Rubella and congenital rubella syndrome

This guide is all about rubella and congenital rubella syndrome (CRS). 

It covers what causes rubella, how it is spread, symptoms, treatment and the serious immediate effects on newborn children of congenital rubella syndrome and possible later complications. 

You’ll also find out about rubella and pregnancy, looking after yourself and your child, and the importance of vaccinating against rubella through the mumps, measles and rubella (MMR) vaccine. 

On this page:

• What is rubella? 
• What causes rubella? 
• How does rubella spread?
• What are the symptoms of rubella? 
• How serious is rubella?
• What should I do if I’m pregnant and think I have rubella?
• What should I do if I think I or my child has rubella? 
• Can rubella be prevented?

What is rubella?

Rubella, also known as German measles, is a mild and preventable disease that is now rare in the UK.  

This is thanks to the introduction of the mumps, measles and rubella vaccine.

In the 1940s to the 1960s, before the vaccine programme was introduced, many babies were born affected by rubella. 

What causes rubella?

Rubella is caused by a type of virus called a togavirus.  

How does rubella spread?

It spreads just like other viruses such as a cold or the flu, through droplets of moisture from the nose or throat of an infected person when they talk, cough or sneeze. 

You can become infected if you come into contact with droplets from an infected person. It can take two to three weeks for symptoms to develop. 

How can I avoid spreading or catching rubella? 

Because rubella spreads in coughs and sneezes, you can reduce the risk of catching or spreading it with these tips.

Do:

• Wash your hands often with warm water and soap. 
• Use tissues when you cough or sneeze. 
• Throw used tissues in the bin. 

Don’t:

• Share cutlery, cups, towels, clothes or bedding with anyone. 

What are the symptoms of rubella? 

If you catch rubella, the main symptom is a red or pink spotty rash: 

• The rash appears two to three weeks after you get infected.  
• The rash starts behind the ears and spreads to the head, neck, and body. 
• The rash can be hard to see on dark skin but might feel rough or bumpy. 
• You might have lumps (swollen glands) in your neck or behind your ears. 

Rubella can also cause: 

• Aching fingers, wrists or knees. 
• A high temperature of 38C or above. 
• Coughs. 
• Sneezing and a runny nose. 
• Headaches. 
• A sore throat. 
• Sore, red eyes. 

How can I treat the symptoms of rubella? 

There’s no specific treatment for rubella and symptoms usually pass within seven to ten days.  

While you wait for the infection to pass, you can:  

• Use paracetamol or ibuprofen to reduce the fever and treat aches or pains.  
• Use liquid infant paracetamol for young children.  

But do not give aspirin to children under the age of 16 years. 

How serious is rubella? 

Rubella is usually mild and gets better without treatment in seven to ten days.  

However, rubella is serious if you catch it in the first 20 weeks of pregnancy.  

There is a risk of miscarriage and rubella can seriously affect your unborn child’s development. 

Congenital rubella syndrome 

A baby born affected by rubella has congenital rubella syndrome or CRS.  

Many babies born with congenital rubella syndrome will have: 

• Hearing loss. 
• Cataracts. 
• Other eye conditions. 
• Heart problems. 
• A small head. 
• Brain damage. 
• Damage to the liver, lungs or bone marrow. 

Complications later in life 

Children born with congenital rubella syndrome can develop problems later in life: 

• Type 1 diabetes  – a lifelong condition that causes a person’s blood sugar level to become too high. 
• Overactive or underactive thyroid. The thyroid gland produces hormones to control the body’s growth and metabolism (how your body converts food into energy). Changes to the thyroid can affect someone in many ways such as weight gain, tremors or increased anxiety. 
• Swelling inside the brain, which affects mental function and causes a loss of movement. 
• Detached retinas, where the retina slips away from the back of the eye causing vision loss. 
• Glaucoma which increases pressure in the eye and can damage the main nerve and affect vision. 

Sometimes, hearing difficulties aren’t obvious at birth and are only diagnosed as the child gets older.

What should I do if I’m pregnant and think I have rubella? 

Urgently call your midwife, maternity unit or GP if you’re pregnant and have either: 

• A new rash. 
• Been in close contact with someone who has rubella. 

What should I do if I think I or my child has rubella? 

Urgently call your GP if you or your child have symptoms of rubella.

Because rubella can spread to others through talking, coughs and sneezes, it’s best to call before you visit your GP. Your GP may suggest an appointment by phone only. 

Avoid contact with pregnant women, including relatives, friends and people you work with until you are no longer infectious or at risk of passing it on. 

How can I look after myself or my child? 

Rubella usually gets better in seven to ten days. It can help to: 

• Get plenty of rest. 
• Drink lots of fluids, like water or squash. 
• Take paracetamol or ibuprofen but do not give aspirin to children under 16 years of age. 
• Stay off nursery, school or work for five days after the rash appears. 
• Avoid close contact with pregnant women. 

Can rubella be prevented? 

The best way to prevent rubella is to be vaccinated against it. 

Mumps, measles and rubella (MMR) vaccine 

Children are offered the MMR vaccine as part of the routine childhood immunisation programme. 

Routine immunisation is important because it reduces the risk of large outbreaks and helps protect pregnant women and their babies. 

MMR is given in two doses: 

• The first when your child is between 12 and 13 months old. 
• A second booster dose before they start school, at three years and four months. 

Read more about booking your child’s vaccination appointment. 

How will I know when my child is due for the MMR vaccine? 

Your GP surgery will contact you when your child is due for a routine vaccination, by letter, text, phone or email. 

You may also receive a letter from the Child Health Information Service to let you know your child is due for a vaccination. 

How effective is the MMR vaccine? 

The MMR vaccine is very effective. After two doses: 

• Around 99% of people will be protected against measles and rubella. 
• Around 88% of people will be protected against mumps. 

Does the MMR vaccine have any side effects? 

The MMR vaccine is very safe. Most side effects are mild and don’t last long. Mild side effects include: 

• The area where the needle went in looking red and swollen, and feeling sore, for two to three days. 
• Seven to eleven days after the injection, babies or young children may feel a bit unwell or develop a high temperature for two to three days. 

Remember: the possible complications of measles and mumps and rubella, and the effects of congenital rubella syndrome are much more serious. 

MMR and older children and adults 

The MMR vaccine can also be given to older children and adults who haven’t been fully immunised before. 

Contact your GP if you’re unsure whether you or your child are up to date with immunisations. 

Why is it important to get the MMR vaccine? 

The MMR vaccine has almost eliminated rubella and congenital rubella syndrome in the UK. 

However, there have been occasional outbreaks.  

In 1996, around 4,000 cases were reported in England and Wales due to a campaign against the MMR. As a result, 12 babies were born with congenital rubella syndrome.

This is why your child should be vaccinated against it. 

Should I get the MMR vaccine if I’m pregnant? 

As a precaution, the MMR vaccine is not recommended if you’re pregnant. 

You should also avoid becoming pregnant for one month after having the MMR vaccine. 

You should let your GP or midwife know if you had the MMR vaccine while you were pregnant. 

Evidence suggests it won’t harm your baby, but it’s better to let them know. 

Can I have the MMR vaccine if I have a weakened immune system? 

The MMR vaccine is not recommended for people with a severely weakened immune system, for example, if you’re receiving  chemotherapy. 

If you have a medical condition or are taking medicine that may affect your immune system, ask your GP if it’s safe for you to have the MMR vaccine. 

Where can I find out more about the MMR vaccine and vaccine safety? 

Read more about the MMR vaccine, including rare side effects, allergic reactions and ingredients, on the NHS website.

This content was last reviewed in April 2023. We’ll review it again in 2025.