Congenital Rubella Syndrome (CRS)

[Guest guest]

Congenital Rubella Syndrome (CRS)

Sheri Nakken (from my online class)

1. There is a difference between:

a. Exposure to Rubella

b. Infant with Rubella infection in utero and after birth

c. And Infant with Congenital Rubella Syndrome (with birth defects)

2. Also Congenital Rubella Infection and

Congenital Rubella Syndrome can follow vaccination of mother

3. Many babies are NOT damaged in utero even if

mother has rubella - why is that?

explored some of that in an article I will send. No one looks at that issue.

4. There is a huge variation in the literature

about risk and statistics. Its really hard to know if accurate.

5. Many other viruses & toxins can cause similar

defects - also noted in 's article

6. Are we causing a form of Congenital Rubella

Syndrome with the autism we are seeing?

*****

You will see a huge variation in numbers for risk............

" in the first 8-10 weeks - fetal damage in up to

90% of infants and multiple defects are common (1) "

" risk of fetal damage declines to 10-20% by 16 weeks (1) "

OR

" " The child has a 50% risk of being born with the

congenital rubella syndrome, if the mother is

infected with rubella in the first trimester (the

first third) of pregnancy. Risks still exist with

infection in the second trimester " "

OR

" Maternal infection during the first 8 weeks of

pregnancy results in an infection rate in the

fetus of about 50%. Subsequently the rate of

transmission drops sharply to less than 10% by

the 16th week of pregnancy. The proportion of

infected fetuses with damage due to Rubella

follows a similar pattern. With maternal Rubella

at 8, 12, 13 to 20, and over 20 weeks of

pregnancy, 85%, 50%, 15%, and 0% (respectively)

of infected live-born infants will have

Rubella-caused defects at birth or during early childhood. "

The first one above makes it sound like 90% of infants exposed have defects

So the last one above is saying that infection of

mother in first 8 weeks results in infection of

infant in 50% of cases and 85% of those will have

Rubella-caused defects. (Equals 42.5%)

*********

Summary of below 2 abstracts....

34 pregnant women thought to have rubella.

8 fetuses were found to have the rubella virus

(no mention of damage) (23.5%) -

6 were aborted & fetal tissue contained rubella

- no mention of damage - would they have had?

2 delivered and no evidence of damage

Remaining 26 cases - 24 healthy babies; 1

abortion; 1 died in 36th week of pregnancy of unknown causes

(2nd article says 2 died of other causes)

SO we have NO damaage reported in above (small)

study.......we don't know about the 6 who chose abortion.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=8\

623788 & dopt=Abstract

Am J Obstet Gynecol. 1996 Feb;174(2):578-82. Related Articles, Links

Diagnosis of fetal rubella infection with reverse

transcription and nested polymerase chain

reaction: a study of 34 cases diagnosed in fetuses.

Tanemura M, Suzumori K, Yagami Y, Katow S.

Department of Obstetrics and Gynecology, Nagoya City University, Nagoya, Japan.

OBJECTIVE: Our purpose was to develop a reliable

method for prenatal diagnosis of fetal rubella

infection through the detection of viral

ribonucleic acid extracted from the chorionic

villi, amniotic fluid, or fetal blood in pregnant women.

STUDY DESIGN: Double amplification of rubella

viral ribonucleic acid by nested polymerase chain

reaction after reverse transcription was applied

to samples from 34 women suspected of having

rubella. The results were compared with those of

serum antibody and levels of rubella

virus-specific immunoglobulin M antibodies in fetal blood.

RESULTS: Viral ribonucleic acid was revealed in 8

of 34 cases (23.5%). In the remaining 26 cases,

healthy babies were born in 24, 1 was electively

aborted, and 1 died in the thirty-sixth week of pregnancy of unknown causes.

CONCLUSIONS: This method allowed very early

detection of fetal rubella infection by sampling

of chorionic villi and amniotic fluid compared

with evaluation of the maternal symptoms and

serum antibody levels. Fetal blood was also more

useful for making a diagnosis up to the twentieth

week of pregnancy than was measuring rubella

virus-specific immunoglobulin M antibodies.

PMID: 8623788 [PubMed - indexed for MEDLINE] ]

ANOTHER VERSION Of above - not sure why SO different

Source: American Journal of Obstetrics and Gynecology, Feb 1996 v174 n2p578(5).

Title: Diagnosis of fetal rubella infection with

reverse transcription and nested polymerase chain

reaction: a study of 34 cases diagnosed in

fetuses. Author: Mitsuyo Tanemura, Kaoru

Suzumori, Yoshiaki Yagami and Shigetaka Katow

Abstract: Evidence of transmission of the rubella

virus from pregnant women to their fetuses may be

found by analyzing samples of the placenta and

amniotic fluid. Fetuses that contract rubella may

be born with cataracts, heart defects, or

deafness. Researchers analyzed samples of

placenta, amniotic fluid and fetal blood for the

presence of the rubella virus from 34 pregnant

women thought to have rubella. Eight fetuses were

found to have the rubella virus. Six mothers

chose to have their fetuses aborted, and fetal

tissue from three of these contained rubella. The

other two fetuses were born at term with no

evident defects. Twenty-four of the remaining 26

fetuses were born at term in good health. The

other two died from other causes. Analysis of

placenta and amniotic fluid may identify

persistent rubella infection in high risk fetuses.

**********

http://www.orpha.net/data/patho/GB/uk-rubella.pdf

Abstract

Congenital rubella syndrome is a group of

physical abnormalities that have developed in an

infant as a result of maternal infection and

subsequent fetal infection with rubella virus.The

main defects caused by rubella infection are:

sensorineural deafness, which can progress after

birth; eye defects such as cataracts;

cardiovascular defects; brain damage, that only

occurs after infection between the 3rd and 16th

week of gestation, causing mild to severe mental

retardation with microcephaly and spastic

diplegia; major structural malformations are

rare. In France, systematic vaccination of male

and female newborns was introduced in 1985 and

induced a marked reduction in the incidence of

CRS, reaching less than 3 cases in 100,000

livebirths in 2002. The prenatal diagnosis of

fetal infection is done on rubella contact

counting with or without eruptive disease,

associated with identification of the virus by

gene amplification on amniotic fluid, or with a

significant rate of IgM in fetal blood (fetal

blood sampling can only be performed after 22 weeks of gestation).

[..]

" Long-term follow-up of newborn (Forrest et al.

2002) with CRS s has revealed that they are at

increased risk of late onset chronic diseases

such as insulin-dependent diabetes (risk 50 times

higher than that in the general population),

thyroid dysfunction, digestive disturbances, and

a rare neuro-degenerative disorder called

panencephalitis. These conditions may result from

ongoing viral infection, or autoimmune response. "

[sOUNDS A LOT LIKE WHAT WE ARE SEEING NOW WITH

INCREASE IN DIABETES, THYROID PROBLEMS AND AUTISM

WITH DIGESTIVE DISTURBANCES AND

PANENCEPHALITIS..............THE VACCINE COULD

CAUSE THE SAME IN A CHILD AS THE DISEASE

RUBELLA.......ARE AUTISM AND THE ABOVE FROM

MOTHERS WHO GOT RUBELLA VACCINE? WE'LL TALK

ABOUT THIS WHEN WE TALK ABOUT THE VACCINE........SHERI]

********

http://www.medterms.com/script/main/art.asp?articlekey=16074

" The child has a 50% risk of being born with the

congenital rubella syndrome, if the mother is

infected with rubella in the first trimester (the

first third) of pregnancy. Risks still exist with

infection in the second trimester "

Congenital rubella syndrome: The constellation of

abnormalities caused by infection with the

rubella (German measles) virus before birth. The

syndrome is characterized by multiple congenital

malformations (birth defects) and mental retardation.

The individual features of the syndrome include

growth retardation, microcephaly (abnormally

small head), cataracts, glaucoma, microphthalmia

(abnormally small eyes), cardiovascular

malformations, hearing loss, and mental

retardation. Deafness is common. After birth the

child may develop diabetes due to gradual

destruction of the pancreas by the rubella virus.

The child has a 50% risk of being born with the

congenital rubella syndrome, if the mother is

infected with rubella in the first trimester (the

first third) of pregnancy. Risks still exist with

infection in the second trimester

The discovery of the congenital rubella syndrome

by the Australian ophthalmologist (eye doctor) NM

Gregg in 1941 is of historic importance. It

provided the first evidence that the placental

barrier between the mother and the fetus does not

fully protect the fetus from teratogens (agents that can cause birth defects).

The rubella epidemic of 1963-1965 resulted in

1,800,000 infected individuals, approximately

20,000 fetal deaths and about 30,000 infants born

with congenital rubella syndrome. Since the

introduction of the rubella vaccine in 1969 there

are less than 120 cases of congenital rubella syndrome reported each year.

The condition also goes by the name of fetal rubella effects.

*******************

" in the first 8-10 weeks - fetal damage in up to

90% of infants and multiple defects are common (1) "

" isk of fetal damage declines to 10-20% by 16 weeks (1) "

http://www.gpnotebook.co.uk/cache/-1758134268.htm

congenital rubella syndrome

This is a condition that appears in the neonate

as a result of rubella infection of the mother.

The risk of developing CRS depends on the length of the pregnancy:

in the first 8-10 weeks - fetal damage in up to

90% of infants and multiple defects are common (1)

risk of fetal damage declines to 10-20% by 16 weeks (1)

fetal damage as a result of maternal rubella

infection is rare after 16 weeks gestation

The occurrence of the rash associated with

rubella infection is a variable feature.

Often, rubella infection of the mother causes

spontaneous abortion or causes serious damage to

the surviving foetus - characterised by deafness, blindness and heart defects.

The viraemia may persist throughout pregnancy and

the infant may continue to excrete virus for many

years after birth. The disease process continues

during the period of virus excretion.

Congenital rubella has been reported after cases

of rubella re-infection during pregnancy. Rubella

re-infection can occur in individuals with both

natural and vaccine-induced antibody.

*********

http://www.deafblind.com/crs.html

The most common congenital defects are cataracts,

heart disease, sensorineural deafness, and mental retardation.

III. Importance of rapid case identification

Infants with CRS should be identified as early in

life as possible in order to prevent further

spread of the virus. Additionally, early

diagnosis will facilitate early intervention for

specific disabilities. Infants with CRS may shed

virus for a prolonged period and should be

considered infectious until they are at least 1

year old or until their urine and pharyngeal

viral cultures, taken every month, are repeatedly negative for rubella.

Clinical description

An illness, usually manifesting in infancy,

resulting from rubella infection in utero and

characterized by signs or symptoms from the following categories:

Cataracts/congenital glaucoma, congenital heart

disease (most commonly patent ductus arteriosus

or peripheral pulmonary artery stenosis), loss of

hearing, pigmentary retinopathy.

Purpura, splenomegaly, jaundice, microcephaly,

mental retardation, meningoencephalitis, radiolucent bone disease.

Clinical case definition

Presence of any defects or laboratory data

consistent with congenital rubella infection.

Laboratory criteria for diagnosis

Isolation of rubella virus, or

Demonstration of rubella-specific immunoglobulin M (IgM) antibody, or

Infant rubella antibody level that persists at a

higher level and for a longer period than

expected from passive transfer of maternal

antibody (i.e., rubella titer that does not drop

at the expected rate of a twofold dilution per month).

Case classification

Suspected: A case with some compatible clinical

findings but not meeting the criteria for a probable case.

Probable: A case that is not laboratory confirmed

and that has any two complications listed in

first paragraph of the clinical description or

one complication from first paragraph and one

from second paragraph, and lacks evidence of any other etiology.

Confirmed: A clinically compatible case that is laboratory confirmed.

Infection only: A case that demonstrates

laboratory evidence of infection, but without any clinical symptoms or signs.

Note: In probable cases, either or both of the

eye-related findings (cataracts and congenital

glaucoma) count as a single complication. In

cases classified as infection only, if any

compatible signs or symptoms (e.g., hearing loss)

are identified later, the case is reclassified as confirmed.

Indigenous case. Any case which cannot be proved to be imported.

Imported case. A case which has its source outside the reporting state.

International. Defined as CRS in a U.S. or

non-U.S. citizen whose mother was outside the

United States for the entire period when she may

have had exposure to rubella ( 21 days before

conception and during the first 20 weeks of

gestation), or who has known exposure to risks outside the United States.

Importation from another state. This

classification requires documentation that the

mother either had face-to-face contact with a

case of rubella outside the state, or was out of

state for the entire period when she might have

become infected (14-23 days before rash onset or

21 days before conception and during the first 20 weeks of gestation).

VII. Laboratory Testing

Laboratory confirmation can be obtained by any of the following:

Demonstration of rubella-specific IgM antibodies

in the infant's cord blood or sera. In infants

with CRS, IgM antibody persists for at least 6-12 months;

Documentation of persistence of serum rubella IgG

titer beyond the time expected from passive transfer of maternal IgG antibody;

Isolation of the virus, which may be shed from

the throat and urine for a year or longer; or

Detection of rubella virus by polymerase chain reaction (PCR)

For additional information on use of laboratory

testing in surveillance of vaccine-preventable diseases, see Chapter 19.

Serologic testing

The serologic tests available for laboratory

confirmation of CRS infections vary among

laboratories. The following tests are widely

available and may be used for screening for

laboratory confirmation of disease. The state

health department can provide guidance on

available laboratory services and preferred tests.

Enzyme immunoassays (EIA). EIA is sensitive,

widely available, and relatively easy to perform.

It can also be modified to measure IgM

antibodies. Most of the diagnostic testing done

for rubella antibodies uses some variation of the EIA.

Immunofluorescent antibody assays (IFA). IFA is a

rapid and sensitive assay. Commercial assays for

both IgG and IgM are available in the United

States. Care must be taken with the IgM assay to

avoid false-positive results due to complexes with rheumatoid antibody.

Virus isolation

Rubella virus can be isolated from nasal, blood,

throat, urine, and cerebrospinal fluid specimens

from rubella and CRS cases. Efforts should be

made to obtain clinical specimens (particularly

pharyngeal swabs and urine specimens) for viral

isolation from infants at the time of the initial

investigation (Appendix 5). However, infants with

CRS may shed virus for a prolonged period so

specimens obtained later may also yield rubella

virus. Specimens for virus isolation (urine

specimens and pharyngeal swabs) should be

obtained monthly until cultures are repeatedly negative.

Virus isolates are extremely important for

molecular epidemiologic surveillance to help

determine 1) the origin of the virus, 2) virus

strains circulating in the U.S., and 3) whether

these strains have become endemic in the U.S.5

Specimens for virus isolation should be sent to

CDC for molecular typing as directed by the state health department.

Polymerase chain reaction (PCR)

Although detection of rubella virus by PCR is not

included as confirmatory in the case definition,

the test does provide presumption evidence of

rubella infection. In the United Kingdom, there

has been extensive evaluation of PCR for

detection of rubella virus in clinical specimens,

documenting its usefulness. 6,7 Clinical

specimens obtained for virus isolation and sent

to CDC are routinely screened by PCR. Further

validation is needed of classification of cases

that test positive by PCR in the absence of virus isolation.

VIII. Reporting

Each state and territory has regulations and/or

laws governing the reporting of diseases and

conditions of public health importance (Appendix

2).8 These regulations/laws list the diseases

which are to be reported, and describe those

persons or groups who are responsible for

reporting, such as health care providers,

hospitals, laboratories, schools, day care

facilities, and other institutions. Contact your

state health department for reporting requirements in your state.

Reporting to CDC

Provisional reports of rubella and CRS cases

should be sent by the state health department to

CDC via the National Electronic

Telecommunications System for Surveillance

(NETSS) within 14 days of the initial report to

the state or local health department. Reporting

should not be delayed because of incomplete

information or lack of confirmation.

In addition, each possible and confirmed case of

CRS should be reported to the National Congenital

Rubella Syndrome Registry (NCRSR), National

Immunization Program (NIP), CDC. The NCRSR case

report form (Appendix 17) is used to collect

clinical and laboratory information on cases of

CRS that are reported by state and local health

departments. NCRSR cases are classified by year

of patient's birth. Although case report forms

should be as complete as possible before case

reporting, lack of complete information should not delay the reporting.

Information to collect

The following data are epidemiologically

important and should be collected in the course

of case investigation. Additional information may

also be collected at the direction of the state health department.

Demographic information

Maternal history including

--Date of rubella vaccination(s)

--Dates and results of previous serologic tests for rubella immunity

--History or documentation of rubella infection during pregnancy

--If possible, country of birth

Clinical details (e.g., cataracts, hearing loss,

mental retardation, type of congenital heart

defect, meningoencephalitis, microcephaly)

Laboratory information including types and

results of laboratory testing performed on both mother and child

IX. Vaccination

Although use of rubella vaccine is

contraindicated in pregnant women or women

planning pregnancy within 3 months, inadvertent

administration of the vaccine to pregnant women

does occur. In order to evaluate the risk to the

fetus of exposure to attenuated rubella vaccine

virus, a pregnancy registry was established. By

April 1989 when the registry was discontinued,

vaccination of 700 women with the RA 27/3 rubella

vaccine within 3 months of conception was

reported. Among the 289 women who were known to

be susceptible at the time of vaccination,

outcomes of pregnancy are known for 275 (94%);

83% delivered living infants, all 229 of whom

were free of defects associated with CRS.

Rubella-specific IgM was detected in three

infants, but all three were normal on physical

examination. These data are consistent with

results reported from other countries, suggesting

that if live attenuated rubella vaccine causes

defects associated with CRS, it does so at a very low rate (<1.6%).

X. Enhancing Surveillance

The following activities may be undertaken to

improve the detection and reporting of cases, and

to improve the comprehensiveness and quality of

surveillance for rubella and CRS. Additional

guidelines for enhancing surveillance are given in Chapter 16.

Active surveillance. Following an outbreak of

rubella, an active surveillance system for CRS

should be established among health care

providers, clinics, and hospitals in the outbreak

area beginning 6-9 months after the rubella outbreak.

Searching laboratory records. Audits of

laboratory records may provide reliable evidence

of previously unreported serologically confirmed

or culture-confirmed cases of congenital rubella

syndrome. Infants with CRS have been identified

by including the serological results for TORCH

agents in audits of laboratory records.

Comparing other data sets. Birth defects

registries may reveal unreported CRS cases.(1)Ç

rubella syndrome, 1980-1990. Epidemiol Rev 1991;13:341-8.

3. CDC. Rubella and congenital rubella syndrome -

United States, 1994-1997. MMWR 1997;46:350-4.

4. CDC. Case definitions for infectious

conditions under public health surveillance. MMWR 1997;46(RR-10):30.

5. Frey TK, Abernathy ES. Identification of

strain-specific nucleotide sequences in the RA

27/3 rubella virus vaccine. J Infect Dis 1993;168:854-64.

6. Bosma TJ, Corbett KM, O'Shea S, Banatvala JE,

Best JM. PCR for detection of rubella virus RNA

in clinical samples. J Clin Micro 1995;33:1075-9.

7. Bosma TJ, Corbett KM, Eckstein MB, O'Shea S,

Vijayalakshmi P, Banatvala JE, Morton K, Best JM.

Use of PCR for prenatal and postnatal diagnosis

of congenital rubella. J Clin Micro 1995;33:2881-7.

8. CDC. Mandatory reporting of infectious

diseases by clinicians. MMWR 1990;39(RR-9):1-17.

9. Garner JS. Guideline for isolation precautions

in hospitals. The Hospital Infection Control

Practices Advisory Committee. Infect Cont Hosp Epid 1996;17:53-80.

10. Greaves WL, Orenstein WA, Stetler HC, et al.

Prevention of rubella transmission in medical facilities. JAMA 1982;248:861-4.

*******

Rubella, Congenital

Synonyms

Congenital German Measles

Congenital Rubella Syndrome

Expanded Rubella Syndrome

Disorder Subdivisions

None

Related Disorders List

None

General Discussion

Congenital Rubella is a syndrome that occurs when

a fetus has been infected with the Rubella virus

while in the uterus. It is primarily

characterized by abnormalities of the

cardiovascular system, the eyes and the ears.

Women who contract Rubella during pregnancy have

a high risk of having a baby with Congenital Rubella.

Symptoms

As many as two thirds of infants with Congenital

Rubella will be free of any abnormality at birth.

The classic Congenital Rubella syndrome has been

characterized by the combination of heart, eye

and hearing defects, although infection and

damage can occur in almost every organ system. Of

the abnormalities most likely to be present at

birth, cardiovascular defects are most common,

such as underdevelopment (hypoplasia) of the

pulmonary artery and the failure of closure of a

duct connecting the pulmonary artery and aorta

(patent ductus arteriosus). Low birth weight,

inflammation of the bones (osteitis), enlarged

liver and spleen (hepatosplenomegaly), disease of

the retina (retinopathy), and cataracts of the

crystalline lens of the eye also occur

frequently. Brain infection (encephalitis), an

abnormally small head (microcephaly), swollen

lymph glands (adenopathy), inflammation of the

lungs (pneumonitis), jaundice, reduced number of

blood platelets (thrombocytopenia), pinpoint

purplish red spots due to bleeding in the skin

(petechiae) or purpura, and anemia may also occur

in babies with Congenital Rubella.

Congenital Rubella can be viewed as a chronic

infection capable of producing progressive

damage. Central nervous system abnormalities such

as hearing loss, mental retardation, behavior

problems and slowness in muscular development,

are the frequent and significant clinical problems.

Most patients who are symptomatic, and many of

those who lack signs of infection at birth, will

develop some degree of hearing loss or

psychomotor damage during early childhood.

Causes

Congenital Rubella can affect a fetus when a

pregnant woman who is not immune to the virus

contracts Rubella (German Measles). The baby may

also be affected if the mother contracts Rubella immediately before conception.

Affected Populations

Congenital Rubella is found in newborns and

infants of mothers who were infected with Rubella

immediately before or during the early months of

pregnancy. The frequency of Congenital Rubella

thus depends upon the number of women of

childbearing age who are susceptible to the

virus, and the frequency of Rubella infection in

the community. Before the development of Rubella

virus vaccine, epidemics of Rubella and

Congenital Rubella occurred about every 6 to 9

years. During epidemic years Congenital Rubella

infection was found (using serologic testing to

identify nonsymptomatic cases) in as many as 2%

of newborns; the rate of its presence at other

times (the endemic rate) is 0.1%. Widespread use

of Rubella vaccine in the United States has

eliminated epidemics, but the endemic rate of

congenital infection appears to be about the same.

Both the chance of transmission of Rubella to the

fetus during pregnancy and the consequences of

the infection to the unborn baby are related to

the stage of development of the fetus at the time

of maternal infection. Maternal infection during

the first 8 weeks of pregnancy results in an

infection rate in the fetus of about 50%.

Subsequently the rate of transmission drops

sharply to less than 10% by the 16th week of

pregnancy. The proportion of infected fetuses

with damage due to Rubella follows a similar

pattern. With maternal Rubella at 8, 12, 13 to

20, and over 20 weeks of pregnancy, 85%, 50%,

15%, and 0% (respectively) of infected live-born

infants will have Rubella-caused defects at birth or during early childhood.

Standard Therapies

There is no treatment for maternal or Congenital

Rubella infection. Therefore, prevention assumes

paramount importance. It is most important to

immunize all children with the goal of preventing

epidemics. Children should receive Rubella

immunization at 15 months of age, along with

mumps and measles in a combined vaccine. Many

authorities now recommend that a repeat Rubella

immunization be given to 10-year-olds, because

vaccine-induced immunity may not persist as long

as naturally acquired immunity.

Women of childbearing age who are susceptible to

Rubella (a serum test can establish the presence

of the Rubella-antibody in their blood) should

also be vaccinated. Care should be taken that

they should not conceive for at least three months following the vaccination.

References

RUBELLA; Public Health Education Information

Sheet: March of Dimes Birth Defects Foundation, 1984.

*******

Here they recommend termination for every fetal

infection detected (we don't even know if damage done)

http://www.thefetus.net/page.php?id=152

Management: Termination of pregnancy should be

considered every time fetal infection is detected

during the first trimester, due to the severity

of the condition in this group. After viability,

monthly sonographic monitoring for growth and

follow up of the anomalies is recommended. PCR on

amniotic fluid or fetal blood is indicated if a

seroversion occurs before 18 weeks gestation.

Therapeutic termination of pregnancy should be

proposed if fetal infection is confirmed during

the first and early second trimesters due to the

severity of the condition in this group. After 18

weeks gestation, there is nearly no risk for the

fetus: invasive procedures for antenatal

diagnostic are not required and ultrasound surveillance is sufficient[6].

*******

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5012a1.htm

http://www.cdc.gov/nip/publications/pink/rubella.pdf

[..]

CONGENITAL RUBELLA SYNDROME (CRS)

Prevention of CRS is the main objective of

rubella vaccination programs in the United States.

A rubella epidemic in the United States in

1964­1965 resulted in 12.5 million cases of

rubella infection and about 20,000 newborns

with CRS. The estimated cost of the epidemic was

$840 million. This does not include the emotional

toll on the families involved.

The estimated lifetime cost of one case of CRS

today is estimated to be in excess of $200,000.

Infection with rubella virus can be disastrous in

early gestation.The virus may affect all organs

and cause a variety of congenital defects.

Infection may lead to fetal death, spontaneous

abortion, or premature delivery. The severity of

the effects of rubella virus on the fetus depends

largely on the time of gestation at which

infection occurs. Up to 85% of infants infected

in the first trimester of pregnancy will be found

to be affected if followed after birth. While

fetal infection may occur throughout pregnancy,

defects are rare when infection occurs after the

20th week of gestation. The overall risk of

defects during the third trimester is probably no

greater than that associated with uncomplicated

pregnancies. Congenital infection with rubella

virus can affect virtually all organ systems.

Deafness is the most common and often the sole

manifestation of congenital rubella infection,

especially after the 4th month of gestation. Eye

defects, including cataracts, glaucoma,

retinopathy, and microphthalmia may occur.

Cardiac defects such as patent ductus arteriosus,

ventricular septal defect, pulmonic stenosis, and

coarctation of the aorta are possible. Neurologic

abnormalities, including microcephaly and mental

retardation, and other abnormalities, including

bone lesions, splenomegaly, hepatitis, and

thrombocytopenia with purpura may occur.

Manifestations of CRS may be delayed from 2­4

years. Diabetes mellitus appearing in later

childhood occurs frequently in children

with CRS. In addition, progressive encephalopathy

resembling subacute sclerosing panencephalitis (SSPE) has been observed in

some older children with CRS [interesting as I

have never heard this.....only hear them

associating this with measles virus (and they

have NO PROOF that it is due to measles virus or

rubella virus......Sheri] infants with CRS may

have low hemagglutination inhibition (HI) titers,

but may have high titers of neutralizing antibody

that may persist for years. Reinfection may

occur. Impaired cell-mediated immunity has been

demonstrated in some children with CRS.12

[..]

CLINICAL CASE DEFINITION OF CONGENITAL RUBELLA SYNDROME (CRS)

The clinical case definition of CRS is an

illness, usually manifesting in infancy,

resulting from rubella infection in utero and

characterized by symptoms from the following

categories: (A) Cataracts, congenital glaucoma, congenital heart disease (most

commonly patent ductus arteriosus or peripheral

pulmonary artery stenosis), loss of hearing, pigmentary retinopathy

( Purpura, hepatosplenomegaly, jaundice,

microcephaly, developmental delay, meningoencephalitis, radiolucent bone

disease.

CASE CLASSIFICATION OF CONGENITAL RUBELLA SYNDROME

An infection-only case is one with laboratory

evidence of infection, but without any clinical symptoms or signs.

A suspected case has some compatible clinical

findings, but does not meet the criteria for a probable case.

A probable case is one that is not laboratory

confirmed, has any two complications listed in

(A) above or one complication from (A) and

one from (, and lacks evidence of any other etiology.

A confirmed case is a clinically consistent case that is laboratory confirmed.

In probable cases, either or both of the

eye-related findings (cataracts and congenital

glaucoma) count as a single complication. In

cases classified as infection only, if any

compatible signs or symptoms (e.g., hearing loss)

are identified later, the case is reclassified as confirmed.

********

Again........

1. There is a difference between:

a. Exposure to Rubella

b. Infant with Rubella infection in utero and after birth

c. And Infant with Congenital Rubella Syndrome (with birth defects)

2. Also Congenital Rubella Infection and

Congenital Rubella Syndrome can follow vaccination of mother

3. Many babies are NOT damaged in utero even if

mother has rubella - why is that?

explored some of that in the article I sent

Lesson 5A, Part 3B. No one looks at that issue.

4. There is a huge variation in the literature

about risk and statistics. Its really hard to know if accurate.

5. Many other viruses & toxins can cause similar

defects - also noted in 's article

6. Are we causing a form of Congenital Rubella

Syndrome with the autism we are seeing?