Can the Rubella (German measles) vaccine cause a rash 2 days after vaccination?

From the Guidelines

Yes, the rubella vaccine can cause a rash, but it typically appears 7-10 days after vaccination, not 2 days later. According to the most recent and highest quality study 1, the most common adverse reactions to the rubella component of the MMR vaccine are transient rashes, which usually appear 7–10 days after vaccination in approximately 5% of vaccinated persons. However, it is possible for the rash to occur earlier or later than this timeframe. The rash is usually a mild form of the immune response to the weakened virus in the vaccine and is not contagious or dangerous.

• The rash typically consists of small, pink spots that are not itchy and generally lasts 1-3 days.
• It is essential to note that if the rash persists longer than a few days, is accompanied by high fever (over 103°F), or causes significant discomfort, you should contact your healthcare provider for further evaluation.
• The evidence does not support a link between MMR vaccination and severe adverse events such as hearing loss, retinopathy, optic neuritis, Guillain-Barré Syndrome, type 1 diabetes, Crohn’s disease, or autism 1.
• In rare circumstances, MMR vaccination of adults has been associated with anaphylaxis, thrombocytopenia, and acute arthritis from the rubella component 1.
• Women who receive the rubella-containing vaccine should be counseled to avoid becoming pregnant for 28 days after receipt of the vaccine 1.

From the Research

Rubella Vaccine and Rash

• The Rubella vaccine can cause a rash in some individuals, as reported in several studies 2, 3.
• A case study published in 2021 described a 54-year-old man who developed a generalized rash and arthralgia 17 days after receiving his first Rubella vaccination 2.
• Another study published in 2021 reported two cases of adult patients who presented with a typical erythematous rash consistent with rubella disease after MMR vaccination, with one patient confirmed to have vaccine-associated rubella via sequencing of virus isolated in viral culture 3.
• The rash caused by the Rubella vaccine can appear at varying times after vaccination, with one study reporting a rash appearing 2 days after vaccination not directly mentioned but symptoms such as arthralgia and rash were observed 17 days after vaccination 2.
• The clinical characteristics of vaccine-associated rubella can include an uncomplicated course with recovery without specific treatment, as well as more severe cases with disseminated disease in both immunodeficient and immunocompetent patients 3.

Timing of Rash Appearance

• The exact timing of the appearance of a rash after Rubella vaccination can vary, with some cases reporting a rash within a few days of vaccination, while others may experience a delay of several days or even weeks 2, 3.
• A study published in 1999 described a 17-month-old child who developed a fever and rash after measles-mumps-rubella vaccination, with detection of vaccine-strain measles virus in his urine by polymerase chain reaction confirming the diagnosis of a vaccine reaction 4.
• Another study published in 2009 reported an 11-year-old female patient who experienced a relapse of systemic type juvenile idiopathic arthritis after receiving a live-attenuated rubella vaccine, with an abrupt onset of symptoms five days after vaccination 5.

Vaccine-Associated Rubella

• Vaccine-associated rubella is a rare condition that can occur after Rubella vaccination, with few reports of clinical disease from rubella vaccine-strains in the literature 3.
• The incidence, risk factors, and clinical characteristics of vaccine-associated rubella require further study to guide infection control recommendations and to investigate the extent of horizontal transmission 3.
• The Rubella vaccine is generally considered safe and effective in preventing rubella and congenital rubella syndrome, with global rubella vaccine coverage reaching 70% in 2020 6.