Rubella is a contagious disease caused by a virus. Rubella is sometimes called “German measles,” but it is caused by a different virus than measles. It is usually mild in children and adults, with fever, rash and swollen lymph nodes, and is spread by respiratory droplets.

Rubella is the leading cause of vaccine-preventable birth defects. Rubella virus infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). CRS can cause serious and often lifelong birth defects, including deafness, eye defects such as cataracts, heart defects and developmental disabilities.

Rubella-containing vaccines (RCV) are live attenuated vaccines. They are available as monovalent vaccines or in combination with measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV). Most countries use combined vaccines, usually MR or MMR, because they are given in the same schedule as measles vaccines. The World Health Organization recommends that all countries introduce RCV into their routine immunization program.

• Countries that have not yet introduced RCV should do so, using combined measles–rubella vaccines, to prevent rubella and CRS.
• In September 2024, the Strategic Advisory Group of Experts on Immunization (SAGE) recommended that countries no longer need to reach 80% coverage with the first dose of measles-containing vaccine before introducing RCV.
• Introduction is usually started with a one-time catch-up campaign with MR vaccine, targeting both sexes across a wide age range (about 9 months to 15 years), followed by inclusion of RCV in the routine immunization schedule.
• Measles elimination activities offer a good opportunity to introduce rubella vaccination. Countries should plan carefully to maintain high and sustained coverage, as long-term low coverage can shift rubella infection to older age groups, where the risk of CRS is highest.
  
  

• The first dose of RCV (RCV1) should be given at 9 or 12 months of age, depending on the epidemiology of measles transmission.
• One dose of RCV is sufficient for rubella elimination if coverage is high. For programmatic reasons, all countries should use a two-dose schedule with the same combined measles- and rubella-containing vaccine.
• Receiving more than one dose of RCV is safe.