’s often more
prominent after a hot shower or bath.
Lymphadenopathy may begin a week before the
rash and last several weeks. Post-auricular,
posterior cervical, and sub-occipital nodes are
commonly involved.
Congenital rubella syndrome (CRS) clinical case
definition (infants/any of the following):
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Deafness, cardiac defects, eye defects,
microcephaly, liver and spleen damage,
developmental delay, bone alterations
When infection occurs during early pregnancy, the
risk of fetal infection may be as high as 85 percent.
The virus may affect all organs of the fetus and
cause a variety of congenital defects, fetal death,
spontaneous abortion, or premature delivery. CRS is
rare when infection occurs after the 20th week of
gestation.
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RUBELLA CLINICAL INFORMATION
Deafness is the most common complication of
congenital rubella infection. Other possible
manifestations include cataracts or congenital
glaucoma, congenital heart disease (most
commonly patent ductus arteriosus or peripheral
pulmonary artery stenosis), pigmentary
retinopathy, purpura, hepatosplenomegaly,
jaundice, microcephaly, developmental delay,
meningoencephalitis or radiolucent bone disease.
Diagnosing rubella
Most U.S. health care providers have never seen a
case of rubella. Rubella cannot be diagnosed
without proper laboratory testing.
Providers should consider rubella in patients who
meet the clinical case definition for rubella or CRS.
Since rubella is rare, providers should ask the
patient about any known exposures or travel history
(domestic or international) in the 30 days prior to
symptom onset.
Differential diagnoses
Providers should also consider other infectious and
non-infectious etiologies that may cause fever and
generalized rash, including:
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Measles, Scarlet fever, Roseola infantum,
Kawasaki disease, Erythema infectiosum (Fifth
Disease), Coxsackievirus, Echovirus, EpsteinBarr virus, HIV, Pharyngoconjunctival fever,
Influenza
Dengue, Rocky Mountain spotted fever, Zika
virus
Dermatologic manifestations of Viral
hemorrhagic fevers (VHFs)
Toxic Shock Syndrome, cutaneous syphilis
Drug reactions (e.g., antibiotics, contact
dermatitis)
Communicability of rubella
(http://www.health.state.mn.us/divs/idepc/disease
s/measles/hcp/minimize.html) as rubella mimics
measles in the early stages of illness.
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The incubation period for rubella is about 14
days (range 12-23) from exposure to rash onset.
Rubella is infectious from 7 days prior to 7 days
after rash onset.
Infants with CRS may shed virus for up to a year.
Subclinical cases can transmit the virus.
Airborne transmission via aerosolized droplet
nuclei is the primary route of transmission.
Airborne precautions are recommended.
Complications of rubella
Rubella is generally mild and self-limited. Rare
complications of acquired rubella include
thrombocytopenic purpura and encephalitis.
Treating rubella
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There is no specific antiviral therapy for rubella.
Post-exposure use of vaccine or Immune
Globulin (IG) is not effective for rubella.
Recommended exclusion
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Suspect and confirmed rubella cases should be
isolated at home with no visitors until day 8 of
rash (rash onset is considered day 0).
Additional recommendations on exclusion or
isolation should be made in collaboration with
MDH and/or local health department.
Minnesota Department of Health
Vaccine-Preventable Disease Section
PO Box 64975
St. Paul, MN 55164-0975
651-201-5414
www.health.state.mn.us/immunize
To obtain this information in a different format, call:
651-201-5414.
If rubella is suspected, health care providers should
follow the infection prevention steps in Minimize
Measles Transmission in Health Care Settings
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