Congenital rubella

Definition

Congenital rubella is a group of physical problems that occur in an infant when its mother is infected with the virus that causes German measles.

Causes, incidence, and risk factors

Congenital rubella is caused by the destructive action of the rubella virus on the fetus at a critical time in development. The most critical time is the first trimester (the first 3 months of a pregnancy). After the fourth month, the mother's rubella infection is less likely to harm the developing fetus.

The incidence of rubella syndrome has decreased dramatically since the introduction of the rubella vaccine.

Risk factors for congenital rubella include lack of the recommended rubella immunization and contact with a person who has rubella (also called the 3-day measles or German measles). Pregnant women who are not vaccinated and who have not had rubella risk infection to themselves and damage to their unborn baby.

Symptoms

• History of mother having rubella while pregnant (particularly in the first trimester)
• Skin rash at birth (purpura, petechiae)
• Low birth weight
• Small head size (microcephaly)
• Lethargy
• Irritability
• Deafness
• Seizures
• Cloudy corneas or white appearance to pupil (leukocoria)
• Developmental delay
• Mental retardation

Signs and tests

Tests include:

• Urine tests, nasopharyngeal secretions tests, or cerebrospinal fluid tests for virus
• Antibody tests

Treatment

There is no specific treatment for congenital rubella. Care involves appropriate treatment of affected systems in consultation with your health care providers.

Expectations (prognosis)

The outcome for a child with congenital rubella depends on the severity of the abnormalities present. Heart defects can often be corrected. Damage to the nervous system is permanent.

Complications

Complications may involve many parts of the body.

Eyes:

• Cataracts
• Glaucoma
• Retinitis

Heart:

• Patent ductus arteriosus (PDA)
• Pulmonary artery stenosis
• Other heart defects

Central nervous system:

• Mental retardation
• Motor retardation
• Small head (microcephaly) from failed brain development
• Encephalitis
• Meningitis

Other:

• Deafness
• Low blood platelet count
• Enlarged liver and spleen
• Abnormal muscle tone
• Bone disease

Calling your health care provider

Call your health care provider if you have concerns about congenital rubella, if you are unsure of your vaccination status, or if you or your child needs rubella vaccine.

Prevention

Vaccination prior to pregnancy can prevent congenital rubella. Pregnant women who are not immune to rubella should avoid contact with persons who have carry the virus.

References

Edlich RF, Winters KL, Long WB 3rd, Gubler KD. Rubella and congenital rubella (German measles). J Long Term Eff Med Implants. 2005;15(3):319-28.

Bar-Oz B, Levichek Z, Moretti ME, Mah C, Andreou S, Koren G. Pregnancy outcome following rubella vaccination: a prospective controlled study. Am J Med Genet A. 2004 Sep 15;130(1):52-4.

Robertson SE, Featherstone DA, Gacic-Dobo M, Hersh BS. Rubella and congenital rubella syndrome: global update. Rev Panam Salud Publica. 2003 Nov;14(5):306-15. Review.

Illustrations

Slit-lamp exam

Rubella on an infant's back

Rubella Syndrome

Page Content:

congenital rubella syndrome; congenital rubella