Congenital rubella syndrome

In the congenital rubella syndrome is a prenatal injury to the child in the womb due to an infection of pregnant women with rubella virus. The rubella virus passes through the placenta to the unborn child and leads during embryonic or fetal development leads to damage to the inner ear, heart, eye, and other organs. Disability, premature birth or miscarriage are the result. Vaccination before pregnancy prevents congenital rubella syndrome.

The Australian ophthalmologist Sir Norman McAlister Gregg (1892-1966) described the first time in 1941, a malformation syndrome in the newborn, which, he realized, was due to a rubella infection of the mother during pregnancy. Named after him Gregg 's syndrome is also called embryopathia rubeolosa.

Cause and infection

Does the pregnant woman no immunity (eg vaccination ) against rubella, it can come to rubella infection during pregnancy. In a prenatal rubella infection, the pathogen is transmitted to the embryo or fetus during maternal diseases through the placenta ( placenta ). In the first eight weeks of pregnancy, rubella infection results in 90 % of cases of damage to the embryo. With the pregnancy progresses, the risk in the middle third of pregnancy drops to 25-30 %.

Symptoms

Possible consequences of the unborn child infection are spontaneous abortion, premature birth or the classic combination of malformations in the form of heart defects ( patent ductus arteriosus, septal defects and tetralogy of Fallot ), clouding of the lens of the eye (cataract ) and sensorineural hearing loss. This full-screen, which is also called Gregg 's syndrome, results from rubella infection in the fourth week of pregnancy, whereas an infection in the 20th week of pregnancy may only triggers an isolated deafness. Further suitable lesions are low birth weight, bleeding tendency due to decreased platelet counts ( thrombocytopenic purpura), Enzephalomeningitis, liver inflammation, enlargement of liver and spleen, heart muscle inflammation ( myocarditis) or reduced head size ( microcephaly ). Therefore, the study belongs to rubella for maternity services

Dissemination

In Germany in 1998 was the number of seronegative women aged 18-30 years, 0.8 to 3 %, so that an average of 700,000 births per year up to 20,000 newborns are vulnerable to prenatal rubella infection. In contrast, in the years 1999 and 2000 only four or five cases were reported by connataler rubella infection in the years 2010 and 2011 no more. However, the RKI is based on a substantial sub- version.

Diagnostics

As an unprotected pregnant women can infect a person with rubella four to seven days before onset of rash, it is still one of primary infection with rubella during pregnancy. In questionable or backed rubella infection of a pregnant woman, prenatal diagnosis by chorionic villus sampling, amniocentesis, or from the 22nd week of pregnancy Nabelblutuntersuchg is possible. After birth in newborns with congenital rubella syndrome itself formed IgM antibodies and also largely derived from the parent IgG antibodies are present. IgM antibodies can not be transferred to the child through the placenta from the mother, they are therefore always an expression of congenital infection ( offspring are born infected and have even formed antibodies). In the blood of newborns viruses are present, the children are so contagious.

Prevention

Regardless of the desire for children recommends the Standing Committee on Vaccination vaccination for all unvaccinated women of childbearing age and those with unclear vaccination, for those with only one-dose vaccination and to all persons without vaccination or with unclear vaccination status, or into pediatrics, obstetrics and prenatal care are employed in community facilities. Often, the pregnancy is not planned. As part of the maternity services rubella antibodies are determined for all pregnant women. Titers of 1:8 and 1:16 are considered as marginal, at 1:32 or later one takes a sufficient protection. By modern analytical methods titer is now replaced, for example, by a quantitative ELISA - result or hemolysis in the gel test (HIG ) which indicates a sufficient immunity in positivity. If there are no antibodies detectable ( = seronegative ), the expectant mother should have no contact with rubella- infected individuals. If a pregnant woman, on which sufficient rubella immunity is proved or is not vaccinated, come with rubella in contact, to be performed at her as well as for the possible source of infection immediately antibody determination. For the expectant mother of proven infection they should be educated about the risk of miscarriage, stillbirth and malformations of up to 85 %.

Treatment

Since the underlying cause is a viral infection and the damage caused in the womb, a causal therapy is not possible. It can only use the existing symptoms are alleviated in terms of symptomatic therapy. Existing hearing should be supervised by a pediatric audiologist and optionally supplied with hearing aids. A cataract can be treated surgically by a lens replacement. Likewise, heart defects may need to be surgically corrected. Of crucial importance is the comprehensive neurodevelopmental follow-up and promotion, for example, in a social pediatric center.