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Rubella infection is caused by a virus. Typical symptoms include swollen lymph nodes, pink spots on the roof of the mouth, and a distinctive skin rash. Diagnosis is based on symptoms. Treatment for rubella aims to relieve symptoms. Routine vaccination can prevent rubella infection. (See also Rubella in Newborns.) Rubella is usually a mild childhood infection. However, it can have devastating consequences for infants infected before birth. A woman who contracts the infection during the first 16 weeks of pregnancy (especially within the first 8 to 10 weeks) is likely to pass the virus to the fetus. This fetal infection can lead to miscarriage, stillbirth, or severe congenital defects in the infant (referred to as Congenital Rubella Syndrome). Rubella was previously called "German measles" or "three-day measles" because it causes a rash similar to measles. However, it is caused by a different virus. Rubella spreads primarily through inhalation of tiny droplets containing the virus, which are released into the air when an infected person coughs. Close contact with an infected person can also transmit the virus. Individuals with rubella are most contagious from a week before the rash appears until about a week after. The infection usually spreads while the rash is present. However, even people without a rash or noticeable symptoms can still transmit the virus to others. Infants infected before birth can continue to spread the virus for several months after delivery. People who have had rubella typically develop immunity and cannot be infected again. Rubella infection was once common in the spring, with large outbreaks occurring every 6 to 9 years, affecting millions of people. Due to widespread vaccination, rubella is now rare in the United States. However, some young women who have never had rubella or received the vaccine remain at risk of giving birth to babies with severe birth defects if they contract the infection during early pregnancy. Since 2004, all cases of rubella in the U.S. have been brought in by travelers from areas where rubella remains more prevalent. These individuals contract the infection abroad before returning to the U.S. Did you know? Routine vaccination can prevent rubella and many other viral infections. Rubella Symptoms Rubella symptoms vary somewhat between children and adults. Many cases are mild. Symptoms usually appear 14 to 21 days after exposure. In children, rubella often causes mild symptoms or none at all. Mild symptoms may appear 1 to 5 days before the rash: Slight fever (below 102°F [39°C]) General discomfort Pink eye (conjunctivitis) Swollen lymph nodes in the neck and back of the head Red, irritated throat Joint pain The rubella rash resembles the measles rash but is less intensely red and does not merge into large blotchy areas. It starts on the face and neck, then spreads quickly to the trunk, arms, and legs. As the rash develops, the skin may appear slightly flushed, particularly on the face. Small, painless red spots may appear on the back of the roof of the mouth and throat (known as Forchheimer spots). The rash usually lasts around three days, though it can persist a bit longer in some cases. In rare cases, complications include: Middle ear infection (otitis media) Low platelet count (thrombocytopenia)