Rubella virus (Latin, rubella = little red), also known as "German Measles" (due to early citation in German medical literature), infection during pregnancy can cause congenital rubella syndrome (CRS) with serious malformations of the developing fetus. The type and degree of abnormality relates to the time of maternal infection.
Rubella Virus, transmission electron micrograph (Image: CDC USA)
Rubella peaked in 1964 and 1965, when 12.5 million cases were reported (USA). As a result, 20,000 babies were born with birth defects, 6,200 babies were stillborn, and an estimated 5,000 births were aborted, both naturally and assisted. At that time no treatment by vaccination existed and this only became available in 1969. The disease was dangerous because in children it was almost unnoticable and pregnant women often did not know that they had been exposed.
Children infected with rubella before birth (a condition known as congenital rubella) are at risk for the following: growth retardation; malformations of the heart, eyes, or brain; deafness; and liver, spleen, and bone marrow problems.
The complete genomic sequence (Dominguez etal., 1990) of Rubella is now known. Rubella is a 9755 bp single stranded RNA positive-strand virus with no DNA stage (Togaviridae; Rubivirus) encoding nonstructural protein, capsid protein, glycoproteins E1 and E2. (More? Genome)
Page Links: Introduction | Some Recent Findings | Rubella Images | Genome | Togaviridae | Congenital Rubella | Neural Effects | Cataracts | Postnatal Infection | References | WWW Links | Glossary
USA Recommendations Update "On May 17, 2006, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations. According to the 1998 ACIP recommendations for measles, mumps, and rubella (MMR) vaccine, for routine vaccination, a first dose of MMR vaccine is recommended at ages 12-15 months and a second dose at ages 4-6 years. Two doses of MMR vaccine also are recommended for students attending colleges and other post-high school institutions. However, documentation of mumps immunity through vaccination has consisted of only 1 dose of mumps-containing vaccine for all designated groups, including health-care workers."
Centers for Disease Control and Prevention (CDC). Notice to readers: updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the control and elimination of mumps. MMWR Morb Mortal Wkly Rep. 2006 Jun 9;55(22):629-30.
The complete genomic sequence of Rubella is now known (Dominguez etal., 1990). Rubella is a 9755 bp single stranded RNA positive-strand virus with no DNA stage (Togaviridae; Rubivirus) encoding nonstructural protein, capsid protein, glycoproteins E1 and E2.
Lineage: Viruses ; ssRNA positive-strand viruses, no DNA stage ; Togaviridae ; Rubivirus ; Rubella virus
Links: Rubella sequence | Rubella Genome | Rubella Taxonomy
Togaviridae (Latin, toga = coat) named due to the virion having an envelope or coat. Members of the Togaviridae family include: Chikungunya virus, Eastern equine encephalitis virus, O'nyong-nyong virus, Ross river virus, Rubella virus, Sindbis virus, Semliki forest virus, Venezuelan equine encephalitis virus, Western equine encephalitis virus.
Congenital Rubella (Image: CDC USA)
"Rubella infection in the first 3 or 4 months of pregnancy provides opportunities during the period of maternal viremia for invasion of the placenta and subsequent fetal infection. Development of infection probably depends upon gestational age. It has been estimated that the fetus has a 40 to 60 percent chance of developing multiple rubella-associated defects if the mother is infected during the first 2 months of pregnancy, with the risk dropping to 30 to 35 percent during the third month of gestation and 10 percent during the fourth."
(Text from: Medical Microbiology 4th ed. Baron, Samuel, editor. Galveston (TX): University of Texas Medical Branch; c1996rubella infection)
Postnatal rubella generally resolves without complication with characterisic rash, lymphadenopathy, and low-grade fever.
Reviews | Articles | Search NCBI Bookshelf | Search PubMed
Reviews
Weir E, Sider D. A refresher on rubella. CMAJ. 2005 Jun 21;172(13):1680-1.
Banatvala JE, Brown DW. Rubella. Lancet. 2004 Apr 3;363(9415):1127-37.
Dwyer DE, Robertson PW, Field PR; Board of Education of the Royal College of Pathologists of Australasia Broadsheet: Clinical and laboratory features of rubella. Pathology. 2001 Aug;33(3):322-8.
Articles
Dominguez, G., Wang, C.Y. and Frey, T.K. Sequence of the genome RNA of rubella virus: evidence for genetic rearrangement during togavirus evolution. Dominguez, G., Wang, C.Y. and Frey, T.K. Virology 177 (1), 225-238 (1990)
Search NCBI Bookshelf: Bookshelf - Rubella | Medical Microbiology - Rubella
Search PubMed: Search May 2006 "rubella virus" 3,354 reference articles of which 173 were reviews. Search term = rubella virus
Search PubMed: term = rubella teratology | embryo infection | fetal infection | neonatal infection
CDC Publications (USA)
National Immunization Program (NIP) "Manual for the Surveillance of Vaccine-Preventable Diseases 3rd Edition, 2002" Chapter 12: Congenital Rubella Syndrome (PDF document) | local 2006 copy
National Immunization Program (NIP) "Manual for the Surveillance of Vaccine-Preventable Diseases 3rd Edition, 2002" MedlinePlus Medical Encyclopedia: Congenital rubella
Guidelines for Vaccinating Pregnant Women October 1998 (updated July 2005) rubella from Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Report Form Congenital Rubella Syndrome Case Report (PDF document)
World Health Organization (WHO) Immunization, Vaccines and Biologicals | Guidelines for surveillance of congenital rubella syndrome and rubella (1999) (PDF document)
NSW Public Health Bulletin (Australia) EPIREVIEW: RUBELLA IN NSW 1991–2000 (March 2001)
International Committee on Taxonomy of Viruses Togaviridae
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Below is a list of some known maternal (then fetal) infections that impact upon neurological development.
Only a very brief overview is given, for more details see Abnormal Development Notes or the listed internal and external links.
Viral infection causes systemic infection and extensive brain damage and cell death by necrosis.
NCBI Bookshelf (external link) Medical Microbiology: Cytomegalovirus | Search Medical Microbiology "Cytomegalovirus"
Viral infection causes systemic infection and extensive brain damage and cell death by necrosis.
NCBI Bookshelf (external link) Search Medical Microbiology "Herpes Simplex Virus"
Bacterial infection by E. coli or streptocci B. can cause vascular thrombosis involving choroid plexus which can effect CSF flow, and can cause hydrocephalus.
NCBI Bookshelf (external link) Search Medical Microbiology "Purulent Meningitus"
Toxoplasma infection causes random necrosis throughout the brain and can cause hydrocephalus.
NCBI Bookshelf (external link) Medical Microbiology: 84. Toxoplasma Gondii | Figure 84-1. Girl with hydrocephalus due to congenital toxoplasmosis. | Search Medical Microbiology "Toxoplasmosis"
The Australian NHMRC (1988) recommends neonates be assessed for follow-up care under the following conditions.
(see the NHMRC WWW Page)
These developmental abnormalities usually involve only small DNA mutations affecting individual or a few genes, two exceptions are the major chromosomal abnormalities usualy trisomy; trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome) (also trisomy 9, 13, 15). Note that the occurance of chromosomal abnormalities also increases with increasing maternal age. There are many pamphlets providing information about prenatal diagnosis (see NSW State Health Publication Checking your baby's health before birth).
Each section of the notes covering early development and specific systems contain references to specific abnormalities (on Page 2 of each notes section). The best source for Australian statistical data is the Australian Institute of Health and Welfare National Perinatal Statistics Unit, UNSW which publishes "Congenital Malformations Australia" every 2 years. Be aware that some congenital abnormalities, by their nature, affect multiple systems. In the USA, the Center for Disease Control (CDC) keeps and publishes relevant statistical information. A very difficult issue in abnormal development are the many different Ethical implications.
This current page is a link to Normal and Abnormal Development and Population Data.
You should look at normal development. Development Notes
Alternatively, go on to look at Systematic Development of organs and tissues.
For those wanting to see dynamic processes of development (and have a reasonably quick connection) then the Movies pages are good for watching changes occur.
The study of human development has relied extensively on studying the process in other model animals. For those wanting to see the process of development in other species then the other embryos pages are a good start.
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How and why do things go wrong in development?
Abnormalities in human development can be due to many different maternal factors, this page gives introduces Rubella infection and links to several external resources for further information.
Please email Dr Mark Hill if you wish to make a comment about this current project.
