Rubella vs. rubeola: Compare causes, symptoms, treatments & more

Rubella and rubeola are viral infectious diseases that each have a history of large outbreaks across the world. For most people who contract these viruses, symptoms are relatively mild but still bothersome. However, each of these viruses has the potential to be life-threatening. Thankfully both are considered eliminated in the United States thanks to vaccine development and high vaccination rates amongst the population. Unfortunately, not all areas of the world have benefitted from vaccines, and both rubella and rubeola continue to be a threat to those who are not vaccinated and those who travel to certain parts of the world. We will discuss the differences between the two viruses including their causes, symptomatology, and impact.

Causes

Rubella

Rubella is a viral infection that is sometimes referred to as the “German measles” or “three-day measles.” In scientific terms, rubella is caused by an RNA virus known as a Rubivirus in the Matonaviridae family.  Rubella primarily attacks tissues of the eyes, skin, and lymph nodes. It is transmitted through direct contact or droplet contact with mucous secretions of an infected person. The virus is only hosted by humans, and people are most contagious when there is a visible rash.

RNA viruses are an intelligent type of virus that use an enzyme called reverse transcriptase to replicate itself by reverse-coding its genes into the DNA of the host cell. Many of the most infectious viral outbreaks in the world have been RNA viruses, including Ebola, West Nile fever, SARS, and most recently, the widespread coronavirus, COVID-19.

Rubeola

Rubeola, which is referred to as “measles” in the United States, is also an RNA virus. It is known as a morbillivirus in the Paramyxoviridae family.  Measles is also only hosted by humans and is highly contagious via airborne droplets or mucosal contact. It can live for up to two hours in the air after the infected person has left the room. Rubeola attacks the tissues of the respiratory system primarily. Rubeola also presents with a rash, but patients are contagious up to four days before the rash appears which contributes to the unintended spread of the virus.

Prevalence

Rubella

Prior to the introduction of a vaccine in the late 1960s, rubella was a common disease that occurred primarily in young children. The last major outbreak of rubella in the United States was in 1964 and 1965 when an estimated 12.5 million people were diagnosed with rubella. During this outbreak, 11,000 pregnant women lost their babies, and over 2,000 babies died shortly after birth. A rubella infection is very dangerous to a pregnant mother and an unborn child. During this same outbreak, roughly 20,000 babies were born with congenital rubella syndrome, or CRS. CRS describes a grouping of birth defects caused by a mother being infected with rubella while their baby is developing in the womb. The most common birth defects include deafness, cataracts, intellectual disability, heart defects, and low birth weight. 

Rubella was eliminated from the United States in 2004. Elimination is defined as the absence of continuous disease transmission for 12 months in a specific geographic area. This means that rubella is no longer consistently present here. However, that does not mean that cases do not sometimes arise. These cases are primarily caused by travel of unvaccinated individuals to areas of the world where outbreaks still occur and vaccine rates are low. When these travelers return to the United States, there is a risk that other unvaccinated people may come into contact with them leading to additional cases in the area. It is important that suspected rubella cases are isolated as soon as possible to prevent further spread. 

Rubella is very rare in the United States. Less than ten people per year are diagnosed, and almost all cases come from travel outside the United States. When traveling to a foreign country, it is imperative to make sure you have all recommended vaccines.

Rubeola

A rubeola vaccine was first introduced in 1963, but prior to that, rubeola was a very widespread disease. There were over 500,000 cases reported annually, and approximately 500 deaths per year. The actual infection rates were suspected to be much higher, perhaps up to three or four million people, but rubeola often went unreported. While rubeola does not cause loss of life as frequently as rubella did, it is still a very dangerous and contagious disease. Prior to the vaccine, 48,000 people were hospitalized each year, and roughly 1,000 people would develop a chronic disability from being infected. The most dangerous complications, while rare, are encephalitis and subacute sclerosing panencephalitis which involve swelling and inflammation of the brain. These can lead to intellectual disabilities and seizures.

Rubeola has been considered eliminated from the United States since the year 2000. Unfortunately, outbreaks do still occur. Rubeola is still transmitted relatively frequently in Europe, Asia, Africa, and the Middle East. Travel to these parts of the world can bring the virus into the United States. Since 2000, infection rates have remained low here, though in 2019 there was a higher number of cases, almost 1,300. The virus was introduced in an area where there were groups of unvaccinated people. Thankfully, the following year in 2020, cases returned to a very low number of 13.

Symptoms

Rubella

Rubella, or German measles, most commonly occurs in children and is a disease of relatively mild symptoms and short duration for most. Up to half of those infected with rubella may display no symptoms at all. A red rash on the face is typically the first sign of infection, and the presence of the rash is the period of time in which the infected person is most contagious to others. The rash appears as red and “spotted” and may spread to other parts of the body, but typically fades rather quickly in just a few days. Prior to the rash, infected persons may have non-specific symptoms including headache, joint pain, cough, runny nose, low-grade fever, and swollen lymph nodes. Conjunctivitis, otherwise known as pink eye, may also occur.

Rubeola

Rubeola, known as measles in the U.S., is a disease that is most dangerous for babies and young children. Rubeola also presents with a rash, but the first symptoms to appear are more severe and include a high fever (up to 104 F), cough, coryza (bacterial infection and inflammation of the mucous membranes of the nasal passage), and conjunctivitis. Two to three days after these symptoms begin, patients may develop Koplik spots inside the mouth. These are tiny white spots visible upon examination. Three to five days later, the measles rash appears. It is red or reddish-brown in color and tends to start in the hairline, is more blotchy than the rash associated with rubella, and lasts longer. It can spread to the face and spread down the body. Initially separate blotches eventually join together as the rash spreads. An infected person’s fever tends to spike when the rash appears.

Diagnosis

Rubella

Although cases are very rare, a diagnosis of rubella should be considered in unvaccinated individuals who present with fever and rash, especially if they have recently traveled outside the U.S. Diagnosis of rubella is made by polymerase chain reaction (PCR) testing and molecular typing in a laboratory setting. Throat swab specimens are the best source for testing, though you can also use nasal or urine samples as well. It generally takes a couple of days to get the test results back, and healthcare providers should promptly isolate any individuals they suspect of a rubella infection until their status is known. 

Rubeola

Rubeola, although considered eliminated, should also be considered for diagnosis in any unvaccinated person who presents with rash and high fever. This is especially true of anyone who has traveled internationally or had known contact with an infected person. Infection can be determined by detecting the measles RNA in a real-time polymerase chain reaction (RT-PCR) test. This is best done with a throat swab, but can also be done with urine samples as well. Serum blood tests of rubeola-specific IgM antibodies can also alert a healthcare provider to the presence of a current or previous infection. Typically, both the RT-PCR and blood test will be done for diagnosis. 

Treatments

Rubella

There is no specific antiviral treatment of rubella. Healthcare providers will aim to provide supportive care to minimize symptom severity. Most cases are very mild and last approximately three days. Getting plenty of rest is best, and if a fever occurs, it can be treated with acetaminophen. 

Rubeola

There is also no specific antiviral treatment for rubeola. Rubeola can lead to secondary upper and lower respiratory bacterial infections which should be treated accordingly. Supportive care such as acetaminophen to control fever is also advised. Vitamin A is recommended in patients who have severe cases of measles requiring hospitalization.

Risk factors

Rubella

The most vulnerable population for rubella infections are unvaccinated individuals who have come into contact with an infected person or contaminated surface. Patients who have a weakened or compromised immune system, such as those with leukemia or HIV, are more vulnerable. Rubella is most common in children. Traveling outside the U.S. without proven immunity is also a risk factor.

Rubeola

Rubeola is highly contagious as it is contracted not only with direct physical contact but is also an airborne virus that can be contracted by just being in the same room as an infected person. Unvaccinated people are at the highest risk of contracting the virus, and this is especially dangerous in women who are pregnant or planning to become pregnant and newborns due to the risk of miscarriage, stillbirth, and severe birth defects. Patients who have a weakened or compromised immune system, such as those with leukemia or HIV, are more vulnerable as well.

Prevention

Rubella

Rubella is preventable with a rubella-containing vaccine. Currently, two vaccine formulations provide rubella immunity: the measles-mumps-rubella (MMR) vaccine and the measles-mumps-rubella-varicella (MMRV) vaccine. There is no formula which only contains the rubella vaccine by itself. One dose provides up to 97% protection against rubella. As part of the childhood vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC), children should receive one dose between 12 and 15 months of age, and a second dose 4 through 6 years of age. 

Some individuals will not be eligible for vaccines due to immune status or religious beliefs. This group must be especially diligent in avoiding infected persons. Persons traveling internationally should ensure they are protected by being vaccinated prior to travel. A child traveling prior to the age of 12 months should get a dose of the MMR vaccine prior to travel, and should still get the two recommended doses after the age of 12 months as well. It is important to keep current copies of your health information and records to be able to prove your vaccination status when needed.

Rubeola

Rubeola is preventable by the same vaccines as rubella, the MMR and MMRV. Like rubella, there is no single antigen vaccination available for rubeola alone. One dose of measles vaccine provides 93% immunity, and the second dose increases this to 97%. Just like rubella, rubeola exposure is particularly dangerous in people who are unable to be vaccinated due to an immunocompromised status or religious beliefs. This population depends on “herd immunity,” or the immunity of the vast majority of those around them to help prevent the introduction of this virus into the community. Again, persons traveling internationally should ensure they are protected by being immunized prior to travel. A child traveling prior to the age of 12 months should get a dose of the MMR vaccine prior to travel, in addition to all regularly scheduled immunizations once they return.

When to see a doctor for rubella or rubeola

Most rubella cases are mild and won’t necessarily require medical intervention. The exception to this are pregnant women and newborns due to the risk of Congenital Rubella Syndrome (CRS). Rubella is most dangerous when contracted in the first trimester as it can lead to miscarriages, stillbirths, and severe birth defects with life-long consequences. Remember, there is no treatment for the rubella virus, so prevention is key. If you are not vaccinated and become pregnant, notify your doctor immediately so that they can advise you on the best course of action for your pregnancy.

Rubeola can become a very serious infection as it impacts the respiratory system. Rubeola can cause high fevers and secondary infections such as bronchitis or pneumonia which can be life-threatening. Rubeola has also been linked to encephalitis, or brain swelling, which can cause permanent brain damage or seizures. See your doctor at the first sign of high fever, difficulty breathing, or a mucous productive cough. While there is no antiviral treatment for rubeola, supportive measures and treatments are key to making a healthy recovery. 

Frequently asked questions about rubella and rubeola

Does MMR cover rubella and rubeola?

The MMR vaccine, also known as the measles-mumps-rubella vaccine, does cover both rubella and rubeola (measles).

Why is measles called rubeola?

Rubeola refers to the reddish-colored rash that is characteristic of the virus.

What is the difference between rubella and mumps?

Rubella is a viral infection that presents with a mild fever and spotted rash. At one time rubella was relatively widespread, but it is relatively mild and short-lived for most patients, typically only lasting a few days. Mumps is also a viral infection, but is relatively rare and presents with swelling of the cheeks due to inflammation of the parotid gland. Mumps can be painful, cause fever, and last for weeks, but there is no rash associated with the mumps virus. 

Is rubella communicable or non-communicable?

Rubella is communicable, meaning that it is able to be passed from one infected being to another. This is also referred to as “contagious.” Rubella can be spread by direct contact with mucous secretions of an infected person.