CONGENITAL RUBELLA –

A POSSIBLE THREAT IN THE NEW MILLENNIUM

Chua Kaw Bing and Lam Sai Kit, Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur.

Rubella is a mild illness in childhood, presenting with a macular rash accompanied usually by pharyngitis and enlargement of the cervical lymph glands. Infection is symptomless in some cases. The incubation period is 14-23 days and the virus is shed in pharyngeal secretions during this period for up to 7 days before the appearance of the rash, and for 2 weeks after the rash disappears. Immunity after rubella is good but it is not solid and re-infection has been documented. Complications are rare but may include post-infectious encephalitis, thrombocytopaenic purpura and arthralgia. Rubella in early pregnancy can cause severe congenital abnormalities and disease in the foetus.

The teratogenic properties of rubella virus were first discovered in Australia in 1941 and the main presenting defects in the newborn baby consist of cataract, nerve deafness and cardiac abnormalities. Affected infants also have a generalized infection which, together with the defects, is known as the rubella syndrome. The signs of this are hepatosplenomegaly, thrombocytopaenic purpura, low birth weight, mental retardation, jaundice, anaemia and lesions in the metaphyses of the long bones. The incidence of defects in the first 3 months of pregnancy varies from 10% to 54%. Maternal rubella at this time is also associated with a higher proportion of abortions and stillbirths.

A study conducted in 1972 in Kuala Lumpur showed rubella antibody rate in the female population of childbearing age was about 50% which was far lower that those reported from temperate countries. A recent retrospective study on 132 patients seen in Universiti Hospital with suspected rubella showed only 65 (50.8%) were serologically confirmed, showing that the clinical diagnosis of rubella is not as simple or accurate as it is made out to be. The incidence of congenital rubella infection during the study period (1993-1998) varies from 19 to 93 per 100,000 deliveries with an average of 48 per 100,000 deliveries.

Selective vaccination against rubella in schoolgirls using the live attenuated vaccine has been on-going since the early 1980s but despite this, congenital rubella continues to occur in the country.

There has been a noticeable increase of rubella activity during the second half of 1999. This may herald an increase of congenital rubella babies in the new millennium since more births are expected in the year 2000 which is also the auspicious Year of the Golden Dragon for the Chinese. It is advisable for those planning to have babies in the new year to undergo a simple blood test to ensure they have adequate protection to rubella and avoid the trauma of having a congenital child.

It is time for the government to consider rubella vaccination to all children regardless of gender instead of only giving the vaccine to schoolgirls as a more cost-effective measure to avoid congenital births. For that matter, why not provide MMR vaccine against measles, mumps and rubella under the National Expanded Programme of Immunization?

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