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CONGENITAL RUBELLA CONGENITAL RUBELLA

SYNDROMESYNDROMEInfectious and TropicalInfectious and Tropical PediatricPediatric DivisionDivision

Department of Child HealthDepartment of Child Health

Medical Faculty, University of Sumatera UtaraMedical Faculty, University of Sumatera Utara



What is RubellaWhat is Rubella

R ubella (German measles) is a diseaseR ubella (German measles) is a diseasecaused by the rubella virus. R ubella iscaused by the rubella virus. R ubella isusually a mild illness. Most people whousually a mild illness. Most people whohave had rubella or the vaccine arehave had rubella or the vaccine areprotected against the virus for the rest of protected against the virus for the rest of their lives. Because of routine vaccinationtheir lives. Because of routine vaccinationagainst rubella since 1970 , rubella is nowagainst rubella since 1970 , rubella is nowrarely reported.rarely reported.



HistoryHistory -- RubellaRubella

The Teratogenic property of theThe Teratogenic property of the

infection was documented by aninfection was documented by anAustralian opthalmologist Greeg inAustralian opthalmologist Greeg in

19411941



RubellaRubella

( German Measles )( German Measles ) R ubella is alsoR ubella is also

called as 3 daycalled as 3 dayMeasles or GermanMeasles or German

Measles.Measles. FamilyFamily ±± TogaviridaeTogaviridae

GenusGenus -- RubivirusRubivirus

In general belongIn general belongto Togavirus groupto Togavirus group



Rubella VirusRubella Virus

R ubella virus areR ubella virus are

ssss ±± RNA virusRNA virus

Diameter 50Diameter 50 ±± 70 nm70 nm

Enveloped SphericalEnveloped Spherical

Virus carryVirus carryhemagglutininhemagglutinin

Virus multiply in theVirus multiply in thecytoplasam of infectedcytoplasam of infectedcell.cell.



EpidemiologyEpidemiology

R ubella is world wide in distributionR ubella is world wide in distribution

Occurs round the year,Occurs round the year,

Epidemics occur every 20Epidemics occur every 20 ±± 25 years25 years

Infection is transmitted by respiratoryInfection is transmitted by respiratoryrouteroute

The use of R ubella vaccine has nowThe use of R ubella vaccine has noweliminated both epidemic and endemiceliminated both epidemic and endemicR ubella in USA and several developedR ubella in USA and several developedcountriescountries



Tr eatment and Pr eventionTr eatment and Pr evention

R ubella is a mild self limited illness.R ubella is a mild self limited illness.

No specific treatment or AntiviralNo specific treatment or Antiviral

treatment is indicated.treatment is indicated.However Laboratory proved andHowever Laboratory proved and

clinically missed R ubella in the Ist 3clinically missed R ubella in the Ist 3--4 months of pregnancy is associated4 months of pregnancy is associatedwith fetal infections.with fetal infections.



Congenital Rubella SyndromeCongenital Rubella Syndrome

Maternal viremia with R ubella infectionMaternal viremia with R ubella infectionduring pregnancy may result in infectionduring pregnancy may result in infectionof placenta and fetus.of placenta and fetus.

The growth rate of fetal cells are reduced.The growth rate of fetal cells are reduced. R esults in fewer number of cells after theR esults in fewer number of cells after the

birth.birth.

Lead to deranged and hypo plastic organLead to deranged and hypo plastic organ

development.development. R esults in structural damage andR esults in structural damage and

abnormalitiesabnormalities



Rubella infectionRubella infection ² ² At various At various

trimesterstrimesters

IIstst trimester infections lead to abnormalities intrimester infections lead to abnormalities in85 % of cases. and greater damage to organs85 % of cases. and greater damage to organs

22

ndnd

trimester infections lead to defects in 16 %trimester infections lead to defects in 16 % > 20 weeks of pregnancy fetal defects are> 20 weeks of pregnancy fetal defects are

uncommonuncommon

However R ubella infection can also lead to fetalHowever R ubella infection can also lead to fetaldeaths, and spontaneous abortion.deaths, and spontaneous abortion.

The intrauterine infections lead to viral excretionThe intrauterine infections lead to viral excretionin various secretion in newborn upto 12in various secretion in newborn upto 12--1818months.months.



Clinical FindingsClinical Findings

(C

ongenital Rubella Syndr ome )(

Congenital Rubella Synd

r ome )

May be transient effects in infants.May be transient effects in infants.

Permanent manifestations may bePermanent manifestations may be

apparent at birth, becomeapparent at birth, becomerecognized during the first year.recognized during the first year.

Developmental abnormalities appearDevelopmental abnormalities appearduring childhood and adolescents.during childhood and adolescents.



Classical Tr iad of RubellaClassical Tr iad of Rubella

Classical TriadClassical Triad CataractCataract

Cardiac abnormalitiesCardiac abnormalities

DeafnessDeafness

Other manifestationsOther manifestationsGrowth retardationGrowth retardation

RashRashHepatosplenomegalyHepatosplenomegaly

JaundiceJaundiceMeingoencephalitisMeingoencephalitisCNS defects lead toCNS defects lead tomoderate to profoundmoderate to profound

mental retardationmental retardation



Other Neur ological manifestionsOther Neur ological manifestions

Problems in balanceProblems in balance

Motor skills inMotor skills inpreschool childrenpreschool children

altered.altered. A rare complication of A rare complication of

Pan encephalitis canPan encephalitis canoccur in secondoccur in seconddecade withdecade with

Congenital rubellaCongenital rubellasyndrome maysyndrome mayprogress to death.progress to death.



Diagnosis of Diagnosis of

Congenital Rubella Synd

r

omeC

ongenital Rubella Syndr

ome

Demonstration of Demonstration of R ubella antibodiesR ubella antibodies

of IgM in a newof IgM in a newborn is diagnosticborn is diagnosticvalue. As IgMvalue. As IgMgroup donot crossgroup donot crossthe placenta andthe placenta andthey are produce inthey are produce inthe infected fetus,the infected fetus,



Treatment, Prevention, ControlTreatment, Prevention, Control

No specific treatmentNo specific treatmentis availableis available

CRS can be prevented by CRS can be prevented by

effective immunization of effective immunization of the young children and the young children and

teenage girls, remain theteenage girls, remain the

best option to prevent best option to prevent

Congenital RubellaCongenital Rubella

Syndrome.Syndrome.

The component of The component of

Rubella in MMR vaccineRubella in MMR vaccine

protects the vaccinated protects the vaccinated



MMR VaccineMMR Vaccine

TheThe MMR vaccineMMR vaccine is a mixture of three liveis a mixture of three liveattenuated virusesattenuated viruses, administered via injection for, administered via injection forimmunizationimmunization againstagainst measlesmeasles,, mumpsmumps andandrubellarubella. It is generally administered to children. It is generally administered to children

around the age of one year, with a second dosearound the age of one year, with a second dosebefore starting school (i.e. age 4/5). The secondbefore starting school (i.e. age 4/5). The seconddose is not adose is not a boosterbooster; it is a dose to produce; it is a dose to produceimmunity in the small number of persons (2immunity in the small number of persons (2--5%)5%)who fail to develop measles immunity after thewho fail to develop measles immunity after the

first dose In the United States, the vaccine wasfirst dose In the United States, the vaccine waslicensed in 1963 and the second dose waslicensed in 1963 and the second dose wasintroduced in the mid 1990s. It is widely used inintroduced in the mid 1990s. It is widely used inall National, Universal Immunization programmesall National, Universal Immunization programmes

congenital rubella kbk

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