Cough and other flu-like symptoms
Rubella starts as a respiratory disease, and it is the way it is transmitted from one person to another. The most important way of transmission is by droplets of saliva or mucosa spread in the air when the person coughs or sneezes. When the virus reaches the respiratory tract, it starts replicating in the mucosa of the lungs and gives out a persistent cough as a part of the prodromal symptoms. Thus, even if the rash has not yet started, the patient may start spreading the disease without even knowing it.
In many cases, rubella is mistaken with a cold or influenza, especially because the prodromal syndrome often includes mild fever, cough, a runny nose and a sore throat with the usual muscle aches and low energy levels that characterize influenza infections. However, as we will describe in the skin rash section, when it appears it will probably help clinicians suspect rubella as a possible diagnosis.