Rubella, congenital syndrome

Reporting Obligations

Individuals with suspect or confirmed cases must be reported to the Thunder Bay District Health Unit by the next working day by fax, phone or mail.

  • Fax: (807) 625-4822
  • Phone: 625-8318 or toll-free at 1-888-294—6630, ext. 8318
  • Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7

 

Epidemiology

Aetiologic Agent:

Rubella virus (family Togaviridae; genus Rubivirus)

Clinical Presentation:

Congenital Rubella Syndrome (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, but the risk of fetal damage following maternal infection is particularly high in the earliest months after conception (90% in the first trimester) with progressive diminution of risk thereafter, and it is very uncommon after the 20th week of pregnancy. 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 1 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 & Laboratory Testing

Two clinically compatible manifestations such as cataracts/glaucoma, congenital heart defect, hearing loss, retinopathy, purpura, hepatosplenomegaly, microcephaly, micro ophthalmia, developmental delay, meningoencephalitis, and radiolucent bone disease, with laboratory confirmation.

Testing includes any of the following:

• Isolation of rubella virus in culture from clinical samples (throat, NP swabs/aspirates, urine)

• Nucleic acid amplifi cation test (NAT) to detect rubella virus RNA

• Positive serology for rubella IgM antibody in the absence of recent (i.e., 7 – 42 days) immunization with rubellacontaining vaccine

• Rubella Immunoglobulin G (IgG) persisting for longer than would be expected (approximately 6 months following birth) from passive transfer of maternal antibody, or in the absence of recent immunization.

Rubella IgM may not always be detectable at birth following congenital infection. Virus isolation and/or detection of rubella RNA and monitoring of IgG response may be necessary.

Testing Information & Requisition

 

Treatment & 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.

 

Patient Information

Patient Fact Sheet

References

1. Ministry of Health and Long Term Care, Infectious Diseases Protocol, 2016. Appendix A (2013) and Appendix B (2013)

 

Additional Resources

1. Heymann, D.L., Control of Communicable Disease Manual (20th Ed.), Washington, American Public Health Association, 2015

2. Pickering LK, et. al. Red Book, 2012 Report of the Committee on Infectious Diseases (29th Ed.). Elk Grove Village, IL, American Academy of Pediatrics,  2012.

Last Updated: 26/10/2017