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18 October 2018

Causative agent

Rubella is also known as "German Measles" and is caused by rubella virus.

Clinical features

Children usually present with a diffuse rash, but adults may experience a 1 - 5 day(s) history of low - grade fever, headache, malaise, enlargement of lymph nodes, upper respiratory symptoms and conjunctivitis followed by skin rash. The rash usually lasts for about 3 days, but some patients may not have rash at all. Arthralgia or arthritis occurs more commonly in adult women with rubella. Rubella infection can also cause anomalies in the developing foetus. Congenital rubella syndrome, characterised by deafness, eye lesions, heart malformations and mental retardation, is likely to occur in infants born to women who got infected during the first 3 months of pregnancy.

Mode of transmission

It can be transmitted by contact with secretions from nose and throat of infected persons through droplet spread or direct contact with patients. This is a highly infectious disease and the patient can pass the disease to other persons from 1 week before to 1 week after onset of rash.

Incubation period

It ranges from 12 – 23 days, usually 14 days.


There is no specific treatment but drugs may be prescribed to reduce discomfort.


1. Maintain good personal hygiene
  • Perform hand hygiene frequently, especially before touching the mouth, nose or eyes, after touching public installations such as handrails or door knobs or when hands are contaminated by respiratory secretion after coughing or sneezing. Wash hands with soap and water for at least 20 seconds, then dry with a disposable paper towel or hand dryer. When hands are not visibly soiled, clean them with 70 - 80% alcohol-based handrub as an effective alternative.
  • Cover your mouth and nose with tissue paper when sneezing or coughing. Dispose the soiled tissues into a lidded rubbish bin, then wash hands thoroughly.
  • When having respiratory symptoms, wear a surgical mask, refrain from work or school, avoid going to crowded places and seek medical advice promptly.
  • Affected persons should be advised to stay at home for 7 days from the appearance of rash and avoid contact with any susceptible persons, particularly pregnant women and women preparing for pregnancy. This is because pregnant women who do not have the immunity to rubella would contract the disease and their foetus could also be affected as well. Therefore, close pregnant contacts should be traced and their immunity status should be checked.
2. Maintain good environmental hygiene
  • Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15 – 30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
  • Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water), leave for 15 – 30 minutes and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
  • Maintain good indoor ventilation. Avoid going to crowded or poorly ventilated public places; high-risk individuals may consider putting on surgical masks while in such places.
3. Immunisation
  • Immunisation with rubella vaccine is effective in preventing the disease. Under the Hong Kong Childhood Immunisation Programme, children are given Measles, Mumps and Rubella (MMR) vaccine at 1 year old and in Primary 1 (Please refer to the Hong Kong Childhood Immunisation Programme).
  • Women of childbearing age who are not immunised should check their immunity status before planning for pregnancy and receive rubella-containing vaccine accordingly.
  • Different places will develop different immunisation programmes in light of their epidemiological profiles. Parents should arrange their children to receive vaccines according to the local immunisation programme of their place of residence. For instance, children aged under one who frequently travel to or stay in the Mainland should follow the Mainland's schedule of rubella immunisation with the first dose of rubella-containing vaccine at 8 months old, followed by another dose at 18 months.
  • All foreign domestic helpers (FDH) who are non-immune* to rubella should receive MMR vaccine, preferably before they arrive in Hong Kong. If this is not possible, they can consult a doctor after they have arrived in Hong Kong. Employment agencies can consider adding the assessment of immune status against rubella or MMR vaccination for FDH as additional items in the pre-employment medical check-up package.

*In general, people can be considered as non-immune to rubella if (i) they did not have rubella infection confirmed by laboratory test before, and (ii) they had not been vaccinated against rubella or have unknown vaccination status.