Rubella and Congenital Rubella (German Measles)

Abstract

Rubella, also known as German measles, is usually a very mild infection that can have devastating effects in certain instances. It is a pleomorphic RNA virus in the Togaviridae family of the genus Rubivirus. It typically causes a scarletiniform rash, cervical lymphadenopathy, and mild constitutional symptoms, but in older children and adults, especially women, it may be more severe, with joint involvement and purpuric rash. Infection during the first 12 weeks of pregnancy results in congenital infection and/or miscarriage in 80-90% of cases. The congenital rubella syndrome (CRS) involves multiple organ systems and has a long period of active infection and virus shedding in the postnatal period. For these reasons, the rubella vaccine program was instituted in 1969, and the incidence of rubella infection in the United States has since declined by 99%. Rubella has been recognized as a disease for approximately 200 years, and it has since been found that humans are the only natural reservoir for the rubella virus. Virus is present in nasopharyngeal secretions, blood, feces, and urine during the clinical illness, although patients with subclinical disease are also infectious. The virus is spread via oral droplets and is shed in the nasopharynx for approximately 7 days before and after the rash is visible. CRS includes a configuration of anomalies, including nerve deafness, cataracts, cardiac anomalies (usually pulmonary artery and valvular stenosis, and patent ductus arteriosis), and mental retardation, with late complications including diabetes, thyroid disease, growth hormone deficiency, and progressive panencephalitis. In 1969, the first rubella vaccine was licensed for use, and the Centers for Disease Control and Prevention (CDC) began its National Congenital Rubella Syndrome Registry. As required under the National Childhood Injury Act, all healthcare providers in the United States who administer any vaccine shall, prior to administration of the vaccine, provide a copy of the Vaccine Information Statements (VIS) produced by the CDC to the parent or legal representative of any child to whom the provider intends to administer such vaccine, or to any adult to whom the provider intends to administer such vaccine. Despite efforts to vaccinate children, CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. HIV-1infected children with a preserved immune system and MMR immunization had a good response to rubella vaccine. In contrast, those in more advanced categories for HIV infection responded poorly. Issues of risk, choice, and chance are central to the controversy over the MMR vaccine that erupted in the UK in 1998, and has continued into the new millennium. An important contribution to the MMR controversy has come from the parents of autistic children, some of whom reject the notion that this disorder is a random genetic misfortune and insist that it is, at least in part, the result of some environmental insult, such as MMR vaccinations.

Birth Defect

“…and, rarely, chickenpox [5][6][7] . Maternal infections such as syphilis and rubella are a significant cause of birth defects in low-and middle-income countries 1 .…”

Profiling of Audiological Characteristics in Infants with Congenital Rubella Syndrome

“…One of the most common causes is the infection due to Rubella virus [1]. Rubella (German measles) is contagious viral infection caused by Rubella virus (RuV) to the fetus during pregnancy [2] WHO (World health organisation) estimate that worldwide more than 100,000 children are born with CRS [1]. It is Togaviridae family of the genus Rubivirus which affects multiple organs [2].…”

“…Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome (CRS) in newborns [2]. The effect of rubella infection varies depending on time of gestational rubella infection.…”

“…auditory deficits, vestibular deficits, cataracts, cardiac defects, nerve deafness and cerebral lesion with late onset complications including thyroid disease, diabetes, growth hormone deficiency and panencephalitis in newborns [2,5]. Studies reported that hearing loss results in delayed development of speech & language milestone [6].…”

Women and vaccinations: From smallpox to the future, a tribute to a partnership benefiting humanity for over 200 years

“…For example, rubella infections during pregnancy may cause congenital rubella syndrome, which can give rise to neurological deficits, blindness, cardiac disease or other defects in the newborn. 23 The risk of congenital rubella syndrome has been reduced greatly (with rubella even eliminated in some cases) in countries that have implemented universal rubella vaccination (Fig. 2).…”