Congenital rubella syndrome: Management, outcome, and prevention
- Simon R Dobson, MD, FRCP(C)
Simon R Dobson, MD, FRCP(C)
- Clinical Associate Professor, Division of Infectious and Immunological Diseases
- BC Children's Hospital
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
The management, outcome, and prevention of congenital rubella syndrome (CRS) will be discussed here. The epidemiology of rubella infection, risk of rubella-associated congenital defects, and the clinical features and diagnosis of congenital rubella infection are discussed separately. (See "Rubella" and "Rubella in pregnancy" and "Congenital rubella syndrome: Clinical features and diagnosis".)
●Congenital rubella infection – Congenital rubella infection (CRI) encompasses all outcomes associated with intrauterine rubella infection (ie, miscarriage, stillbirth, combinations of birth defects, asymptomatic infection) .
●Congenital rubella syndrome – CRS refers to variable constellations of birth defects (eg, hearing impairment, congenital heart defects, cataracts/congenital glaucoma, pigmentary retinopathy, etc) (table 1) .
The clinical course of intrauterine rubella infection is not altered by treatment with antiviral or biologic agents [2-5], nor do these agents appear to have any long-term effect on the duration of viral shedding.
OVERVIEW OF MANAGEMENT
Supportive care and surveillance and are the cornerstones of management for CRS. Specific treatment depends upon the clinical manifestations, which may develop or progress over time (table 2). (See "Congenital rubella syndrome: Clinical features and diagnosis", section on 'Clinical features'.)
- Reef SE, Plotkin S, Cordero JF, et al. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31:85.
- Plotkin SA, Klaus RM, Whitely JP. Hypogammaglobulinemia in an infant with congenital rubella syndrome; failure of 1-adamantanamine to stop irus excretion. J Pediatr 1966; 69:1085.
- Arvin AM, Schmidt NJ, Cantell K, Merigan TC. Alpha interferon administration to infants with congenital rubella. Antimicrob Agents Chemother 1982; 21:259.
- Larsson A, Forsgren M, Hård af Segerstad S, et al. Administration of interferon to an infant with congenital rubella syndrome involving persistent viremia and cutaneous vasculitis. Acta Paediatr Scand 1976; 65:105.
- Plotkin, SA, Reef, et al. Rubella. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington, JS, Klein, JO, Wilson, CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.861.
- Cherry JD, Adachi K. Rubella virus. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.2195.
- Menser MA, Dods L, Harley JD. A twenty-five-year follow-up of congenital rubella. Lancet 1967; 2:1347.
- McIntosh ED, Menser MA. A fifty-year follow-up of congenital rubella. Lancet 1992; 340:414.
- Forrest JM, Turnbull FM, Sholler GF, et al. Gregg's congenital rubella patients 60 years later. Med J Aust 2002; 177:664.
- Alford CA Jr, Kanich LS. Congenital rubella: a review of the virologic and serologic phenomena occurring after maternal rubella in the first trimester. South Med J 1966; 59:745.
- Cradock-Watson JE, Ridehalgh MK, Anderson MJ, et al. Fetal infection resulting from maternal rubella after the first trimester of pregnancy. J Hyg (Lond) 1980; 85:381.
- Peckham CS. Clinical and laboratory study of children exposed in utero to maternal rubella. Arch Dis Child 1972; 47:571.
- American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120:898.
- Harlor AD Jr, Bower C, Committee on Practice and Ambulatory Medicine, Section on Otolaryngology-Head and Neck Surgery. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics 2009; 124:1252.
- Cooper LZ. The history and medical consequences of rubella. Rev Infect Dis 1985; 7 Suppl 1:S2.
- Gregg, N. Congenital cataract following German measles in the mother. Trans Ophthalmol Soc Aust 1941; 3:35.
- GREGG NM. Congenital defects associated with maternal rubella. Aust Hosp 1947; 14:7.
- Centers for Disease Control and Prevention. Rubella. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book, 12th ed, Atkinson W, Wolfe S, Hamborsky J (Eds). Public Health Foundation, Washington, DC 2011. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf (Accessed on August 10, 2011).
- Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR Recomm Rep 2001; 50:1.
- American Academy of Pediatrics. Rubella. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.688.
- Rubella prevention. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep 1990; 39(RR-15):1.
- CLINICAL COURSE
- OVERVIEW OF MANAGEMENT
- SYMPTOMATIC MANAGEMENT
- Neonatal period
- Older infants and children
- LONG-TERM MONITORING
- Eye disease
- Cardiac disease
- Endocrine disease
- Immune deficiency
- Prevention of transmission
- - Child care
- - Hospitalized patients
- SUMMARY AND RECOMMENDATIONS