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Classification according to ICD-10
B06.0 Rubella with neurological complications
B06.8 Rubella with other complications
B06.9 Rubella without complication
ICD-10 online (WHO version 2019)

The rubella or rubeola (also Rubeolae , Rubeolen and rubella ) is a highly contagious infectious disease caused by Rubella virus is triggered and a lifelong immunity leaves, so they to teething counts. Rubella virus only affects humans. Besides the typical red spots on the skin (a measles-like rash ) and fever and can lymphadenopathy occur. Rubella infection is feared during pregnancy because it can lead to serious complications ( rubella embryo fetopathy ) with pronounced malformations in the child and miscarriages. The treatment consists in a purely symptomatic treatment (alleviation of disease symptoms ). Live preventive vaccination is available.

Rubella is notifiable in Germany, Austria and Switzerland .


The rubella virus is spread worldwide - with humans as the only host . In populations with a low vaccination coverage , 80–90% of infections occur in childhood. In Germany, until March 2013, there was only a compulsory registration in the new federal states, then in the entire federal territory. Before March 2013, the current distribution can only be extrapolated. The figures reported in Germany showed an incidence of 0.33 cases per 100,000 inhabitants for 2003 . The European Center for Disease Prevention and Control recorded over 30,000 infections from 26 countries from October 2011 to September 2012 with the highest incidences in Romania (114.32 / 100,000) and Poland (13.93 / 100,000). The average incidence of all 26 countries was 8.6 / 100,000. In school entry examinations in Germany in 2010, 91.2% of the children were fully vaccinated. Incomplete vaccination coverage of the population can lead to sporadic and epidemic infections in children, adolescents and adults. Selective vaccinations of young girls and women from the age of 13 - due to the particular risk of this disease during pregnancy - have achieved in the female population that the immunity gaps that still existed in the natural infection are increasingly closed in young adulthood. In 2015, the Organización Panamericana de la Salud declared the western hemisphere (North and South America) to be rubella-free.

In Germany, rubella occurred especially in spring before the vaccinations, and epidemics about every 6 to 9 years.


Rubella virus ( TEM image )

The rubella virus is the only member of the genus Rubivirus and belongs to the Togaviridae family , whose members typically have a single-stranded RNA with positive polarity as the genome , which is surrounded by an icosahedral capsid . The RNA genome inside the capsid is approximately 9,757 nucleotides in length and codes for two non-structural proteins and three structural proteins. The capsid protein and the two envelope proteins E1 and E2 make up the three structural proteins.

The spherical virus particles of the Togaviridae have a diameter of 50–70  nm and are surrounded by a lipid membrane ( virus envelope ). The heterodimers of the two viral envelope proteins E1 and E2 are embedded in the envelope as distinct spikes (protuberances) 6 nm in length . There is a uniform form of the surface structure, i.e. only a single serotype .


The transmission mostly takes place by droplet infection with 50 percent contagiousness . Viruses are particularly high in nasopharyngeal secretions. The incubation period is 14-21 days. The patient is contagious a week before to a week after the rash breaks out. Even asymptomatic infected people are infectious. The viruses usually penetrate through the mucous membranes of the upper respiratory tract and are initially reproduced preferentially in lymphatic tissue. Then it is released into the bloodstream ( viraemia ) so that the viruses can reach many organs. In case of pregnancy passing the virus on the can placenta ( placenta ) carried on the unborn child.

Symptoms of illness

The course of the disease is very different from person to person and not very specific , i.e. easily confused with other febrile diseases with a rash. In about half of the infections there are no symptoms at all (asymptomatic course, silent celebration ).

Typical symptoms

Rubella rash

After the incubation period , reddened, isolated, slightly raised spots ( efflorescences ) may form on the face , which spread to the trunk and extremities . These usually regress after one to three days. This is often accompanied by an increased temperature of up to 39 ° C. Other possible symptoms are headache and body aches, swelling of the lymph nodes at the back of the head, neck and behind the ears, mild catarrh of the upper airways and conjunctivitis .


Rare complications that become more common with increasing age are joint inflammation ( arthritis ), a reduction in the number of blood platelets ( thrombocytopenia ) with an increased tendency to bleed, or encephalitis . In addition, it can also cause a bronchitis , a middle ear infection or heart involvement ( myo - and pericarditis ) may occur.

However, rubella infection poses a particular risk during pregnancy. In the first eight weeks of pregnancy, rubella infection leads to damage to the embryo in 90% of cases . As the pregnancy progresses, the risk falls to 25–30% in the middle third of pregnancy. Possible consequences of an infection of the unborn child are spontaneous abortion , premature birth or the classic combination of malformations in the form of heart defects ( open ductus botalli , septal defects and Fallot tetralogy ), clouding of the lens of the eyes ( cataract ) and inner ear hearing loss . This full picture, also called Gregg syndrome , occurs in rubella infections in the fourth week of pregnancy, whereas an infection in the 20th week of pregnancy may only trigger isolated deafness. Other possible damage is low birth weight, a tendency to bleed due to reduced blood platelet counts ( thrombocytopenic purpura ), encephalo meningitis , liver inflammation, enlarged liver and spleen, heart muscle inflammation ( myocarditis ) or reduced head circumference ( microcephaly ). Therefore, testing for rubella is part of maternity care (see Rubella During Pregnancy ).

A congenital rubella infection was no longer reported in 2010 and 2011. However, the Robert Koch Institute assumes that there is considerable under-reporting because there are indications that only recognizably damaged newborns are examined and reported. Cases in which the consequences of rubella infection can only be identified later during pregnancy are likely to escape recording and reporting.

Worldwide, however, it is assumed that over 100,000 children are born with rubella embryo fetopathy each year .

The number of cases reported to the RKI for Germany has developed as follows since 2014:

year reported case numbers
2014 40
2015 21st
2016 30th
2017 18th
2018 16
2019 18th


In contrast to other childhood diseases, a reliable diagnosis based on the symptoms alone is not possible. Rubella can be confused with other infectious diseases that are associated with a blotchy rash, such as three-day fever , rubella , measles , enteric or adenovirus infections, mycoplasma or scarlet fever . The direct detection of the rubella virus in throat irrigation fluid, urine or other secretions is basically possible in special laboratories, but it is more complex and does not make sense in routine diagnostics. It is reserved for special questions, for example congenital infections. If important decisions depend on the diagnosis, for example if rubella is suspected in a pregnant woman, the diagnosis must be made by examining the antibodies in the blood using an immunoassay ( ELISA ). A positive detection of IgM antibodies is taken as an indication, but not yet as evidence of an infection, since the test can also be false-positive due to cross-reactions with antibodies against other viruses. A rubella infection can be confirmed by detection of antibodies against rubella viruses in the hemagglutination inhibition test (HHT). In this case, an increase in the amount of antibody (of the titer ) in two successive blood samples at an interval of 14 days by at least fourfold must be detected. The hemolysis-in-gel test is another confirmation method . In the newborn, the detection of rubella IgM is within the STORK - serology proving on a bought during pregnancy rubella infection. In the event of a possible or confirmed rubella infection in a pregnant woman, a prenatal infection can be diagnosed in the fetal blood from the 22nd week of pregnancy by detecting the rubella virus by means of cell culture or polymerase chain reaction (PCR) in the amniotic fluid or in the material of a chorionic villus sampling . In the current version of the Infection Protection Act, the suspicion, the illness and the death as well as the proof of the pathogen are notifiable.


There is no causal treatment. Symptomatic therapy is limited to antipyretic agents and anti-inflammatory pain relievers for joint involvement. Sick people or their parents should be made aware of the possible danger to susceptible pregnant women. The best prevention is vaccination.

Children with rubella acquired during pregnancy (rubella embryofetopathy) require comprehensive care, if necessary including eye or heart operations, hearing aid care and support, for example through speech therapy and physiotherapy .


Exposure prophylaxis

Exclusion of sick people or contact persons from community facilities is not necessary for epidemiological reasons. In the hospital, patients with rubella should be isolated. This also applies to children with congenital rubella infection for the first six months of life, at least as long as several virus cultures from nasopharyngeal secretions and urine have not been negative.

Post exposure prophylaxis

A post-exposure passive vaccination with specific immunoglobulins in pregnant women is possible within 72 hours after contact with rubella, but does not in any way provide reliable protection against infection. Therefore, administration to seronegative pregnant women has not been recommended since 2002.

In the event of contact with rubella in the first trimester of pregnancy, a lack of vaccination and a history of negative antibody status, an antibody test should be carried out immediately. If maternal infection is proven during pregnancy, the risk of malformations in the child depends crucially on the time of infection; Before the 12th week of pregnancy, the risk of complete rubella embryopathy is high, after which it drops drastically. In the case of infections after the 12th week of pregnancy, the child usually only has hearing damage.


Comparison of the complications of illness with rubella and after vaccination against measles, mumps and rubella (MMR). (Adapted from and)
Symptom / illness Complication rate
in rubella disease
Complication rate
after MMR vaccination
Joint discomfort
in adults
40 to 70%, persistent 1 / 10,000, mostly
short and weak
Encephalitis 1/6000 0
Decrease in blood platelets 1/3000 1/30,000 to 1/50,000
Rubella embryo fetopathy in
infection during pregnancy
> 60% 0
Cases of rubella in the US from 1966 to 2017. The rubella vaccine was approved in the US in 1969.

A safe vaccine against measles , mumps, and rubella is available with the MMR vaccine that includes a mumps vaccine , measles vaccine, and rubella vaccine .

In Germany, the rubella vaccination in the form of the MMR vaccination found its way into the vaccination calendar for the first time in 1984 from the age of 15 months . In 1991, the two-time MMR vaccination was introduced in the vaccination calendar by the STIKO (2nd dose from the age of 6), from 2001 the first MMR vaccination should finally take place between the 11th and 14th Month, the second vaccination in the 15th - 23rd Month. In addition, the STIKO recommends vaccination for all adults born after 1970 in certain areas of activity, such as in medical facilities according to Section 23 of the Infection Protection Act (IfSG) or care facilities according to Section 71 of the Social Security Code (SGB XI). Women should be vaccinated twice for each of the three components of the vaccine (M – M – R); men should have a single vaccination to protect against rubella.

Vaccination confers lifelong immunity with 95% efficiency. A revaccination, at the earliest one month after the first vaccination, should close vaccination gaps for the remaining 5%. In Austria and Switzerland the corresponding vaccination recommendations are identical. Rubella vaccination is part of national vaccination programs in 125 countries worldwide, including the entire American, Australian and European continent (as of 2007). It is not yet widespread in Africa and much of Asia, which means that more than two-thirds of the world's birth cohorts are not vaccinated.

Fever and local vaccination reactions such as redness, pain and swelling at the injection site can occur, as with all vaccinations, and are to be regarded as harmless side effects. Since the MMR vaccination is a vaccination with an attenuated live vaccine, attenuated forms of the three infectious diseases can develop in rare cases. As a result, symptoms similar to those of infectious diseases can develop (see table). These effects are usually mild and short-term in nature. So although there are known side effects, the benefits far outweigh a “natural” infection. Other possible side effects have repeatedly been discussed controversially. The article MMR vaccine contains more detailed information on this.

There are no known safety concerns about further MMR vaccination (s) with existing immunity to one of the components (“over-vaccination”).

Vaccine rubella are considered non-infectious, vaccinated people do not give the vaccine virus to others.

Immunity and nest protection

Basically, after a wild rubella infection and a two-time vaccination, there is lifelong or decades-long immunity. Asymptotic reinfection cannot be ruled out.

Maternal IgA antibodies from pregnant women pass through the placenta into the unborn child and thus provide nest protection for about 3 to 6 months after birth.


Up until the 18th century rubella was not differentiated from other febrile and rash infectious diseases. The first descriptions of the clinical symptoms are ascribed to the German physicians de Bergan and Orlow, which is why they were also used in English as German measles . Up into the 19th century there were many speculations about the relationship between rubella on the one hand and measles or scarlet fever on the other, until a German doctor, George de Maton, finally described rubella as an independent disease in 1814. The English name Rubella was introduced in 1864 by the British military doctor Henry Veale. For a long time they were then classified as a harmless childhood disease with no significance. The final recognition of rubella ( German measles ) as an independent clinical picture against measles ( English measles ) and scarlet fever took place in 1881 at a congress in London.

Only in 1938 did Hiro and Tasaka prove the viral cause of the disease. Finally, in 1941 , Norman McAlister Gregg first described the serious malformations in newborns whose mothers had rubella during pregnancy. This was the starting point for numerous researches that led to the isolation of the rubella virus in 1962. In 1964–65 there was a rubella epidemic in Philadelphia that spread across the United States with over 20,000 newborns affected. Finally, Stanley A. Plotkin's American team of researchers succeeded in developing a vaccine that had been used worldwide since 1966. The first electron microscope image was taken in 1967 .

While rubella has only been found in newcomers for years on the American continents due to the high vaccination rates and is considered to be eliminated, in Europe it is "controlled" in most countries, but not so far in some countries due to insufficient vaccination rates, especially among those against vaccinations eliminated.

Reporting requirement

Rubella and rubella embryopathy are notifiable diseases in Germany according to Section 6 (1) of the IfSG [mandatory reporting by name in the event of suspicion, illness and death]. Its pathogen, the rubella virus, is also a pathogen that must be reported by name according to Section 7 [direct or indirect evidence that indicates an acute infection].

In Austria rubella is a notifiable disease according to Section 1, Paragraph 1, Number 2 of the Epidemic Act 1950 [cases of illness and death].

In Switzerland rubella (including congenital ones ) is also a reportable disease according to the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and (Annex 1 and 2) of the EDI Ordinance on the reporting of observations of communicable diseases in humans [especially positive laboratory analysis].

See also


  • Reinhard Marre, Thomas Mertens, Matthias Trautmann, Ernst Vanek: Clinical Infectiology. 1st edition. Urban & Fischer Verlag, Munich / Jena 2000, ISBN 3-437-21740-2 .
  • Fritz H. Kayser, Kurt A. Bienz, Johannes Eckert, Rolf M. Zinkernagel: Medical microbiology: understand, learn, look up. 9th edition. Thieme, Stuttgart / New York 1998, ISBN 3-13-444809-2 .
  • Hans W. Ocklitz, Hanspeter Mochmann, Burkhard Schneeweiß: Infectology. 2nd Edition. VEB Verlag Volk und Gesundheit, Berlin 1978, DNB 780363132 .
  • Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 64 f.

Individual evidence

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Web links

Commons : Rubella  - Album with pictures, videos and audio files
Wiktionary: Rubella  - explanations of meanings, word origins, synonyms, translations
This article was added to the list of excellent articles on December 14, 2008 in this version .