Everything You Need To Know About Rubella

Isn't it just awful when one day you feel like your best self, then the next you're hit with this feeling of fatigue, an annoying cough, and an overall uncomfortable feeling that seems to have come out of nowhere? If this sounds familiar to you, chances are you've already experienced what it's like to have a viral infection.

According to National Geographic, viruses are very small microorganisms that must use cells from another living organism (i.e., a host) — be it human, animal, plant, or even bacteria — to multiply and proliferate. Although they are small, viruses can cause serious damage to the host they infect by multiplying really fast to create large numbers. Most of the time, a healthy body can kill the invading virus on its own. But sometimes, it needs a little help. That's where medicines and, most importantly, vaccines come in.

Think of vaccines as a safer way to get an infection. They train your body to fight, so that if you get infected by the real thing, your body knows exactly what to do to stop it from causing more damage (per the World Health Organization). One such infection that can be — and is already being — prevented by vaccines is rubella.

According to the National Organization for Rare Disorders (NORD), rubella is a highly contagious infection caused by the rubella virus. It's often referred to as three-day measles or German measles, but shouldn't be confused with measles, which is a completely different viral infection caused by the measles virus. Setting aside the confusing terminology, it's important that we talk more about how rubella impacted the lives of our ancestors, and what has changed since then.

Unlike its recently discovered relatives, the rubella virus is known to infect only humans. Before rubella vaccination in the United States was initiated in 1969, outbreaks of rubella occurred frequently, according to the Centers for Disease Control and Prevention (CDC). The last outbreak happened between 1964 to 1965 and affected nearly 12.5 million Americans. Once widespread vaccination began however, the number of rubella cases started declining quickly. As of 2004, the disease is considered to be eliminated in the U.S.

However, the disease is still present in other countries. Per the CDC, cases that get reported in the U.S. are from people who got infected while traveling or living overseas. Fortunately in 2012, the Measles & Rubella Initiative was created through the collaborative efforts of the American Red Cross, CDC, World Health Organization (WHO), United Nations Foundation, and UNICEF. To date, they continue to work with countries around the world to help them eradicate measles and rubella permanently.

As Children's National describes, one to five days following the nonspecific symptoms of rubella, a widespread rash with a distinct pattern may appear. The spots are small, red or pink, with a mixture of flat and raised surfaces. The rash begins on the face, then continues down the body, arms, and legs, until it disappears after three to five days in the same order it appeared. The duration of the rash is what inspired one of rubella's alternate names, "three-day measles," according to WebMD.

But according to Medical News Today, in babies who are born from mothers who contracted rubella while they were pregnant, a different and unique type of rash appears called "blueberry muffin rash." The lesions are dark, blue, or purple, and they form on the face and body.

These two types of rubella rashes can be distinguished from other infections like rubeola, roseola, and fifth disease (via Children's National). The rash of rubeola looks and spreads the same way as the rash of rubella. However, the small, pin-point rubeola spots eventually combine to form one giant rash, which doesn't happen in rubella. In roseola, the rash appears as the fever goes away and begins on the torso before it spreads outward to the face, arms, and legs. And the rash of fifth disease begins on the cheeks, making a person look as if their cheek was slapped, then spreads to the rest of the body. The rash may reappear on exposure to sunlight, extreme temperature, and skin trauma.

No medicine exists to treat rubella. That's because most of the time, the infection just goes away on its own. Per Rubella, treatment for rubella is mostly supportive, which means treating the symptoms and not the disease itself. This includes plenty of bed rest, fever reducers, and non-steroidal inflammatory drugs (NSAIDs).

The Mayo Clinic warns that aspirin should never be given to children and teenagers for fever or muscle aches because of its link to a rare but dangerous condition called Reye's syndrome. Acetaminophen and ibuprofen are better options.

If you're looking for a more natural remedy, try honey. A 2015 review published in The Malaysian Journal of Medical Sciences suggests that natural honey may help in fighting many microbes and parasites, including the rubella virus. According to the authors, honey's ability to draw water out of its surroundings, and its high sugar content, acidity, and ability to produce hydrogen peroxide, are responsible for its antimicrobial properties. According to Healthline, taking ½ to 1 tablespoon of a specific type of honey called Manuka honey can help relieve a sore throat and make your immune system stronger, among many other things. Although honey is generally safe to eat or drink for most people, it should still be taken in moderation — too much can cause your blood sugar level to go up, which is something you want to avoid if you have diabetes. And always remember that infants under one year old should never be given honey due to the risk of botulism (via Nemours KidsHealth).

Rubella is a highly contagious viral infection, and it spreads through contact with an infected person (via Rubella). When someone sneezes, coughs, or talks, small particles from their respiratory tract mix with the air. In a person who has rubella, these particles contain the virus, and transmission happens when an uninfected person inhales or comes into contact with them. From there, the virus multiplies, spreads to other parts of the body, and causes symptoms. A person with rubella can spread the infection to other people between eight days before and eight days after the rash develops. The CDC adds that even if a person doesn't have symptoms (which happens in 25-50% of people with rubella), they can still transmit it to other people.

Because rubella is airborne, it can be almost impossible to know if the air that you breathe in has the virus or not. The good news is, if you're in the United States, the chance of that happening has been extremely small ever since the eradication of rubella in 2004. But if you're traveling to places that still have rubella, like Africa, the Middle East, and some parts of Asia, or if you come into contact with someone who was recently in any of those areas, your risk of contracting rubella greatly increases (per Medical News Today). Because of this possibility, it's important that you take measures to protect yourself. The best way to do this is through vaccination.

The first dose of the MMR vaccine is typically given to children 12 to 15 months old, and the second dose at 4 to 6 years old (via CDC). Another vaccine called MMRV can also be used instead of the MMR vaccine and follows the same schedule. The MMRV vaccine provides the same protection as the MMR vaccine, with an added protection against varicella, aka chickenpox (via Rubella). A doctor can help you decide if the MMR or the MMRV vaccine is the better option.

Per the CDC's recommendation, the following people should get the MMR vaccine: all children (two doses), post-high school students and healthcare personnel who don't have evidence of immunity (two doses), teenagers and adults without evidence of immunity who are planning to travel internationally (two doses), and all other adults without evidence of immunity (at least one dose). Infants between 6 to 11 months old who will travel internationally are unique in that they should receive one dose prior to travel, followed by one dose at 12 to 15 months, and a third dose after at least 28 days.

While vaccination gives you the best protection against rubella, the CDC also warns that certain people should not get the MMR vaccine, or should wait before getting it. These include people who are pregnant, are moderately or severely ill, have life-threatening allergies, have weak immune systems, have bleeding problems, had a recent blood transfusion, or have recently received other vaccines.

Despite having similar-sounding names, these three viral conditions are actually different from one another. They all can cause a widespread rash and may present somewhat similarly, but the viruses that cause these infections are not the same.

Rubella, rubeola, and roseola are similar in that all three can present with nonspecific symptoms like fever, red and swollen eyes, and a rash that spreads throughout the body. But as Children's National explains, rubella is caused by the rubella virus, rubeola is caused by the measles virus, and roseola is caused by many viruses, but most commonly human herpesvirus 6 (HHV-6). Rubeola, aka measles, has a fever that continues even as the rash appears, and the rash starts as small red spots that eventually combine to form one large rash. On the other hand, roseola presents with high fever, and a rash that begins on the body then spreads outward to the face, arms, and legs. They also differ in complications. Serious sequelae of rubeola include ear infections, pneumonia, croup, and brain inflammation, while roseola can cause febrile seizures. Despite clinical differences, they are diagnosed somewhat similarly with the use of a thorough history and physical examination, with or without specific laboratory tests. The treatment is likewise the same, which includes adequate hydration, rest, and acetaminophen for fever.

Vaccines are available for both rubella and rubeola, but not roseola. You can protect yourself by practicing good hand hygiene, and avoiding contact with infected persons (via Cleveland Clinic).

One thing that has arisen from the COVID-19 pandemic is the vast amount of research that's been going into learning more about the virus, how to fight it, and how it affects different aspects of our lives. In connection to rubella, many studies have been done on the relationship of the MMR vaccine to COVID-19. In a 2021 systematic review published in the International Journal of Molecular Epidemiology and Genetics, some findings suggest that while the MMR vaccine may not prevent someone from getting COVID-19, it may affect its natural course, such as decreasing its severity. Other studies also looked into the immunoglobulin G (IgG) levels from the MMR vaccine and found that the mumps and rubella IgG may have a role in decreasing the severity of COVID-19.

Although the results are promising, it's important to remember that these studies are still premature. We need a lot more evidence before we can truly say that the MMR vaccine can help reduce the severity of COVID-19. What we do have is a lot of evidence on the effectiveness of the MMR vaccine against rubella — 97% after one dose, per the CDC. So if you want to protect yourself from getting rubella, get the MMR vaccine if you haven't already.