Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
RUBELLA (GERMAN MEASLES) 
 
Rubella is a childhood viral disease, which causes 
a rash, low -grade fever and swollen glands in the 
area behind the ears.  Some children may have a 
very mild illness with no rash at all.  However, if 
a pregnant woman without pr otection against 
rubella is exposed to the disease, there could be 
harmful effects to her baby.  Pregnant women 
should consult their physician at once if they 
have been exposed to rubella! 
 
Who gets this disease? 
Some young adults remain susceptible to rubella 
due to high school graduation prior to the school 
rubella vaccination laws.  Rubella is most often 
seen in unimmunized children and in this 
susceptible adolescent and young adult group. 
 
How is it spread? 
The virus is spread by large droplets spread 
through the air from sneezing or coughing, or by 
direct contact with infected nasal or saliva 
secretions. 
 
What are the symptoms? 
1. A two to three day rash that begins on the 
face and quickly spreads downward over 
the entire body. 
2. A low- grade fever of 101- degrees 
Fahrenheit or less. 
3. Swollen glands behind the ears. (NOTE: 
this may appear before the rash). Joint and 
body pain is most commonly experienced 
in adults. 
4. Symptoms appear 12 -23 days after 
exposure; usually 16-18. 
 
Infected persons are contagious from one week 
before to 5-7 days after the appearance of the 
rash.  A small percentage of properly immunized 
children may be infected with rubella due to 
occasional vaccine failure. 
How can the spread of this disease be 
prevented? 
The national Advisory Committee  on 
Immunization Practices (ACIP) recommends that 
children be immunized against rubella after 12-
months of age.  The two dose vaccine should be 
completed at 12 -15 months of age and 4- 6 years. 
This immunization is  required for both childcare 
and school atte ndance. The vaccine is  usually 
combined with measles and mumps vaccine.   
Who should be excluded? 
A child or staff member with rubella or suspect 
rubella should not return to daycare until seven 
days after the onset of the rash. 
 
Reportable? 
Yes.  Rubella is reportable immediately  by New 
Hampshire law to the Division of Public Health 
Services, Bureau of Infectious Disease Control  at 
(603) 271-4496.