After being infected, the incubation period (the time it takes for the rubella virus to become established and for symptoms to appear) is 14-21 days.

Some people experience prodromal (early) symptoms during the incubation period, before any other symptoms develop.

Between 25-50% of people with rubella (German measles) may not have any symptoms. If you are infected with the rubella virus, but do not have any symptoms, it is known as a 'sub-clinical infection'.

Prodromal symptoms

Prodromal symptoms can last for about five days before the rash (see below) starts to appear. These symptoms are more common in adults than children and can include:

• a slightly raised temperature - a normal temperature is between 36-36.8C (96.8-98.24F),
• conjunctivitis - inflammation of the transparent membrane that covers the whites of your eyes,
• sore throat,
• runny nose,
• headache, and
• feeling unwell.

Main symptoms

Some of the main symptoms of rubella are described below.

Swollen lymph nodes

Swollen lymph nodes (glands) usually appear behind the ears, below your skull at the back of your head, and in your neck. They can be painful, and will sometimes appear before the rash, and can last for a week after the rash has disappeared. The medical term for this symptom is lymphadenopathy. 

A distinctive red-pink rash

The rubella rash is a distinctive red-pink colour and appears 3-4 days after the first symptoms. The rash usually appears as spots, which may be slightly itchy. It usually starts behind the ears, before spreading around the head and neck. It may then spread to the trunk (abdomen and chest), legs, and arms. The rash usually lasts for 3-7 days. 

A high temperature

A high temperature (fever) of 38C (100.4F) or over is a symptom of rubella which, although more common in children, can be more severe in adults. Your temperature may remain high for several days before retuning to normal.  

Cold-like symptoms

Cold-like symptoms, such as a runny nose, watery eyes, sore throat, and cough, are common symptoms of rubella, particularly in adults. 

Painful or swollen joints

Painful, or swollen, joints affect up to 60% of adult women with rubella, but are less common in children. Swelling tends to affect the hands, knees, wrists, and ankles, but it is usually mild. It appears during, or up to a week after, the rash, and can last up to a month.

Tiredness, irritability and a general lack of energy plus aches and pains, and a poor appetite are also common symptoms of rubella.

If you have rubella, you are infectious for one week before symptoms appear, and for four days after the rash has started. Children with rubella should be kept away from school and should not mix with other children during the time they are infectious. If it is suspected that a child or an adult has rubella, they should avoid all contact with pregnant women.

Rubella in pregnant women

If a pregnant woman catches rubella, it can result in a miscarriage (the loss of the pregnancy during the first 23 weeks) or stillbirth (where a baby is born after the 24th week of pregnancy without any sign of life). Since the introduction of the MMR vaccination, the number of rubella infections in pregnant women has fallen from 167 in 1987, to just one in 2003. 

The rubella infection can also pass to the unborn baby and cause birth defects. This is known as congenital rubella syndrome (CRS).

Congenital rubella syndrome

Congenital rubella syndrome (CRS) can cause the following problems in unborn babies:

• cataracts (cloudy patches in the lens of the eye) and other eye defects,
• deafness,
• cardiac (heart) abnormalities,
• a small head , compared to the rest of the body, as the brain is not fully developed,
• a slower than normal growth rate, and
• inflamed (swollen) wounds in the brain, liver, lungs, or bone marrow.

Children born with CRS can develop symptoms later in their lives as well. These include:

• pneumonitis - inflammation (swelling) of the lungs caused by a virus,
• diabetes mellitus - a long-term condition that is caused by too much glucose in the blood,
• thyroid gland problems - the thyroid gland produces hormones to control the body's growth and metabolism; it could be over-active or under-active, and
• progressive panencephalitis (inflammation of the brain) - this causes a loss of mental and motor (movement) functions.

Fever

A fever is when you have a high body temperature (over 38C or 100.4F).  

MMR

MMR stands for measles, mumps and rubella. It's a vaccine that prevents measles, mumps and rubella by making the body produce antibodies to fight off the viruses.  

Vaccination

Vaccination or immunisation is usually given by an injection that makes the body's immune system produce antibodies that will fight off a virus.  

Disease

A disease is an illness or condition that interferes with normal body functions.

Lymph nodes

Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.