Questionnaire/history: Rash (in 50-80%)? - Started on the face and neck before spreading down the body and becoming generalized? - Pink or light red, maculopapular? - Transient (usually 3–5 days)? Lymphadenopathy (may precede the rash and last for 2 weeks after the rash resolves)? - As most often affected areas at lower part of the back of the skull (suboccipital), behind the ears (postauricular) and/or at the neck (cervical)? Arthritis and arthralgia (more common in adults)? Non-specific symptoms (more common in adults)? - Low-grade fever (<39°C)? - Headache? - Malaise? - Nausea? - Mild upper respiratory tract symptoms? - Non-purulent conjunctivitis? Risk factors? - Contact with a person who is unwell or has had a rash in the previous 3 weeks? - Incomplete immunization and no laboratory evidence of previous infection (unlikely in people who have previously had rubella (although reinfection can occur))? - Travel to an area endemic for rubella? Possibility of pregnancy? (Notes: - No clinical features specific to rubella infection, may be asymptomatic in 50% - Laboratory confirmation required - Rubella is unlikely in people who have previously had rubella (although reinfection can occur) Past medical history (eg immunosuppression)? Current medication? Drug allergies? Examination: Temperature? Rash? Lymphadenopathy? Conjunctivitis? Respiratory signs? Musculoskeletal signs? Neurological signs? Images Management: Non-pregnant: As suspicion of rubella infection and rubella is a notifiable disease notified local Health Protection Team (HPT) (Note: if clinically indicated, the HPT may advise oral fluid sample and investigations for parvovirus B19 and measles infection) Discussed appropriate investigations with specialist Advised: - Rubella usually a mild, self-limiting condition which typically resolves within a week - No specific treatment - Rest, drink adequate fluids and paracetamol or ibuprofen (if appropriate) for symptomatic relief - To stay away from school or work for at least 5 days after the initial development of the rash - To avoid contact with pregnant women - Pregnant women who develop a rash, or have been in direct contact with someone with a rash who is potentially infectious, should consult a doctor or midwife immediately - To inform clinical staff of confirmed or suspected infection prior to attending medical areas, until known to be non-infectious or uninfected - To minimise the risk of spread of infection to others by simple hygiene measures such as covering their mouth and nose with a disposable tissue and washing their hands after using or disposing of tissues - To seek urgent medical advice if symptoms do not settle as expected or new features suggestive of complications of rubella develop - To get up-to-date with their vaccinations, if applicable, once recovered from the acute symptoms - If a non-pregnant person has been in contact with confirmed or suspected rubella, to seek medical advice if they develop symptoms (if symptoms suggestive of rubella develop, the local Health Protection Team must be contacted immediately and laboratory confirmation will be required) - Susceptible people who have been in contact with confirmed or suspected rubella should avoid contact with pregnant women Pregnant (Note: Essential to have a low threshold of suspicion for rubella in pregnant women with rubella-like rash (esp. < 20 weeks' gestation), when rubella must be excluded even when other causes (such as measles, enterovirus, infectious mononucleosis, and streptococcal infection) more likely and regardless of previous immunization history - women who have not spent their childhood years in the UK may be at increased risk.) Reference(s): NICE CKS: Rubella Information for patient/carer(s): NHS Health A to Z: Rubella (german measles) Patient UK: Rubella in pregnancy