Rubella (German measles)—Child Care and Schools

What is rubella?

Rubella is a mild viral infection usually lasting 3 days that is now rare in the United States because of routine immunization.

What are the signs or symptoms?

• Many children have no signs or symptoms.

• Red or pink rash appearing first on the face and then spreading downward over the body.

• Swollen glands behind ears.

• Slight fever.

• May experience joint aches or pain (rare in children; more common in adults).

What are the incubation and contagious periods?

• Incubation period: 12 to 23 days; average of 17 days.

• Contagious period: 7 days before to 14 days after the rash begins. People are most contagious when rash starts.

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

• Contact with respiratory secretions or contaminated objects from children who carry the rubella virus.

How do you control it?

• Rubella is a vaccine-preventable infection. Immunize according to the current schedule—when a child is 12 to 15 months of age and with a second dose at 4 to 6 years of age.

• Review immunization status of all children and staff members and identify those who are not protected by the rubella vaccine in the event there is a risk of rubella exposure.

• Underimmunized children should be excluded from educational settings if there is an outbreak.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members and parents of underimmunized children to watch for symptoms and notifies the Child Care Health Consultant.

• Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

• Staff members of childbearing age who care for children should have rubella immunity documented because rubella infection during pregnancy can result in miscarriage; fetal death; or severe abnormalities in the fetus, including developmental delays.

Exclude from educational setting?

Yes.

• Rubella is a highly contagious illness for which routine exclusion of infected children is warranted.

• For outbreaks, exclude exposed children who lack immunity or have not been immunized until they become immunized. If they remain underimmunized because of an accepted exemption, they should be excluded for 21 days after the onset of rash in the last case of rubella.

Readmit to educational setting?

Yes, when all the following criteria are met:

• Seven days after onset of rash

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group