May 29, 2025 Author : Saraiva da Cunha (infectious diseases) Rubella is a contagious viral disease caused by the rubella virus. Although it is also known as German measles or 3-day measles, the rubella virus is different from the measles virus. Rubella virus infects only humans, who are its only reservoir and therefore the only source of infection. Contagion occurs through the respiratory tract , most often from droplets expelled by sneezes or coughs from infected people who have the virus lodged in their throat. Rubella may be asymptomatic or cause only mild symptoms. However, infection during pregnancy can cause serious complications. Rubella is prevented through vaccination and this vaccine is part of the Portuguese national vaccination program. Symptoms and complications of rubella In most cases, rubella is a mild disease, with a large percentage of asymptomatic cases. Symptomatic cases occur after an incubation period of 2-3 weeks: In general, increased lymph nodes (mainly in the neck below the ears and occipital region) first appears, which can last for 5-8 days; This is followed by a rash , with the formation of pink spots, which start on the face, spread to the rest of the body within 24 hours and disappear in about 3 days; In adults, these symptoms can be preceded by fever, malaise, and headache . Rubella can have more severe symptoms, but they are rare, such as: Encephalitis (1 in 5-6 thousand cases) and neuritis; Small cutaneous hemorrhages (thrombocytopenic purpura); Testicular inflammation in men; Joint pain and inflammation in adolescent and adult women. Congenital rubella syndrome is the most serious and common complication of rubella: It is characterized by a set of congenital malformations - auditory, ophthalmological, neurological and cardiac - in babies; It is due to infection of the mothers, mainly in the first trimester of pregnancy; It can also result in miscarriage; It is the main reason why rubella elimination is a global goal and why it requires a constant vaccination coverage of over 95%. The ability of an infected person to transmit the virus is maintained from 7 days before the rash appears until 6 days after it appears. Diagnosis and treatment of rubella The diagnosis of rubella is based primarily on symptoms, physical examination, and patient vaccination history. The infection can be confirmed with laboratory tests. There is no treatment aimed at eliminating the rubella virus. So, this is based on symptom relief and other supportive measures that are needed. Rubella prevention The only way to prevent rubella is through vaccination, which is given in childhood . The rubella vaccine is included in the vaccination programs of European countries, including the Portuguese National Vaccination Program since 1987, and in many other countries around the world. In Portugal : The vaccine is called VASPR and simultaneously protects against measles, mumps and rubella. Complete vaccination against these diseases includes two doses: the first administered at 12 months and the second at 5 years of age. Assessment of vaccination status against various diseases, including rubella, is part of pre-conception routines. Pregnant women , especially those who have not been vaccinated and/or are from countries where the disease is endemic, and who have been in contact with someone with rubella should inform the doctor monitoring their pregnancy as soon as possible and remain alert to the occurrence of symptoms that may be related to rubella. Rubella in Portugal and Europe Rubella was endemic in Europe before widespread vaccination of children, mainly affecting those aged 4–9 years. In Portugal, in the 1980s, more than 2,000 cases were recorded in one year. The elimination of this disease was confirmed in Portugal by the World Health Organization in 2015. Only by continuing to have high vaccination coverage of the population is it possible to maintain protection , particularly against contagion originating from people coming from areas of the world where the disease is endemic. Rubella is a notifiable disease in the European Union / European Economic Area: Between April 2024 and March 2025, 46 cases were reported, of which 16 were confirmed. These cases occurred in Germany (10), Sweden (3), Italy (1), Poland (1) and Lithuania (1). Sources European Centre for Disease Prevention and Control. Rubella (German measles) . European Centre for Disease Prevention and Control. Surveillance atlas of infectious diseases . 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