Congenital Rubella Syndrome (CRS)

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Organism
Rubella virus, which is in the family togaviridae. 

Transmission 
Congenital rubella syndrome (CRS) is a condition that occurs in a developing baby in the womb of a mother who is infected with the rubella virus. 

Incubation Period 
Congenital Rubella Syndrome is contracted during pregnancy. 

Communicability 
Infants with CRS can shed the virus in the nasopharyngeal secretions and urine for up to a year or longer. Rubella virus has been recovered from the lens of children with CRS who have congenital cataracts for up to several years. Therefore, it is essential that infected infants be identified as early in life as possible in order to prevent further spread of the virus. 

Infected infants should be considered infectious until they are at least 1-year-old or until two cultures of clinical specimens obtained 1 month apart after the infant is older than 3 months of age are negative for rubella virus.

Symptoms
Pregnant women who contract rubella are at risk for miscarriage or stillbirth, and their developing babies are at risk for severe birth defects with devastating, lifelong consequences. CRS can affect almost everything in the developing baby’s body.

In mild forms of CRS, there may be no obvious clinical manifestations at birth, and the onset of CRS-related symptoms can be delayed until 2-4 years. 

The severity of effects on the fetus depends on the period of gestation at which the infection occurs. A fetus infected early in the pregnancy (especially during the first trimester) has a high probability of developing CRS. In symptomatic women infected with rubella during the first 12 weeks (first trimester) of pregnancy, CRS-associated congenital defects occur in up to 85% of infants. The likelihood of congenital defects decreases if the woman’s rubella infection occurs later in the gestational period, dropping to 25% when the woman has a rubella infection late in the second trimester.

The most common birth defects from CRS can include:
•Deafness
•Cataracts
•Heart defects
•Intellectual disabilities
•Liver and spleen damage
•Low birth weight
•Skin rash at birth

Less common complications from CRS can include:
•Glaucoma
•Brain damage
•Thyroid and other hormone problems
•Inflammation of the lungs

Although specific symptoms can be treated, there is no cure for CRS. Since there is no cure, it is important for women to get vaccinated before they get pregnant.

Prevention and Vaccination 
Women who are considering pregnancy should ensure they are up to date with the MMR vaccine to prevent Congenital Rubella Syndrome. If they are not vaccinated they should be vaccinated prior to becoming pregnant.

Because MMR vaccine is an attenuated (weakened) live virus vaccine, pregnant women who are not vaccinated should wait to get MMR vaccine until after they have given birth. Adult women of childbearing age should avoid getting pregnant for at least four weeks after receiving MMR vaccine. Pregnant women should NOT get MMR vaccine.

Prenatal care usually includes testing to ensure the mother is immune to rubella. If a pregnant woman thinks she might have rubella or is exposed to someone with rubella, she should contact her physician immediately for follow up.

There is no treatment for rubella, however it can be prevented by the measles mumps rubella (MMR) vaccine. That vaccine is currently required for school entry in the state of Texas. Children may also get the MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox).

School Exclusion Policy
Infected infants should be considered infectious until they are at least 1-year-old or until two cultures of clinical specimens obtained 1 month apart after the infant is older than 3 months of age are negative for rubella virus. 

Texas Trends
Although rubella was declared eliminated from the U.S. in 2004, cases can occur when unvaccinated people are exposed to infected people, mostly through international travel. In 2017, Texas had two imported cases of congenital rubella syndrome. These are the first reported cases of congenital rubella syndrome in Texas since 1998, and there have been no reported cases in Texas since.