Rubella: Questions and Answers

Immunization Action Coalition  •  Saint Paul, Minnesota  •  www.vaccineinformation.org  •  www.immunize.org

www.immunize.org/catg.d/p4218.pdf  •  Item #P4218 (3/14) 

Rubella: Questions and Answers

Information about the disease and vaccines

Technical content reviewed by the Centers for Disease Control and Prevention

Page 1 of 4

What causes rubella? 

Rubella is caused by a virus. 

How does rubella spread? 

Rubella spreads from person to person via droplets 

shed from the respiratory secretions of infected peo-

ple. Rubella is contagious but less so than measles 

and chickenpox.

How long does it take to show signs of rubella after 

being exposed? 

The incubation period varies from 12 to 23 days (av-

erage, 14 days). Symptoms are often mild and may 

be subclinical or inapparent up to half of the time. 

What are the symptoms of rubella?

Children with rubella usually develop a rash, which 

starts on the face and progresses down the body. 

Older children and adults usually have low-grade 

fever, swollen glands in the neck or behind the ears, 

and upper respiratory symptoms before they develop 

a rash. Adult women often develop pain and stiffness 

in their finger, wrist, and knee joints, which may last 

up to a month. Up to half of people infected with 

rubella virus have no symptoms at all.

How serious is rubella? 

Rubella is usually a mild disease in children. The 

main concern with rubella virus infection, however, 

is the effect it can have on an pregnant woman. Ru-

bella infection in the first trimester of pregnancy can 

lead to fetal death, premature delivery, and serious 

birth defects.

What are possible complications from rubella? 

Encephalitis (brain infection) occurs in one in 6,000 

cases, usually in adults. Temporary blood problems, 

including low platelet levels and hemorrhage, also 

occur rarely. Up to 70% of adult women with rubella 

have pain and/or swelling of the joints, which is 

usually temporary. 

The most serious complication of rubella infection 

is congenital rubella syndrome (CRS), which occurs 

when the rubella virus infects a developing fetus. Up 

to 85% of infants infected during the first trimester 

of pregnancy will be born with some type of birth 

defect, including deafness, eye defects, heart defects, 

and mental retardation. Infection early in the preg-

nancy (less than 12 weeks gestation) is the most 

dangerous; defects are rare when infection occurs 

after 20 weeks gestation. 

Is there a treatment for rubella? 

There is no cure for rubella, only supportive treat-

ment, such as bed rest, fluids, and fever reduction. 

How do I know if a child has rubella? 

Because the rubella rash looks similar to other rash-

es, the only sure way to diagnose rubella is by a 

laboratory test.

How long is a person with rubella contagious? 

The disease is most contagious when the rash first 

appears, but the virus can be spread from 7 days 

before to 5 to 7 days after the rash begins. People 

with rubella without symptoms can also transmit 

the virus.

What should be done if a child is exposed to rubella? 

The child should be vaccinated with MMR. If the 

child has not been vaccinated against rubella, receiv-

ing the vaccine after exposure to the virus will not 

help prevent disease if the child has already been in-

fected. However, if the child did not become infected 

after this particular exposure, the vaccine will help 

protect him or her against future exposure to rubella. 

How common is rubella in the United States? 

Due to high immunization coverage, rubella and 

congenital rubella syndrome are rare in the United 

States at the present time. From 2005 through 2011, 

an average of 11 rubella cases was reported each 

year in the United States (range, 4 to 18 cases per 

year). In addition, two rubella outbreaks involving 

three cases as well as four congenital rubella syn-

drome cases were reported. Among the 67 rubella 

cases reported from 2005 through 2011, a total of 

28 (42%) cases were known to have been imported 

from outside the U.S. 

Can someone get rubella more than once? 

Second cases of rubella are believed to be very rare. 

Why do people call rubella "German measles"? 

Rubella was first described as a separate disease in 

the German medical literature in 1814, and the rash 

is similar to measles.

When did vaccines for measles, mumps, and rubella 

become available? 

The first measles vaccines (an inactivated and a live 

virus product) became available in 1963, both of 

Immunization Action Coalition  •  Saint Paul, Minnesota  •  www.vaccineinformation.org  •  www.immunize.org

Page 2 of 4

which were largely replaced by a further attenuated 

live virus vaccine that was licensed in 1968. The 

mumps vaccine first became available in 1967, fol-

lowed by the rubella vaccine in 1969. These three 

vaccines were combined in 1971 to form the mea-

sles-mumps-rubella (MMR) vaccine. A vaccine that 

combines both MMR and varicella (chickenpox) vac-

cines, known as MMRV, became available in 2005. 

Single antigen measles, mumps, and rubella vaccines 

are no longer available in the U.S. 

What kind of vaccine is it? 

MMR vaccine contains live, attenuated (or weak-

ened) strains of the measles, mumps, and rubella 

viruses. 

How is this vaccine given? 

This vaccine is a shot given subcutaneously (in the 

fatty layer of tissue under the skin). 

Who should get this vaccine? 

All children, adolescents, and adults born in 1957 or 

later without a valid contraindication should have 

documentation of vaccination or other evidence of 

immunity. Additionally, some healthcare personnel 

who were born before 1957 may also need proof of 

vaccination or other evidence of immunity. 

What kind of “evidence of immunity” can substitute 

for MMR vaccination? 

Evidence of immunity can be shown by having lab-

oratory evidence of immunity to measles, mumps, 

and/or rubella or laboratory confirmation of disease. 

However, if a person doesn’t have evidence of immu-

nity to all three diseases (e.g., measles, mumps, and 

rubella), they would still need to get vaccinated with 

MMR since the vaccine is not available as a single 

antigen product in the U.S. 

At what age should the first dose of MMR be given? 

The first dose of MMR should be given on or after the 

child’s first birthday; the recommended age range is 

from 12–15 months. A dose given before 12 months 

of age will not be counted, so the child’s medical 

appointment should be scheduled with this in mind. 

When should children get the second MMR shot? 

The second dose is usually given when the child is 

4–6 years old, or before he or she enters kindergar-

ten or first grade. However, the second dose can be 

given earlier as long as there has been an interval of 

at least 28 days since the first dose. 

How effective is this vaccine? 

The first dose of MMR produces immunity to measles 

and rubella in 90% to 95% of recipients. The sec-

ond dose of MMR is intended to produce immunity 

in those who did not respond to the first dose, but 

a very small percentage of people may not be pro-

tected even after a second dose. 

Which adolescents and adults should receive the 

MMR vaccine? 

All unvaccinated adolescents without a valid contra-

indication to the vaccine should have documentation 

of two doses of MMR. All adults born in or after 1957 

should also have documentation of vaccination or 

other evidence of immunity.

Adults born before 1957 are likely to have had 

measles and/or mumps disease as a child and are 

generally (but not always) considered not to need 

vaccination. 

Which adults need two doses of MMR vaccine? 

Certain adults are at higher risk of exposure to mea-

sles, mumps, and/or rubella and may need a second 

dose of MMR unless they have other evidence of 

immunity; this includes adults who are: 

•  students in postsecondary educational institutions 

(for measles and mumps) 

•  healthcare personnel (for measles and mumps) 

•  living in a community experiencing an outbreak 

or recently exposed to the disease (for measles 

and mumps) 

•  planning to travel internationally (for measles and 

mumps)

•  people who received inactivated (killed) measles 

vaccine or measles vaccine of unknown type dur-

ing 1963-1967 should be revaccinated with two 

doses of MMR vaccine.

•  people vaccinated before 1979 with either killed 

mumps vaccine or mumps vaccine of unknown 

type who are at high risk for mumps infection 

(e.g., persons who are working in a healthcare 

facility) should be considered for revaccination 

with 2 doses of MMR vaccine. 

Why do healthcare personnel need vaccination or 

other evidence of immunity to measles, mumps, and 

rubella? 

People who work in medical facilities are at much 

higher risk for being exposed to disease than is the 

general population. Making sure that all personnel 

are immune to these diseases protects both the em-

ployee and the patients with whom he or she may 

have contact. All people working in a healthcare fa-

cility in any capacity should have documentation 

of vaccination or evidence of immunity, including 

full- or part-time employees, medical or non-med-

Immunization Action Coalition  •  Saint Paul, Minnesota  •  www.vaccineinformation.org  •  www.immunize.org

Page 3 of 4

ical, paid or volunteer, students, and those with or 

without direct patient responsibilities.

Facilities should consider vaccinating with MMR vac-

cine those healthcare personnel born before 1957 

who lack laboratory evidence (e.g., blood test) of 

measles, mumps, and rubella immunity or labora-

tory confirmation of previous disease. These facilities 

should vaccinate healthcare personnel with MMR 

during an outbreak of any of the diseases, regardless 

of birth date.

Who recommends this vaccine? 

The Centers for Disease Control and Prevention 

(CDC), the American Academy of Pediatrics (AAP), 

the American Academy of Family Physicians (AAFP), 

the American College of Obstetricians and Gynecolo-

gists, and the American College of Physicians (ACP) 

have all recommended this vaccine. 

How safe is this vaccine? 

Hundreds of millions of doses of measles, mumps, 

and rubella vaccine prepared either as separate vac-

cines or as the combined MMR have been given in 

the United States, and its safety record is excellent. 

What side effects have been reported with this  

vaccine? 

Fever is the most common side effect, occurring in 

5% to 15% of vaccine recipients. About 5% of people 

develop a mild rash. When they occur, fever and rash 

usually appear 7 to 12 days after vaccination. About 

25% of adult women receiving MMR vaccine de-

velop temporary joint pain, a symptom related to the 

rubella component of the combined vaccine. Joint 

pain only occurs in women who are not immune to 

rubella at the time of vaccination. MMR vaccine may 

cause thrombocytopenia (low platelet count) at the 

rate of about 1 case per 30,000 to 40,000 vaccinated 

people. Cases are almost always temporary and not 

life-threatening. More severe reactions, including 

allergic reactions, are rare. Other severe problems 

(e.g., deafness, permanent brain damage) occur so 

rarely that experts cannot be sure whether they are 

caused by the vaccine or not. 

If a child develops a rash after getting the MMR vac-

cine, is he contagious? 

Transmission of the vaccine viruses does not occur 

from a vaccinated person, including those who de-

velop a rash. No special precautions (e.g., exclusion 

from school or work) need be taken. 

Who should NOT receive MMR vaccine? 

Anyone who had a severe allergic reaction (e.g., gen-

eralized hives, swelling of the lips, tongue, or throat, 

difficulty breathing) following the first dose of MMR 

should not receive a second dose. Anyone know-

ing they are allergic to an MMR component (e.g., 

gelatin, neomycin) should not receive this vaccine.

As with all live virus vaccines, women known to be 

pregnant should not receive the MMR vaccine, and 

pregnancy should be avoided for four weeks fol-

lowing vaccination with MMR. Children and other 

household contacts of pregnant women should be 

vaccinated according to the recommended schedule. 

Women who are breast-feeding can be vaccinated. 

Severely immunocompromised people should not be 

given MMR vaccine. This includes people with con-

ditions such as congenital immunodeficiency, AIDS, 

leukemia, lymphoma, generalized malignancy, and 

those receiving treatment for cancer with drugs, ra-

diation, or large doses of corticosteroids. Household 

contacts of immunocompromised people should be 

vaccinated according to the recommended schedule.

Although people with AIDS or HIV infection with 

signs of serious immunosuppression should not be 

given MMR, people with HIV infection without who 

do not have laboratory evidence of severe immuno-

suppression can and should be vaccinated against 

measles.

Can individuals with egg allergy receive MMR  

vaccine? 

In the past it was believed that people who were al-

lergic to eggs would be at risk of an allergic reaction 

from the vaccine because the vaccine is grown in 

tissue from chick embryos. However, recent studies 

have shown that this is not the case. MMR may be 

given to egg-allergic individuals without prior testing 

or use of special precautions. 

Does the MMR vaccine cause autism? 

There is no scientific evidence that measles, MMR, 

or any other vaccine causes or increases the risk of 

autism. The question about a possible link between 

MMR vaccine and autism has been extensively re-

viewed by independent groups of experts in the U.S. 

including the National Academy of Sciences’ Insti-

tute of Medicine. These reviews have concluded that 

there is no association between MMR vaccine and 

autism. 

For a summary of the issues on this topic, please 

read “Do Vaccines Cause Autism?" on the website of 

the Vaccine Education Center at Children's Hospital 

of Philadelphia. This discussion can be accessed at 

www.chop.edu/service/vaccine-education-center/

vaccine-safety/vaccines-and-health-conditions/au-

tism.html

Immunization Action Coalition  •  Saint Paul, Minnesota  •  www.vaccineinformation.org  •  www.immunize.org

Page 4 of 4

“MMR vaccine does not cause autism. Examine the 

evidence!” lists all the major studies related to this 

issue with links to journal article abstracts: www.

immunize.org/catg.d/p4026.pdf 

Dr. Ari Brown has written a good piece for parents 

questioning the safety of vaccines. To access “Clear 

Answers & Smart Advice about Your Baby’s Shots,” 

go to: www.immunize.org/catg.d/p2068.pdf 

For more information, visit CDC’s web page about 

vaccines and autism at www.cdc.gov/vaccinesafety/

Concerns/Autism/Index.html 

Can the live virus in the vaccine cause measles, 

mumps, and/or rubella? 

Because the measles, mumps, and rubella viruses in 

the MMR vaccine are weak versions of the disease 

viruses, they may cause a very mild case of the dis-

ease they were designed to prevent; however, it is 

usually much milder than the natural disease and 

is referred to as an adverse reaction to the vaccine. 

What if a pregnant woman inadvertently receives 

the MMR vaccine? 

Women are advised not to receive any live virus vac-

cine during pregnancy as a safety precaution based 

on the theoretical possibility of a live vaccine caus-

ing disease (e.g., rubella virus leading to congenital 

rubella syndrome). 

Because a number of women inadvertently received 

this vaccine while pregnant or soon before concep-

tion, the Centers for Disease Control and Prevention 

collected data about the outcomes of their births. 

From 1971–1989, no evidence of congenital rubella 

syndrome occurred in the 324 infants born to 321 

women who received rubella vaccine while pregnant 

and continued pregnancy to term. As any risk to the 

fetus from rubella vaccine appears to be extremely 

low or zero, individual counseling of women in this 

situation is recommended, rather than routine ter-

mination of pregnancy.