Rubella infection in pregnancy.

Telefono Rosso, Teratology Information Service, Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli, 8. Rome, Italy.
Reproductive Toxicology (Impact Factor: 2.77). 06/2006; 21(4):390-8. DOI: 10.1016/j.reprotox.2005.01.014
Source: PubMed

ABSTRACT Rubella is the first virus demonstrated as a teratogen. There is a high risk to develop congenital rubella syndrome (CRS) if the infection occurs in the first part of pregnancy, particularly in women without specific immunological protection. Specific therapies to prevent CRS are not available. Many developed countries have specific vaccination programs and maternal rubella is rare. However, in developing countries or where campaigns of rubella surveillance and preconceptional vaccination are inadequate, there are still cases of CRS registered despite primary possibilities of prevention. Maternal infection is not indicative of vertical transmission in 100% of cases, and damage does not necessarily occur in all cases of fetal infection. This is the reason why an adequate prenatal counselling is mandatory, particularly in cases of proven maternal infection. Advanced prenatal diagnostic techniques, invasive or not, should be offered to the women especially in order to distinguish the cases without fetal damage. Prevention of voluntary interruption of pregnancy for the latter or in case of maternal false IgM rubella antibody positivity or IgM "chronic carrier" patients is mandatory. World wide, the aim is to perform an adequate primary prevention through vaccination of childbearing age women without specific immunological protection.

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    ABSTRACT: Background: Congenital rubella syndrome (CRS) caused by rubella infection in uterine, is a major public health problem among women of child bearing age as it causes serious complications including foetal death or abnormalities including cardiovascular, ophthalmologic, respiratory and hearing impairment. Though there is evidence of rubella infection amongst the population under the expanded programme on immunization (epi) surveillance programme, there is no documented evidence of laboratory confirmed congenital rubella syndrome cases in Zambia. A report is given on four cases of CRS that were identified and confirmed during routine activities of the national measles surveillance program in Zambia. Clinical data on the symptomatic cases were collected and serum samples tested for rubella IgM to confirm the cases. Case presentation: The first confirmed case was a baby girl presented to the Neonatal Intensive Care unit of the University Teaching Hospital for low birth weight and hypothermia. At seven weeks, the girl was found to have cataracts, spleno-hepatomegaly, microcephaly, and patent ductus arteriosus (PDA). The baby tested positive to rubella IgM antibodies. The second case was a baby boy who was first seen at the University Teaching Hospital at three weeks and on examination was found to have bilateral cataracts, congenital heart disease and microcephaly. Rubella Immunoglobulin M (IgM) results were positive. The third case, a girl, was seen at twelve weeks and brought in for slow growth rate. On examination, the girl was found to have bilateral cataracts, microcephaly and developmental delay. The fourth case is a girl who was brought to the hospital for failure to thrive, tachypnea and fever. On further investigations there was evidence of cataracts, patent ductus arteriosus. At eight weeks, she tested positive for rubella IgM antibodies. Conclusion: The clinical symptoms and laboratory evidence of rubella infection confirmed congenital rubella syndrome in the four patients. There is an urgent need for surveillance of congenital rubella syndrome and a baseline rubella sero-prevalence survey in Zambia in order to determine the burden of the disease and use this data to direct policy in terms of interventions for supportive treatment, control and possible elimination of rubella infection through immunization with measles-rubella vaccine.
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