Congenital Rubella Syndrome results from rubella virus infection during pregnancy. Rubella causes miscarriages in CRS during early pregnancy.

Congenital Rubella Syndrome

Online Consultation

Iqra Mazhar

Overview

Congenital rubella syndrome is an illness caused by the rubella virus that affects the unborn child during the mother&rsquo;s pregnancy.

The name rubella comes from a Latin term that means &ldquo;little red&rdquo;. Rubella is generally a contagious disease caused by the rubella virus. Though nearly half the individuals infected with the virus are asymptomatic. The severity of the illness varies depending on age. For example, infection in younger children is characterized by a rash and lymph node involvement, whereas in older children, adolescents, and adults, the virus may cause arthralgia, arthritis, and thrombocytopenic purpura. In rare cases, the virus may cause <a href="https://merisehat.pk/disease/encephalitis">encephalitis</a> in children.&nbsp;

 
A major complication of the syndrome is its teratogenic effects in pregnant women. Teratogens can be infections, drugs, or chemicals that can cause abnormal fetal development. The virus can be transmitted to the fetus through the placenta and cause complications such as stillbirths, abortions, and various congenital defects. In 1969, a successful immunization program was initiated in the United States and the disease was declared eliminated in 2004. However, despite successful global immunization programs for rubella infection and congenital rubella syndrome, it continues to be endemic in Pakistan. In addition, 17,000 suspected cases of measles and rubella were reported in Pakistan in 2021. There was a sharp increase in cases from 2020 to 2021. The outbreaks were reported in 70 districts, and 51 deaths were reported because of disease complications. 70% of the children suffered from congenital heart disease and 30% from congenital cataracts<a href="#accordion">[1]</a>. Pregnant women who contract the virus are at risk of miscarriage and stillbirth. Whereas, developing babies are at risk of severe birth defects and lifelong consequences.&nbsp;

 
Rubella has dangerous complications for pregnant women, babies, and anyone who is not vaccinated against the virus. Thus, women should ensure that they are vaccinated and protected from the disease before they get pregnant. The infection causes more severe damage in early pregnancy, especially in the first 12 weeks. It is further estimated that each year, more than 100,000 infants are born with congenital rubella syndrome<a href="#accordion">[2]</a>. According to the World Health Organization, there are currently 148 countries that have incorporated the rubella vaccine into their immunization programs<a href="#accordion">[3]</a>. 

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Signs And Symptoms

The most common birth defects of congenital rubella syndrome are:&nbsp;

<ul>
	<li>Deafness&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/cataract">Cataracts</a> or clouding in the lens of the eye, which is normally clear</li>
	<li>Intellectual disabilities&nbsp;</li>
	<li>Low birth weight&nbsp;</li>
	<li>Damage to the spleen and liver&nbsp;</li>
	<li>Skin rash at birth&nbsp;</li>
</ul>

Other less common symptoms include:

<ul>
	<li>Brain damage&nbsp;</li>
	<li>Glaucoma&nbsp;</li>
	<li>Thyroid and hormone problems&nbsp;</li>
	<li>Lung inflammation&nbsp;</li>
</ul>

While the symptoms can be treated, there is currently no cure for congenital Rubella syndrome. Therefore, women need to get vaccinated before they get pregnant.

&nbsp;

Causes

Congenital rubella syndrome refers to a group of birth defects caused by a virus known as the Rubivirus. When adults or children are infected with the disease, it is known as rubella or German measles. In addition, if a pregnant woman contracts the virus in her first trimester, there is a high chance that the virus will transfer to the fetus. Pregnant women who are not vaccinated for rubella and have not been infected in the past, are at a higher risk of infecting their unborn baby. The virus spreads from a pregnant woman to the fetus via the bloodstream.&nbsp; 
&nbsp;

There are many successful screening programs in place in developed countries for rubella immunity. A rubella test is usually done to check whether there is a high risk for rubella. Several laboratory tests are used to detect rubella antibodies in the blood, enzyme-linked immunosorbent assay (ELISA, EIA) is the most common. The antibodies for rubella stay in the blood for years. In addition, the presence of certain antibodies means that you have either had a past infection or have been vaccinated against the disease. 
&nbsp;

Diagnosis

Diagnostic tests used to confirm congenital rubella syndrome include:

<ul>
	<li>Placental biopsy&nbsp;</li>
	<li>Rubella antigen detection by monoclonal antibody&nbsp;</li>
	<li>Polymerase chain reaction&nbsp;</li>
</ul>

Specimens used for viral isolation include:&nbsp;

<ul>
	<li>Nasopharyngeal swab&nbsp;</li>
	<li>Urine&nbsp;</li>
	<li>Cerebrospinal fluid&nbsp;</li>
	<li>Buffy coat of the blood&nbsp; 
	&nbsp;</li>
</ul>

Treatment

There is no cure for congenital rubella syndrome and the best treatment is prevention. Women who plan to become pregnant should be vaccinated at least 28 days before. However, women who are pregnant should not be vaccinated because the vaccine consists of a live virus.

&nbsp;

Congenital rubella syndrome may have severe consequences on the development of organs in babies. The infection may cause birth defects or even problems later in life. The severity and nature of the complications depend on the stage of pregnancy at which the infection occurs. Complications of Rubella syndrome may include:&nbsp;

<ul>
	<li>Deafness&nbsp;</li>
	<li>Cataracts&nbsp;</li>
	<li>Heart defects&nbsp;</li>
	<li>Brain disorders&nbsp;</li>
	<li>Mental retardation&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/arthritis">Bone problems</a>&nbsp;</li>
	<li>Liver and spleen damage</li>
</ul>

The complications may either appear immediately after birth or up to the age of 4 years. Late-onset manifestations of the infection include:&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a>&nbsp;</li>
	<li>Thyroid dysfunction&nbsp;</li>
	<li>Visual and neurological abnormalities 
	&nbsp;</li>
</ul>

Rubella is very dangerous for:

<ul>
	<li>Pregnant women and their developing babies</li>
	<li>Anyone who is not vaccinated against the virus&nbsp; 
	&nbsp;</li>
</ul>

Congenital rubella syndrome can be prevented by ensuring:

<ul>
	<li>Women who are planning to get pregnant are vaccinated against the virus, to protect them and the baby&nbsp;</li>
	<li>Women avoid getting pregnant for 4 weeks following the vaccination 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Rubella is an infection caused by the rubella virus. It is characterized by a rash and lymph node involvement.&nbsp;</li>
	<li>In more severe cases, the disease may cause arthralgia, arthritis, and thrombocytopenia purpura. In addition, in rare cases, the virus may cause encephalitis in children.&nbsp;</li>
	<li>Pregnant women who contract the virus are at risk of miscarriage and stillbirth. Whereas, developing babies are at risk of severe birth defects and lifelong consequences, including intellectual disabilities and brain damage.&nbsp;</li>
	<li>Despite successful global immunization programs, the disease is still endemic in Pakistan.&nbsp;</li>
	<li>There is currently no cure for congenital rubella syndrome, and the only prevention is vaccination against the virus.&nbsp;</li>
	<li>Congenital rubella syndrome is a notification priority disease and authorities should be informed immediately.</li>
</ul>

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[1] Ilyas, Faiza., (2021), “14 infants diagnosed with congenital rubella syndrome in three years”, Dawn News.

[2] Robertson, S.E., Featherstone, D.A., Gacic-Dobo, M. and Hersh, B.S., 2003. Rubella and congenital rubella syndrome: global update. Revista Panamericana de salud publica, 14, pp.306-315.