What is Congenital Rubella (German Measles)?
Rubella, commonly known as German Measles, is a viral infection that triggers symptoms including skin rash, swollen glands, and fever. It is very contagious but typically causes a mild illness that usually doesn’t lead to any serious issues. However, if a pregnant woman contracts the virus in her first three months of pregnancy, it can result in her baby being born with a condition known as congenital rubella syndrome, which involves several birth defects.
What Causes Congenital Rubella (German Measles)?
The Rubella virus is a specific type of virus that has a protective outer layer and contains positive-stranded RNA, which is a type of genetic material. It belongs to the family of viruses known as Togaviridae and is classified as a Rubivirus.
Risk Factors and Frequency for Congenital Rubella (German Measles)
Congenital rubella syndrome, which is one of the known causes of autism, is a significant global health issue. Over 100,000 cases get reported every year globally. It’s caused by a natural infection during pregnancy. Before a vaccine was made available in the United States in 1969, rubella, which primarily affected young children, was widespread. However, since 2004, the disease has been eliminated from the US, with fewer than 10 cases reported annually, many of which come from outside the US.
Rubella continues to be widespread in many other parts of the world, often unrecognized due to its rash, which looks like many other illnesses. Also, up to half of all infections may not show any symptoms. The disease only spreads through people, specifically through direct contact with secretions from the nose and throat. After the virus is inhaled, it replicates in the respiratory mucosa and cervical lymph nodes and then spreads to the target organs. The contagious period is roughly 8 days before to 8 days after the rash appears.
- When a pregnant woman contracts rubella, it may lead to miscarriage, fetal death, or congenital rubella syndrome.
- Few infants with rubella continue to spread the virus through their nose and throat secretions and urine for a year or more.
- Moreover, the rubella virus has been found in lens aspirates in children with congenital cataracts for several years.
Signs and Symptoms of Congenital Rubella (German Measles)
Mild forms of rubella disease often present with few or no obvious symptoms at birth. The chance of a newborn being infected with rubella is highest during the early and late periods of pregnancy and results in a higher risk of birth defects if the infection occurs earlier in the pregnancy.
If a mother gets infected during the first 12 weeks of her pregnancy, there’s an 85% chance of the baby having a birth defect. This drops to 50% if the infection happens between weeks 13 and 16, and to 25% if the infection happens in the later part of the second trimester.
Some of the serious birth defects that can arise from rubella are:
- Heart defects like patent ductus arteriosus, peripheral pulmonary artery stenosis, ventricular septal defects, atrial septal defects
- Sensorineural hearing impairment
- Eyes-related defects such as cataracts, pigmentary retinopathy, microphthalmos, chorioretinitis
- Brain conditions such as microcephaly, cerebral calcifications, meningoencephalitis, behavioral disorders, mental retardation
- Blood-related conditions like thrombocytopenia, hemolytic anemia, petechiae/purpura, a “blueberry muffin” rash caused by dermal erythropoiesis
- Signs in newborns such as low birth weight, interstitial pneumonitis, a “celery stalking” appearance of long bones due to radiolucent bone disease, and an enlarged liver and spleen (hepatosplenomegaly)
- Late onset of diseases like insulin-dependent diabetes and thyroid disease
Testing for Congenital Rubella (German Measles)
It’s standard practice for soon-to-be mothers in the United States to have their blood tested for rubella early in pregnancy. If a mother-to-be shows signs of rubella during early pregnancy, additional tests will be done to confirm the diagnosis. These tests work by watching how the levels of two rubella-specific immune system proteins (RV-IgG and IgM) in the blood change over time. If rubella is confirmed, mothers may opt for counseling or the potential termination of their pregnancy.
For unborn babies, rubella diagnosis is made by checking for the presence of the virus in samples taken from the amniotic fluid surrounding the baby, fetal blood or tissues from the placenta.
After birth, doctors check for rubella infection by looking for the RV-IgG protein in the newborn’s blood using a method called ELISA. This test is effective and precise, nearly 100% of the time, for babies younger than three months. To further confirm the infection, doctors can look for the rubella virus in samples taken from the baby’s nose and throat, urine, or oral fluid using a technique called PCR.
Rubella infections can also be confirmed by seeing if levels of rubella-specific IgG in the baby’s blood remain steady or increase over their first year of life. However, it’s hard to diagnose rubella in children older than one year of age.
It’s important to confirm if a baby was born with a rubella infection, even if they don’t show any symptoms of the disease. This helps doctors to put together a specific care plan that includes early detection of any longer-term issues affecting the nervous system or eyes, which can be caused by rubella.
Treatment Options for Congenital Rubella (German Measles)
If a pregnant woman gets infected with rubella before 18 weeks of pregnancy, the unborn baby is at high risk for infection and could get severe symptoms. Depending on local laws, ending the pregnancy could be an option. Doctors generally recommend a detailed ultrasound examination to check the baby’s health, and they might test the amniotic fluid to see if the baby has the virus.
For women who get infected with rubella after 18 weeks of pregnancy, doctors might advise to continue the pregnancy. In such cases, the baby’s condition would be closely monitored through ultrasound scans, and, after birth, doctors would examine the baby and do a test for a specific immune response to rubella.
Medical professionals believe that injecting the mother with Immune Globulin (a substance rich in antibodies) could help fight the rubella infection, reducing the chances of transmitting the virus to the baby.
It’s important to understand that while doctors can manage symptoms associated with congenital rubella syndrome (a condition that can cause various health problems in babies if their mother had rubella during pregnancy), they can’t cure it. Hence, preventing rubella is crucial.
Children with congenital rubella syndrome might continue to spread the virus up to the age of one unless specific tests show that they’re no longer contagious. Newborns with this condition should be kept isolated. Washing hands thoroughly and regularly is vital in preventing the spread of rubella, especially when handling children with the infection.
What else can Congenital Rubella (German Measles) be?
- Infections caused by Herpesvirus 6
- Measles or the ‘Rubeola’ virus
- Infections caused by Parvovirus B19, often causing Fifth disease in children
- Contact dermatitis in children, a skin rash caused by contact with certain substances
- Cytomegalovirus infection in children, a common virus that can infect almost anyone
- Enterovirus infections in children, which often cause high fever and other symptoms
- Mononucleosis, often referred to as ‘Mono’, in children
- Mycoplasma infections in children, a type of bacteria which can infect different parts of the body
- Syphilis in children, a sexually transmitted disease which is rare but can occur
- Toxoplasmosis, a disease that results from an infection with the Toxoplasma gondii parasite