Rubella

Also called German measles

Mild in the person who has it and devastating for a baby in early pregnancy. Eliminated by MMR, and returning as uptake falls.

What it is

A viral infection causing a mild illness with a rash, and severe harm to a developing baby when a woman catches it in early pregnancy.

**In the person infected it is usually trivial**: a low fever, a rash, and swollen glands behind the ears and at the back of the neck. Many infections cause no symptoms at all.

**In pregnancy it is a different matter entirely.** Infection in the first ten weeks causes congenital rubella syndrome in the majority of affected babies, with deafness, cataracts and other eye problems, congenital heart disease, brain damage and learning disability. The risk falls with gestation and is small after 20 weeks.

The UK achieved rubella elimination status through MMR vaccination, and that status depends on maintaining high uptake. Uptake has fallen below the level needed for herd immunity in many areas, and cases have returned.

Rubella immunity is no longer routinely checked in pregnancy in the UK, because the assumption is vaccination, and the MMR vaccine cannot be given during pregnancy because it is a live vaccine. **The time to check and vaccinate is before conceiving**, and that message is not widely known.

Anybody planning a pregnancy who is unsure of their MMR status should have two doses recorded, or be vaccinated, before trying.

Signs you might notice

A mild fever.

A pink or red spotty rash, starting on the face and spreading, lasting around three days and less intense than measles.

Swollen, tender glands behind the ears and at the back of the neck, which is characteristic.

Aching joints, particularly in adults and especially women, sometimes lasting weeks.

Cold-like symptoms and sore red eyes.

Often no symptoms at all.

**Contact a midwife or GP by phone, not in person, for a rash or exposure in pregnancy.** Do not sit in a waiting room.

Urgent: any rash in pregnancy needs advice; blood tests distinguish rubella, slapped cheek syndrome and measles, which have different implications.

Rubella is notifiable and confirmed by saliva or blood testing.

How it can affect day-to-day life

The practical message belongs before pregnancy rather than during it: check MMR status, and have two doses if there is any doubt. It cannot be given once pregnant, and there is then nothing to do but avoid exposure.

Women who grew up outside the UK, or who were born before routine vaccination, are the group most likely to be susceptible, and pre-pregnancy checks are especially worthwhile.

After MMR vaccination, avoiding pregnancy for one month is advised.

Anybody with a rash who might be infectious should phone rather than attend, to avoid exposing pregnant women in waiting rooms.

MMR is safe, and the claimed link with autism was fraudulent and has been thoroughly disproved. Falling uptake is the reason these infections are returning, and clear, non-defensive information is more useful than exasperation.

Two doses are needed for full protection, and catch-up is available free at any age, which many adults do not realise.

Supporting someone well

Check MMR status before pregnancy, and have two doses if unsure. It cannot be given once pregnant.

Ask for catch-up MMR at any age; it is free and never too late.

Phone rather than attend if you have a rash and might be infectious.

In pregnancy, report any rash or exposure to the midwife the same day.

Keep children's MMR up to date, on time, both doses.

Avoid pregnancy for one month after MMR vaccination.

For women who grew up outside the UK, ask specifically about rubella immunity before conceiving.

Support accurate information about MMR; falling uptake is why this is back.

Where to get help

A GP practice for MMR, including adult catch-up, and for pre-pregnancy checks.

A midwife or maternity unit for any rash or exposure in pregnancy.

Tommy's midwives on 0800 014 7800 for pregnancy questions.

UKHSA immunisation guidance for the schedule.