While acquired rubella infection is generally benign, congenital rubella infection can be more severe.

• Acquired infection: With an incubation period of 14 days, acquired rubella is characterized by a generalized maculopapular rash that lasts ≤3 days; ~50% of infections are subclinical or without rash.
  • - Occipital and/or postauricular lymphadenopathy may occur during the second week after exposure.
  • - In older children and adults, the rash may be preceded by a 1- to 5-day prodrome consisting of low-grade fever, malaise, and upper respiratory symptoms.
  • - Arthralgias and arthritis are common among adults, particularly women.
• Congenital infection: Congenital rubella infection can lead to a number of physical defects, usually involving the eyes (e.g., cataracts), ears (e.g., deafness), and heart (e.g., pulmonary arterial stenosis).
  • - Up to 90% of women infected with rubella virus during the first 11 weeks of pregnancy will deliver an infant with congenital rubella.
  • - The congenital rubella rate is 20% for maternal infections acquired during the first 20 weeks of pregnancy.