History and exam
Key diagnostic factors
common
presence of risk factors
Strong risk factors include incomplete immunisation, exposure to infectious contacts, and international travel.
maculopapular rash
Rash is often the first manifestation of rubella in young children. The rash of rubella is erythematous, discrete, maculopapular, and sometimes mildly pruritic, and may be accentuated by heat.
[Figure caption and citation for the preceding image starts]: Rubella rashCenters for Disease Control and Prevention (CDC) Public Health Image Library [Citation ends].
It usually begins on the face and spreads from the head to the feet. Occasionally, there may be a petechial component to the rash or palatal petechiae. The rash persists for an average of 3 to 4 days.
fever
Low-grade fever >37.2°C (99°F) occurs in up to 50% of infections.
arthralgias
Arthralgias are common in adults (occurring in up to 70% of adult women) but uncommon in children. The most common joints affected are the fingers, wrists, and knees. The onset of joint symptoms usually coincides with the rash and symptoms may persist for weeks. Rarely, symptoms may be recurrent or chronic.[23]
lymphadenopathy
Mild lymphadenopathy involving the post-auricular, posterior cervical, and occipital lymph node groups occurs in almost all patients and may precede the onset of rash by up to 1 week. Nodes are typically non-tender and mobile.
incomplete immunisation
Un-immunised people or those whose immunisation status is unknown (e.g., people born in countries where immunisation is not carried out or where measles-mumps-rubella [MMR] or measles-rubella [MR] immunisation rates are low).
Other diagnostic factors
common
malaise
Prodromal malaise and other mild constitutional symptoms are more common in adults than in children.
coryza or pharyngitis
Mild upper respiratory symptoms are common in school-age children and adults, and may precede the onset of rash by several days.
arthritis
Arthritis is common in adults (occurring in up to 70% of adult women) but uncommon in children. The most common joints affected are the fingers, wrists, and knees. The onset of joint symptoms usually coincides with the rash and symptoms may persist for weeks. Rarely, symptoms may be recurrent or chronic.[23]
conjunctivitis
Non-purulent conjunctivitis is reported in about 70% of adolescents and adults, but is less common in children.[25]
Risk factors
strong
incomplete immunisation
In the US, 65% to 80% of rubella infections are reported in un-immunised people or those whose immunisation status is unknown (i.e., people born in foreign countries where immunisation is not carried out or where measles-mumps-rubella [MMR] or measles-rubella [MR] immunisation rates are low).[4] Rubella vaccines are reported to be approximately 97% effective in preventing disease after a single dose.[12]
exposure to infectious contact
Rubella has been reported among susceptible contacts of people with rubella, often individuals who have been infected abroad.[6] Up to 50% of cases are asymptomatic, so a negative exposure history does not exclude rubella.
international travel
Rubella remains a global infectious disease concern, but vaccination efforts have decreased reported cases by 97% between 2000 and 2018.[13] By the end of 2022, 175 countries had introduced rubella vaccines and global coverage was around 68%.[3][14] Since 2012, all people in the US with rubella infection had evidence of becoming infected while living or traveling outside the US.[5] The risk to un-immunised travellers to areas where rubella remains endemic or where outbreaks have been reported, particularly in developing regions of Africa and Asia, may be high.[15]
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