German measles (rubella) is considered to be eradicated in the United States, due to a very successful vaccination program. German measles is most dangerous for pregnant people and is highly contagious. While it’s possible to get German measles twice, it’s very rare.

Can you get German measles (also known as rubella) twice? The answer is yes, but it’s thought to be very rare.

In fact, it’s unusual to get rubella in the United States at all anymore.

The last epidemic in the United States took place from 1964 to 1965 and affected 12.5 million people, according to the Centers for Disease Control and Prevention (CDC). Now, the number of cases in the United States is estimated to be about 10 annually, thanks to a successful national vaccination program.

The name rubella comes from the Latin for “little red,” and the viral disease was thought to be a type of scarlet fever or measles until the 1800s, according to the CDC. That’s when German medical researchers identified it as an illness in its own right, hence the nickname “German measles.”

Here’s what else to know about the virus, who’s most at risk, and how the vaccine works.

Rubella symptoms typically include:

  • a mild rash that starts on the face and spreads to the rest of the body
  • slight fever
  • swollen lymph nodes
  • sore throat
  • pink eye

Some adult women who get it may also feel pain and stiffness in their fingers, wrists, and knees. The pain can last for up to a month.

As many as 25% to 50% of people who get German measles don’t show any symptoms.

It’s very rare to get rubella in the United States. All the reported cases originated outside the United States. Worldwide, those most likely to get it are children and young adults.

In the vast majority of cases, just one dose of the virus creates lifelong immunity. While it’s possible to get the infection twice, it’s very rare.

Most rubella symptoms aren’t severe. The disease can’t be cured once you have it. Instead, treatment is focused on rest, fever management, and ensuring you get enough fluids.

The main risks are to pregnant people and their unborn children because the rubella virus creates a very high risk of serious birth defects among unborn babies.

Up to 85% of babies who contract the virus during the first 12 weeks of pregnancy are at risk of having one or more birth defects or neurological problems such as congenital rubella syndrome (CRS).

The virus can cause birth defects. Birth defects are less common if a pregnant person is affected with the rubella virus after the 20th week of pregnancy.

During the last outbreak in the 1960s, before immunization was widespread:

  • 12.5 million people got sick
  • 20,000 babies were born with CRS
  • 11,000 pregnant people lost their babies
  • 2,100 newborns died

Today, the virus is no longer causing these kinds of statistics, thanks to a successful vaccination program.

The rubella virus is very contagious. People can transmit the virus through breathing, sneezing, or coughing. Many people who have the virus don’t know it and can pass it up to a week before the rash appears and a week after.

The vaccine is given twice, as part of a combination vaccine that protects against measles, mumps, and rubella (MMR).

The first dose is up to 95% effective. The second dose is intended for those who didn’t respond to the first dose. In very rare cases, some people don’t respond to a second dose, either.

In most cases, vaccination is given during childhood, although adults may need it if they didn’t get it when they were young. Protection is assumed to be lifelong.

While one dose is usually effective, experts recommend that the following groups have two doses of MMR, mostly for the measles and mumps protection:

  • students in postsecondary educational institutions
  • healthcare personnel
  • people living in a community experiencing an outbreak or recently exposed to the disease
  • people planning to travel internationally to vulnerable areas
  • people who received inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963–1967 (two doses recommended)
  • people vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (e.g., persons who are working in a healthcare facility), (two doses recommended)

When to get the vaccine

The measles mumps rubella (MMR) vaccine is given twice. It protects against all three illnesses.

The CDC recommends children get two doses given at:

  • ages 12–15 months
  • ages 4–6 years

The CDC also recommends an MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chicken pox), but the vaccine is only approved for children up to age 12.

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If you’re unsure of your immunity status, you can ask your doctor for a rubella test. A technician will draw your blood and send it to a lab to determine whether you have immunity. This is especially important if you may become pregnant.

German measles (rubella) has been eradicated in the United States, although a handful of rare cases occur each year. While it’s possible to get it twice, it’s very rare.

Rubella symptoms are often mild or nonexistent, but it’s very contagious. Vaccination is very important, especially for women who may become pregnant. Rubella can cause serious birth defects and complications in the vast majority of first-trimester pregnancies.

The vaccine is usually given to children in two separate doses, but adults can also be immunized. If you’re unsure of your immunity status, you can discuss it with your healthcare professional and request a blood test to determine whether you’re immune.