RUBELLA: Rubella or German measles (RNA virus) is transmitted by respiratory droplet

exposure. Maternal Rubella infection is manifested by rash, malaise, fever, lymphadenopathy

and polyarthritis. Fetal infection is by transplacental route throughout pregnancy. Risk of
major anomalies when this infection occurs in first, second and third month is approximately
60%, 25% and 10%, respectively. Multisystem abnormalities are seen following congenital
rubella infection. Congenital rubella syndrome (CRS) predominantly include cochlear
(sensorineural deafness), cardiac (septal defects, PDA), hematologic (anemia,
thrombocytopenia), liver and spleen (enlargement, jaundice), ophthalmic (cataracts,
retinopathy, cloudy cornea), bone (osteopathy) and chromosomal abnormalities. The virus
predominantly affects the fetus and is extremely teratogenic if contracted within the first
trimester. There is increased chance of abortion, stillbirth and congenitally malformed baby.
Infants born with congenital rubella shed the virus for many months and is a source of
infection to others. Test for rubella specific antibody (IgM) should be done within 10 days of
the exposure to know whether the patient is immune or not. Rubella specific IgG antibodies
are present for life after natural infection or vaccination. If the patient is not immune,
question of therapeutic termination should be seriously considered. Detection of viral
RNA by PCR is possible. Prenatal diagnosis of rubella virus infection using PCR can be done
from chorionic villi, fetal blood and amniotic fluid samples. Active immunity can be
conferred in non-immune subjects by giving live attenuated rubella virus vaccine (MMR)
preferably during 11–13 years. It is not recommended in pregnant women. When given
during the child-bearing period, pregnancy should be prevented within three months by
contraceptive measure. However, if pregnancy occurs during the period, termination of
pregnancy is not recommended.