Primary prevention

The rubella vaccine is a live attenuated virus. In the UK, it is available only in combination with measles and mumps vaccine (MMR vaccine). The first dose of MMR vaccine is given at 1 year of age and the second dose is given before school entry, at around 3 years and 4 months old.​[16]

Two live attenuated viral vaccines for the prevention of rubella are available in the US, a trivalent measles-mumps-rubella formulation (MMR) and a quadrivalent measles-mumps-rubella-varicella formulation (MMRV; licensed for use in people aged ≤12 years only).[12][17][18] CDC: rubella vaccination Opens in new window​​​ Since 1978, there has only been one MMR vaccine used in the US, M-M-R II; however, in June 2022, PRIORIX was licensed as an additional MMR vaccine option.[19]​ The RA 27/3 strain rubella component of each of these vaccines is identical. Rubella vaccines are reported to be approximately 97% effective in preventing disease after a single dose.[12] Although 1 dose of rubella vaccine is highly protective, 2 doses of a rubella-containing vaccine are recommended for children and adolescents because of the 2-dose recommendations for measles- and mumps-containing vaccine and to provide additional protection to people who experience primary vaccine failure. Depending on age and risk of exposure, 1 or 2 doses are recommended for susceptible adults.[12][18]​​​ Adverse reactions to MMR vaccines are infrequent. The most common adverse reactions include low-grade fever, transient rash, and lymphadenopathy.[12]​ Multiple studies have failed to demonstrate a link between MMR vaccines and autism.[20][21][22]

​In countries where there is a very low incidence of measles, mumps and rubella, clinical diagnosis of rubella should not be considered acceptable evidence of immunity.[12] Local guidelines on immunisation should be consulted. People at increased risk of rubella infection (healthcare professionals, educators, childcare workers) should be assessed for susceptibility to rubella and, if susceptible, should be immunised with MMR vaccine. CDC: rubella Opens in new window Pan American Health Organization/WHO: rubella Opens in new window

Post-pubertal women should be assessed for susceptibility to rubella at all healthcare encounters. If these women are found to be susceptible by serological screening or their immunisation status is undocumented, they should be immunised with MMR vaccine unless they are known to be pregnant. Routine antenatal screening for rubella immunity is recommended. Pregnant people who do not have acceptable evidence of rubella immunity should be advised to avoid travel to countries where rubella is endemic or to areas with known rubella outbreaks, especially during the first 20 weeks of pregnancy.[11]​ In addition, MMR vaccination should be given to susceptible women in the immediate postnatal period.

Country-specific guidelines should be followed regarding rubella vaccination prior to travel. In the US, unless contraindicated, MMR vaccination should be given to all travellers aged ≥12 months who do not have acceptable evidence of immunity to rubella (documented by ≥1 dose of rubella-containing vaccine on or after the first birthday, laboratory evidence of immunity, or birth before 1957). Before departure from the US, infants aged 6–11 months should receive 1 dose of MMR vaccine (for measles protection), and children aged ≥12 months and adults should receive 2 doses of MMR vaccine ≥28 days apart.[11]

Secondary prevention

Patients with postnatal rubella should be isolated for 7 days after the onset of rash. Droplet and standard precautions are recommended for hospitalised patients.​[51]

Contact isolation is recommended for congenitally infected infants until 2 serial nasopharyngeal and urine cultures obtained after 3 months of age are sterile, or for the first year of life.

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