Clinical features

There is an incubation of from 14 days, up to 21 days (1), after which clinical features include:

• prodromal symptoms - may be none in young children; older children and adults may may present with a 1-5 day prodrome with symptoms like fever, headache, malaise and upper respiratory symptoms (1)
• pink macular rash -
  • usually the first sign of the disease, seen in 50-80% of rubella infected individuals (2)
  • transitory, erythematous maculopapular rash appears over one or two days. It fades within four days, leaving neither staining nor desquamation (2)
  • may be mildly pruritic (2)
    • develops behind the ears and on the face and neck and then spreads to the trunk and limbs (1,2)
    • in some patients no rash develops at all
• cervical lymphadenopathy -
  • may precede the rash by a week and may persist for several weeks (2)
  • post-auricular, sub-occipital and posterior cervical nodes are commonly involved
• arthralgia & arthritis
  • seen mostly in adolescent and adult women (60-70%)
  • usually fingers, wrists, and knees are affected symmetrically
  • symptoms tend to appear during or shortly after the rash and pain may last for about one to four weeks (2)
• grittiness of eyes and suffusion of conjunctivae

References:

1. Leung AKC, Hon KL, Leong KF. Rubella (German measles) revisited. Hong Kong Med J. 2019 Apr;25(2):134-141.
2. Centers for Disease Control and Prevention. Rubella (German measles, three-day measles). Dec 2020 [internet publication].