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In addition to the above symptoms, signs of meningeal irritation and muscle spasm occur in the absence of frank paralysis. This disease is indistinguishable from aseptic meningitis caused by other enteroviruses.
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Live attenuated rubella virus vaccine should be given to all infants and to susceptible girls before the menarche. When women are immunized, they should not be pregnant, and the absence of antibodies should be established. (In the United States, about 80% of 20-year-old women are immune to rubella.) Postpartum administration to susceptible female hospital employees is recommended, though many hospitals fail to comply. It is recommended that women not become pregnant for at least 1 month after vaccine administration. Nonetheless, there are no reports of congenital rubella syndrome after rubella immunization, and inadvertent immunization of a pregnant woman is not considered an indication for therapeutic abortion. Arthritis is more marked after rubella vaccination than in native disease and appears to be immunologically mediated. The association between chronic arthropathies and rubella vaccination is controversial. MMR may be given in conjunction with diphtheria–pertussis–tetanus (DPT) boosters as adequate serologic responses are documented. The administration of two or more doses appears to overcome an immunogenetic risk for vaccine failure in some vaccinees.

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