Rubella, also known as German measles or three-day measles, is an acute viral infection. Before a rubella vaccine became available in 1969, there were outbreaks of the disease every six to nine years. Now rubella is rare in locations where vaccination is standard practice. In the United States, for example, there were only between 128 and 192 cases reported annually throughout the 1990s and 4 to 11 cases per year of congenital rubella syndrome, a syndrome that may occur in a fetus and which is linked with serious birth defects and developmental delay.

A virus causes rubella. It can be spread in airborne droplets, such as from a cough or sneeze, from an infected person. Individuals can be contagious for as much as one week before a rash erupts and up to one week after it disappears. Infants with congenital rubella syndrome (see section entitled Special Considerations for explanation) may spread rubella virus in respiratory secretions and urine for up to two years.

These factors increase the risk for rubella:

• Lack of immunization
• A nonimmune person coming in close contact with infants who have congenital rubella syndrome (such as in a hospital or day-care setting) 
• A nonimmune person coming in close contact with large numbers of people from countries that don't routinely vaccinate against rubella

Symptoms are usually mild. In up to half of all cases, the disease is so mild that there are no detectable symptoms. The most distinctive sign of rubella is swollen lymph nodes behind the ear, in the neck, and at the back of the head. A rash is usually the first sign in younger children. In older children and adults, it is more common to have a low-grade fever, malaise (feeling unwell), loss of appetite, swollen glands, and upper respiratory infection for one to five days before the onset of full-blown disease.

Other signs and symptoms include:

• Arthritis and joint pain; more common in older girls and women and may persist up to weeks or, rarely, months
• Conjunctivitis (inflammation of the membrane around the eye) 
• Pain and inflammation of the testes 
• Mild itching

Healthcare providers will perform an exam to look for common signs and symptoms, and may perform blood tests or culture a sample of fluid from the nose or throat to check for the rubella virus.

The rubella vaccine causes immunity in 90% to 95% of those who receive it. Children should receive two doses (usually as part of the combination measles-mumps-rubella [MMR] vaccine) at least 4 weeks apart. Anyone born in or after 1957 should have at least one dose of MMR. Persons born before 1957 are considered immune. Women of childbearing age should still be vaccinated prior to becoming pregnant (or demonstrate that they are immune to the virus via a laboratory test) even if they were born before 1957. (Having had rubella makes a person immune for life.)

Controversy surrounds the MMR vaccine because of concern that it may be linked to disorders such as autism and inflammatory bowel disease. However, a population-based study investigating a potential association between the incidence of autism and the introduction of the MMR vaccine in the United States and Britain did not confirm any link between the two.

Rubella vaccine should not be given to anyone who:

• Has a history of severe allergic reaction to a previous rubella or other vaccine
• Is pregnant or planning to become pregnant
• Has a deficient or suppressed immune system
• Has a moderate to severe illness
• Has received antibody-containing blood products within the previous three months.

There is no specific therapy to fight the rubella virus. Treatment is supportive, and the infection generally resolves on its own. Complications are rare. Individual symptoms, such as fever, arthritis, and joint pain, may be treated.

• Acetaminophen or ibuprofen can be taken to reduce fever.
• A pain reliever and anti-inflammatory, such as ibuprofen, can be used for arthritis or joint pain.
• Aspirin or other medicines that contain salicylates should not be used in children who have certain viral illnesses, such as rubella, because this increases the risk for developing Reye's syndrome -- a serious illness characterized by changes in the liver, vomiting, and seizures.

Due to the controversy surrounding routine MMR vaccination, some people may seek alternative treatments in place of vaccination. However, there is no evidence that any CAM method confers immunity against rubella. Some CAM approaches may help alleviate symptoms of rubella.

No clinical trials have investigated the use of specific foods or nutrients to treat rubella. However, the following nutrients may be used to support the immune system in general:

• Vitamin A
• Vitamin C
• Zinc

In addition, a laboratory study found that honey helped fight the rubella virus in test tubes; however, it is not clear what ingredient in the honey is responsible for this anti-viral activity nor is it known whether this same benefit would be conferred to people.

The value of treating rubella with herbal therapies has not been explored in scientific studies. However, to treat viruses in general, herbalists may recommend remedies that stimulate the immune system and that have fever-reducing and anti-infectious properties; in addition, agents that improve symptoms of rubella may be considered. These may include:

• Willow bark (Salix alba, S. purpurea, S. fragilis) to reduce fever 
• Calendula flower (Calendula officinalis) for rash 
• Hay flower (Poa spp.) used externally for joint pain 

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for rubella based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum — for individuals who experience a sudden fever, rash, and thirst
• Belladonna — for rubella that appears suddenly, is associated with high fever, flushed face and red lips, and heat that radiates from the skin; this remedy is most appropriate for individuals who perspire minimally and may experience strange dreams
• Ferrum phosphoricum — this remedy is used early in the illness when symptoms are not specific and mild to moderate fever is present; children for whom this remedy is appropriate tend to be tired with a mildly flushed face
• Pulsatilla — for individuals with fever and chills that are worse in warm rooms and better in fresh air; symptoms tend to be less intense than for the other remedies listed

Electroacupuncture (in which acupuncture points are stimulated with electrodes) successfully treated two cases of visual and hearing impairments linked to congenital rubella syndrome (see section entitled Special Considerations for explanation about this condition). Acupuncture may also help relieve arthritis pain.

Therapeutic massage may help relieve arthritis pain.

Most people who have rubella recover completely without permanent side effects and are immune to rubella afterward. This is not the case for a fetus infected in the womb. Fetal infection can cause serious long-term effects (see section entitled Special Considerations).

Complications are more common in adults than children and may include:

• Arthritis or joint pain—Occurs almost exclusively in women; fingers, wrists, and knees tend to be affected. This develops along with rash and may take several weeks to resolve. 
• Encephalitis (inflammation of the brain)—More common in adults (especially in women) than in children. The severity can vary greatly. Up to 50% of people affected by this complication may die from it.
• Internal bleeding, including in the skin, gastrointestinal tract, brain, or kidneys—More common in children than in adults. This may last for days or, rarely, months. 
• Inflammation of the testicles, nerves, and brain 
• Pregnancy complications—Rubella infection during pregnancy can lead to miscarriage or stillbirth, as well as to congenital rubella syndrome in the child (see section entitled Special Considerations). 

If a fetus is infected with rubella in the womb, this can cause severe defects known as congenital rubella syndrome. The younger the fetus is at the time of infection, the more likely the syndrome is to occur and the more severe the effects are likely to be. Temporary effects of congenital rubella syndrome may include:

• Slow growth in the womb 
• Low birth weight 
• Bleeding disorder 
• Overgrowth of the liver and spleen 
• Anemia 
• Jaundice (yellowish coloration of the skin, tissues, and body fluids) 
• Pneumonia 

Permanent effects of congenital rubella syndrome may include:

• Deafness 
• Heart defects 
• Glaucoma and other vision problems 
• Mental retardation 
• Behavior disorder 
• Diabetes mellitus 
• Thyroid disease 
• Growth hormone deficiency 

Advisory Committee on Immunization Practices (ACIP). Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. MMWR Morb Mortal Wkly Rep. 1998;47(RR-8):4.

Afzal MA, Minor PD, Schild GC. Clinical safety issues of measles, mumps and rubella vaccines. Bull World Hlth Org. 2000;78(2):199-204.

American Academy of Pediatrics. Age for routine administration of the second dose of measles-mumps-rubella vaccine (RE9802). Pediatrics. 1998;101(1):129-133.

Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass.: Integrative Medicine Communications; 1998:144.

Blumenthal M, Goldber A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass.: Integrative Medicine Communications; 2000:44-46; 408-412.

Centers for Disease Control and Prevention (CDC). Rubella. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atlanta, Ga: Centers for Disease Control and Prevention. April 2000. Available at www.cdc.gov. Search term: rubella (Ch 11 ed. 6). Accessed 11/1/00.

Chen RT, DeStefano F. Vaccine adverse events: causal or coincidental [letter]. Lancet. 1998;351:611-612.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. New York: Tarcher/Putman; 1997:112-114.

Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax. 1998;53:927-932.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine.14th ed. New York: McGraw-Hill; 1998.

Galewski R. Electroacupuncture: an effective treatment of some visual disorders. Acupunture in Medicine. 1999;17(1):42-49.

Gershon A. Rubella (German measles). In Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine.14th ed. New York: McGraw-Hill; 1998:1125-1127.

Greene E. Massage therapy. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:338-348.

Hurwitz E, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York: Warner Books; 1996:228-230, 166-169.

Maldonado Y. Rubella. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000:951-953.

NIH Consensus Statement Online. Acupuncture. November 3–5, 1997;15(5):1-34. Accessed on July 11, 2000 at dowland.cit.nih.gov/odp/consensus/107/107intro.htm.

Odent MR, Kimmel T. Pertussis vaccination and asthma: is there a link? JAMA. 1994;272:592-593.

Ouhilal S. Viral diseases in pregnancy: a review of rubella, chickenpox, measles, mumps and 5th disease. Prim Care Update Ob/Gyn. 2000;7:31-34.

Peter G. Immunization practices. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000:1081-1089.

Reef S, et al. Rubella. Chapter 11 in VPD Surveillance Manual. Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-11.

Reef S, et al. Congenital Rubella Syndrome. Chapter 12 in VPD Surveillance Manual. Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-12.

Starr M. A rash of exanthems: how they affect children and pregnant women. Aus Fam Phys. 2000;29(7):631-637.

Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353:2026-2029.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 86.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 176.

Vandenbosche RC, Kirchner JT. Intrauterine growth retardation. Am Fam Phys. 1998;58(6):1384-1390.

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637-41.

West R, Roberts PM. Measles, mumps and rubella vaccine: current safety issues. BioDrugs. 1999;12(6):423-429.

Wood RA, Doran TF. Atopic disease, rhinitis and conjunctivitis, and upper respiratory infections. Curr Opin Pediatr. 1995;7:615-627.

Zeina B, Othman O, Al-Assad S. Effect of honey versus thyme on rubella virus survival in vitro. J Altern Complement Med. 1996;2(3):345-348.