Congenital Rubella Syndrome: Understanding the Impact, Symptoms, and Preventive Measures

Introduction:

Congenital rubella syndrome (CRS) is a disease in babies that happens when a mother gets the rubella virus while she is pregnant. When a woman gets rubella early in her pregnancy, it can cause serious problems like miscarriages, stillbirths, and a number of serious birth defects. The risk of birth defects and infections is highest in the first 12 weeks of pregnancy and goes down after that. Birth defects are rare after an infection in the 20th week of pregnancy or later. Some of the most common birth defects caused by CRS are cataracts, congenital heart disease, hearing loss, and delayed development. Infants with CRS often have more than one of these signs, but they can also have one problem, most commonly hearing loss.

What Is the Cause of Congenital Rubella Syndrome?

Congenital rubella happens when the rubella virus in the mother is transmitted to the baby while it is still growing in the womb during the first three months of pregnancy. If the mother has rubella after the fourth month, it is less likely that it will hurt the baby. Since the rubella vaccine was made, the number of babies born with this condition has decreased significantly.

What Are the Signs and Symptoms of Congenital Rubella Syndrome?

1. In Mother: During pregnancy, a woman may have no symptoms of rubella at all, or she may experience upper respiratory tract symptoms, mild fever, conjunctivitis, and lymphadenopathy (maculopapular rash, which is the classic sign of rubella. Symptoms may sometimes follow the infection in joints.

2. In Infant: It is likely for the fetus to develop congenital rubella syndrome, which is a collection of various birth defects, or there may be no consequences at all (CRS). The most common anomalies include the following:

• Cataracts or congenital glaucoma.

• Congenital heart disease, like PDA, called patent ductus arteriosus or peripheral pulmonary artery stenosis, can occur.

• Pigmentary retinopathy.

• Deafness.

• Growth retardation.

• Irritability.

• Low fetal weight.

• Below-average mental performance (intellectual disability).

• Seizures.

• Small-sized head.

• Dermatitis (skin rash) at birth.

What Are the Diagnostic Tests for Congenital Rubella?

The diagnostic tests done are:

• Maternal serum rubella titers.

• Viral detection in the mother utilizing blood culture or reverse transcriptase–polymerase chain reaction (RT-PCR) of amniotic fluid, nose, throat (preferred), urine, cerebrospinal fluid (CSF), or blood specimens.

• Infant antibody titers which are measured serially.

1. In Pregnant Women: Serum rubella IgG titers are often checked on pregnant women early in their pregnancies. The titer is repeated in women who are not immune to rubella but show symptoms or signs of it. A positive serologic test for IgM antibody confirms the diagnosis. The virus can be grown from nose and throat swabs, but it is hard to grow. RT-PCR can confirm culture results or find viral RNA directly in patient samples.

2. In Fetus: A few healthcare centers have the ability to identify fetal infection through the detection of the virus in the amniotic fluid, the detection of rubella-specific IgM in the fetal blood, or the application of RT-PCR techniques to chorionic villus biopsy specimens of fetal blood.

3. In Infants: If a baby is thought to have congenital rubella syndrome, antibody titers, and viral samples are taken. If the baby still has rubella-specific IgG after six to 12 months, it means it was infected before birth. Rubella infection is usually also shown by the presence of IgM antibodies that are specific to rubella, but false-positive IgM results can happen. The virus is usually found in samples from the nasopharynx, urine, CSF (cerebrospinal fluid), and conjunctiva of infants with CRS. Samples from the nasopharynx are the most sensitive for culture, and if the rubella virus is suspected, the laboratory personnel should be informed.

What Is the Treatment for Congenital Rubella?

The prenatal care of the mother and fetus is dependent on the gestational age of infection onset. If infection occurs before 18 weeks of gestation, the fetus is at increased risk for infection and severe symptoms. The termination of a pregnancy could be debated depending on local law. Recommendations include a thorough ultrasound examination and evaluation of viral RNA in amniotic fluid.

For infections beyond 18 weeks of pregnancy, the pregnancy could be continued with ultrasound surveillance, followed by a physical examination of the newborn and testing for RV-IgG. Some experts advocate administering nonspecific immune globulin (0.55 mL/kg IM) for exposure early in pregnancy; however, this treatment does not prevent infection, and the use of immune globulin should only be considered in women who decline abortion.

Although the symptoms of congenital rubella syndrome are treatable, there is no cure for the illness; therefore, prevention should be the primary objective.

What Control Measures Should Be Taken in Children Born With Congenital Rubella?

Children diagnosed with congenital rubella syndrome should be considered contagious until at least one year of age unless two negative cultures are obtained one month apart after the age of three months, in which case they can be regarded as no longer infectious. Isolation is necessary for neonates. The spread of the rubella virus should be prevented from the urine of children with congenital rubella. Proper hand sanitation is of the utmost importance in preventing the spread of infection.

How to Prevent Congenital Rubella?

Prevention is the best treatment for congenital rubella syndrome, which has no known cure. At least 28 days before getting pregnant, women should be vaccinated against rubella. Since the vaccine contains a live virus, pregnant women should not be vaccinated.

Conclusion:

The severity of the birth abnormalities will determine the overall development of a child born with congenital rubella syndrome in terms of their long-term outlook. On the other hand, damage to the baby's neurological system is typically permanent, so getting it checked out as soon as possible is important if the patient suspects anything is wrong. Because no treatment is available for congenital rubella syndrome, its prevention is of the utmost importance. If the patient intends to get pregnant within the next 28 days, one should talk to the doctor about getting the MMR vaccine, which protects against measles, mumps, and rubella. In children born with congenital rubella syndrome, individual symptoms of the condition can be addressed in accordance with their severity.