Congenital Rubella Syndrome

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent:  Rubella virus

Description of illness:  Congenital rubella syndrome (CRS) is an illness that can occur in infants as a result from maternal infection with the rubella virus during pregnancy. When rubella infection occurs during early pregnancy, serious consequences-such as miscarriages, stillbirths, and sever birth defects can result. The risk of congenital infection and defects is highest during the first 12 weeks of gestation and decreases after the 12th week of gestations. Common congenital defects of CRS include: cataracts; congenital heart disease; hearing impairment; and developmental delay. Infants with CRS often present with more than 1 sign or symptom consistent with congenital rubella infection. Infants may also present with a single defect with hearing impairment being the most common single defect.

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

Rubella is a contagious viral illness, often mild, with about 25%–50% of infections showing no noticeable symptoms.

The typical clinical features: a low-grade fever, swollen lymph nodes (especially posterior auricular/sub-occipital), and a faint maculopapular rash that starts on the face, generalizes within ~24 hours and lasts about 3 days. 

The incubation period averages ~17 days (range ~12-23 days); virus shedding (and contagiousness) begins about 7 days before rash onset and continues up to 7 days afterwards. 

No specific antiviral treatment exists; management is supportive (rest, symptom relief) and patients should be isolated (especially important around pregnant persons) for about 7 days after rash onset.

The major concern: if rubella infects a pregnant person (especially in the first trimester), it can cause miscarriage, stillbirth or the serious congenital condition Congenital Rubella Syndrome (CRS) in the fetus.

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What It Is

Rubella is a contagious viral infection caused by the rubella virus (a member of the genus Rubivirus) that spreads by respiratory droplets (coughs, sneezes) or direct contact. 

The illness is often mild or even asymptomatic in many individuals (about 25 %–50 % of infections show no noticeable symptoms).

The major public-health concern is when rubella infects a pregnant person, especially during the first trimester, because of the risk of passing the virus to the fetus and causing severe complications.

Types

Postnatal/acquired rubella: the form most people get (children or adults), typically mild and self-limited.

Congenital rubella syndrome (CRS): happens when a pregnant person becomes infected and the virus crosses the placenta, potentially causing miscarriage, stillbirth, or a spectrum of birth defects in the infant (hearing loss, heart defects, eye defects, cognitive impairment). 

Subclinical/inapparent infection: about 25 %–50 % of infections show no rash or symptoms but can still spread. 

Signs and Symptoms

Typical onset: in children, a red-pink maculopapular rash usually begins on the face, then spreads to the body within ~24 hours; the rash lasts a median ~3 days.

Lymphadenopathy (swollen lymph nodes), especially posterior auricular and sub-occipital nodes, often precedes the rash by several days and can persist 5-8 days. 

Other symptoms may include low-grade fever, headache, mild conjunctivitis (pink eye), runny nose/cough, general malaise. In adult women, joint pain or arthritis (especially fingers/wrists/knees) can occur. 

Incubation: average ~14-17 days (range ~12-23 days) from exposure to rash onset. Virus shedding may begin ~7 days before rash and continue ~7 days after.

In pregnant persons (and their fetuses): infection may lead to miscarriage, stillbirth or congenital rubella syndrome with defects like cataracts, heart defects, deafness. 

 


 

 

Treatment

There is no specific antiviral treatment for rubella.

Management is supportive: rest, use of fever-/ache-relievers (for example acetaminophen) and isolation (to prevent spread) especially until at least 7 days after the rash appears.

Prevention via vaccination (the MMR vaccine — measles, mumps, rubella) is key to stopping infection and protecting pregnant persons and their unborn babies. 

This Page Last Updated: March 25, 2026 at 8:53 PM