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Rubella, congenital syndrome

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Reporting Obligations

Individuals who have or may have rubella shall be reported to the local Health Unit. Laboratory confirmed cases are to be reported by phone as soon as identified.

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Epidemiology

Aetiologic Agent

Rubella virus (family Togaviridae; genus Rubivirus).

Clinical Presentation

CRS can result in miscarriage, stillbirth and fetal malformations, including congenital heart disease, cataracts, deafness and intellectual disabilities. Fetal infection can occur at any stage of pregnancy. The greatest risk of fetal damage following maternal infection is highest in the first trimester (90%) which is reduced as the pregnancy progresses and is very uncommon after the twentieth week. Infected infants who appear normal at birth may later show eye, ear or brain damage. Congenital infection may give rise to such problems as diabetes mellitus and panencephalitis later in life. Congenitally infected infants may shed the virus in the urine and in nasopharyngeal secretions for one year or more.

Modes of Transmission

Transplacental passage of rubella virus from maternal blood.

Incubation Period

Not applicable.

Period of Communicability

Birth to 9–12 months of age, rarely longer. A small number of infants with congenital rubella continue to shed virus in nasopharyngeal secretions and urine for 1 year or more and can transmit infection to susceptible contacts.

Risk Factors/Susceptibility

Fetuses of rubella-susceptible pregnant women who have not received at least one dose of rubella-containing vaccine. Immunity is usually permanent after immunization and natural infection.

Diagnosis and Laboratory Testing

Any of the following will constitute laboratory confirmation:

  • Positive for rubella IgM in the absence of recent (i.e., 7–42 days) immunization with rubella-containing vaccine
  • Rubella IgG persisting longer than would be expected (approximately 6 months) from passive transfer of maternal antibody, or in the absence of recent immunization
  • Isolation of rubella virus from an appropriate clinical specimen
  • Detection of rubella virus RNA
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Treatment and Case Management

There is no specific treatment for congenital rubella except for symptomatic and supportive care. Infants with congenital rubella infection should be isolated from non-immune pregnant women, infants and children, and should be considered infectious until there are 2 set of negative tests. Urine and nasopharyngeal (NP) specimens in addition to serology should be collected shortly after birth and again in 1–2 months. If the test results are not negative, the infant is considered infectious and should continue to be isolated from non-immune persons. Regular testing should be done until tests are negative. All those who are close contacts and are susceptible to rubella will be notified by Public Health staff.

Patient Information

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Additional Resources

Heymann, D.L. Control of Communicable Disease Manual (19th Ed.). Washington, American Public Health Association, 2008.

Pickering LK, Baker CJ, Long SS, McMillan JA editors. Red Book, 2006 Report of the Committee on Infectious Diseases (27th Ed.). Elk Grove Village, IL, American Academy of Pediatrics, 2006.

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.