Congenital Rubella Syndrome (CRS)

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. 

Congenital Rubella Syndrome is contracted during pregnancy. 

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.

Pregnant women who contract rubella are at risk for miscarriage or stillbirth. Their developing babies are also 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. Women showing rubella symptoms during their first 12 weeks (first trimester), are at risk for CRS congenital defects. This occurs in up to 85% of infants. The likelihood of congenital defects decreases if the woman’s rubella infection occurs later in the pregnancy. The percentage drops 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.

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 before becoming pregnant.

The MMR vaccine is an attenuated (weakened) live virus vaccine. Pregnant women who are not vaccinated should wait to get the 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 healthcare provider 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).

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. 

Rubella was declared eliminated from the U.S. in 2004, but cases can occur when unvaccinated people are exposed to infected people. This mostly occurs 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.

• CDC Pink Book Rubella Vaccine (MMR) 
  • Center for Disease Control and Prevention’s (CDC) Rubella Vaccine Chapter within the Pink Book

• For Healthcare Professionals
  • Rubella Vaccine (MMR) information for healthcare professionals on the CDC website
  • MMRV vaccine 
     
• For the Public
  • Rubella Vaccine (MMR) information for the public FAQs on the CDC website
  • MMRV Vaccine
     
• ACIP Recommendations: Measles, Mumps and Rubella (MMR) Vaccine | ACIP Recommendations | CDC
  • Most recent articles and recommendations for rubella vaccination (MMR) from the Advisory Committee on Immunization Practices.
     
• ACIP Recommendations: Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine | ACIP Recommendations | CDC
  • Most recent articles and recommendations for rubella vaccination (MMRV) from the Advisory Committee on Immunization Practices.

• Vaccine-Preventable Disease Investigation
• Vaccine Preventable Disease Reporting
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