Rubella (German measles) is usually a mild illness. However, it can cause serious damage to the unborn child of a pregnant woman. Rubella immunisation is routinely given to children (as part of the MMR vaccine). Women should have a blood test to check if they are immune to rubella, before their first pregnancy.
What is rubella?
Rubella (German measles) is usually a mild illness causing a rash, sore throat and swollen glands. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child or cause a miscarriage. Rubella can lead to damage to the heart, brain, hearing and sight. The baby is likely to be born with a very serious condition called the congenital rubella syndrome.
Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome. Rubella is now a very uncommon infection in the UK as a result for the vaccination programme.
Rubella vaccine is only available as part of the measles, mumps and rubella (MMR) vaccine. Two doses of the vaccine are needed to provide satisfactory protection against rubella.
The first dose of vaccine is usually given as the MMR vaccine between 12 and 13 months of age. It is usually given at the same time as the pneumoccocal vaccine (given as a separate injection). A second dose is usually given at age 3 years and four months to 5 years at the same time as the preschool booster of DTaP/IPV(polio) (given as a separate injection). (DTaP stands for diphtheria (D), tetanus (T) and acellular pertussis (aP) (whooping cough). IPV stands for inactivated polio vaccine. Polio is short for poliomyelitis.)
If a dose of MMR is delayed for any reason it can still be given at a later age. If necessary, MMR vaccine can be given at any age. The second dose is then given one month after the first one.
However, if the first dose of MMR has been given when the child is under one year old (for example, if they are travelling to an area with rubella so need the vaccine early) then two further doses of the vaccine are then needed.
Before you become pregnant
Even if you have had a rubella immunisation, or have had rubella, there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunisation has worked is to have a blood test. This checks for rubella antibodies. Because the congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time, you should have a blood test to check that you are protected.
This blood test may be offered to younger women in routine health checks. But, if you have not had it, ask your practice nurse for the blood test. In particular, women who have come to the UK from overseas and have not been immunised are at greatest risk of having a baby with congenital rubella syndrome.
When you are pregnant
One of the routine blood tests taken in early pregnancy checks for rubella antibodies:
- In most women the test is positive, which means that you are protected from rubella.
- If your test is negative (no antibodies), you are at risk if you come into contact with rubella. You should keep away from people who might have rubella. Once your baby is born, you should then have a rubella immunisation to protect against rubella in future pregnancies.
The MMR vaccine is safe to have if you are breast-feeding.
Are there any side-effects from the vaccine?
Serious problems with the rubella vaccine are rare. However, mild reactions such as a slight fever, a mild sore throat and joint pains sometimes occur about 1-3 weeks after the injection. These soon subside and are of no consequence. Note: there is overwhelming evidence that the MMR vaccine does not cause autism or bowel disease.
Who should not receive the vaccine?
- Pregnant women. Also, you should not become pregnant for one month after having a rubella (MMR) immunisation. It is safe, however, to have if you are breast-feeding.
- If you are having chemotherapy or if your immune system is suppressed for other reasons.
- If you are allergic to the medicines neomycin or gelatin (which are part of the vaccine). It is safe to give if you are allergic to eggs.
If you have had an anaphylactic reaction to egg-containing food then the MMR vaccine is usually given in hospital under controlled conditions.
Rubella and MMR
Information about rubella, congenital rubella syndrome, and immunisation against rubella from Sense. Sense was founded in 1955 as a support group for the parents of children born deafblind as a result of their mothers catching rubella in pregnancy.
Further reading & references
- Immunisation against infectious disease - the Green Book (latest edition); Public Health England
- Davidkin I, Kontio M, Paunio M, et al; MMR vaccination and disease elimination: the Finnish experience. Expert Rev Vaccines. 2010 Sep;9(9):1045-53.
- Muscat M, Zimmerman L, Bacci S, et al; Toward rubella elimination in Europe: An epidemiological assessment. Vaccine. 2011 Dec 14.
- McIntyre P, Leask J; Improving uptake of MMR vaccine. BMJ. 2008 Apr 5;336(7647):729-30. Epub 2008 Feb 28.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Louise Newson
Dr John Cox