The main symptom of rubella is a red rash, usually starting on the head and neck. The rash doesn't appear until 14 to 21 days after infection, with most people developing their rash on Day 17 or Day 18 after exposure.
Some people experience a prodrome (warning symptoms), which appears as fever, swollen glands (particularly behind the ear), general aches, and fatigue. These symptoms last from 1 to 5 days before the rash appears and are more common in adults than in children. Once the rash appears, the fever resolves.
The rash usually consists of small red or pink spots that may be itchy. It tends to spread down the body, disappearing from the head as it reaches the trunk. It usually lasts about 3 to 5 days. Other possible symptoms include:
- mild conjunctivitis (pinkeye)
- runny nose
Up to 50% of people infected with rubella have no symptoms at all. It's unknown how many rubella infections go unnoticed and unreported.
You're infectious from 10 days before the rash appears until about 2 weeks after it disappears. This means, of course, that people can transmit rubella before they know they have it.
The most common complication associated with rubella is the development of a mild form of arthritis that usually goes away on its own. It seems to be more common and more severe in adults and more common in women than men. As with many other viral infections, people can also get an ear infection, usually in children under 4 years old. There are rare but serious complications that can occur. One is bleeding due to low platelets (thrombocytopenia). Another rare complication is encephalitis (infection of the brain).
Another serious complication of rubella occurs when it infects pregnant women. There is a high risk of major birth defects or miscarriage if a woman contracts rubella in the first 3 months of pregnancy. After 3 months, the risk begins to fall and it's almost unknown for a baby to have problems if the mother catches rubella after Week 20 of pregnancy. Problems observed in children born to infected mothers include:
- bone marrow defects
- slowed growth
- malformations of the heart
- developmental problems