Clinical manifestations of congenital rubella syndrome: A review of our experience in Vietnam

Abstract

Rubella vaccination programs have dramatically reduced the incidence of rubella and congenital rubella syndrome (CRS) in developed countries. However, CRS prevalence is still rising in developing countries where rubella-containing vaccines (RCV) are not included in the immunization program and even in some countries where a part of the population lacks immunity to rubella despite the presence of RCV in the regular immunization program. This review aimed to summarize the clinical features of CRS using data from our studies conducted between 2011 and 2015 in Vietnam, wherein we examined clinical manifestations in Vietnamese children with CRS who were born after the large rubella outbreak of 2011; a series of studies dealing with CRS in North America and Europe after the 1960s epidemic; and those from countries before introduction of RCVs. This review shows that children with CRS have a variety of disabilities such as hearing, visual, developmental, behavioral, cardiac, and endocrine impairments, which have variable severity and may appear in different combinations. Some of these impairments can appear or worsen later in the lives of these children. Physicians should thus complete pediatric, cardiac, auditory, ophthalmologic, and neurologic examinations along with laboratory diagnostic testing soon after birth. These assessments should be repeated during follow-up if congenital rubella infection is suspected in a neonate. Timely intervention for cardiac defects can be lifesaving. Early introduction and continuation of speech, occupational, physical, and behavior therapies and training with appropriate medical interventions by a multidisciplinary team approach are required to maximize quality of life. Highlights: • The incidence of CRS is still rising in developing countries • Children with CRS present with a variety of disabilities • A timely multidisciplinary approach improves the quality of life in children with CRS. • A timely multidisciplinary approach can be lifesaving in some children with CRS.

Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State of Pernambuco, Brazil

“…Although the clinical presentation has not yet been fully established and much research is still underway with the aim of fully characterizing this new syndrome, studies from other congenital viral infections support the biological plausibility of endocrine dysfunction in CZS. Specifically, children with congenital rubella infections have been reported to have higher risk of diabetes mellitus, thyroid dysfunction, growth hormone deficiency, and Addison's disease [11,12]. Similarly, children with congenital cytomegalovirus infections, which may cause severe brain damage resembling that of CZS [3], may develop endocrine disorders [13,14].…”

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

“…In poorer countries, CRS is a major cause of developmental anomalies, especially blindness and deafness [7]. Worldwide, about 100,000 infants are born annually with CRS [8,9,10]. Fetal damage associated with rubella tends to result only when infection occurs in the first 16 weeks of gestation.…”

Pregnancy and Congenital Rubella Incidence

“…5 A global incidence of rubella among fecundity women remains as high as 60 percent with around 0.1 million births with congenital rubella syndrome. 6,8 The virus is transmitted through sneezing, coughing, or inhaling the microbes from an infected person.…”

“…7 Viremia occurs post this stage causing fetal damage, cell destruction and mitotic cessation. 8 In cases of acute infection neurological disabilities and impairment can be caused by autoimmune reactions as research has proved no evidence of virus presentation inside the brain of infected individual. [9][10][11] The present study was designed for estimating the incidence of rubella in pregnant women of Pakistan so that they can be better managed and policies could be drafted for awareness of women towards opting immunization against the disease for their and their new born safety.…”