A case of congenital rubella syndrome and infection in South-East London in 2015: prevention, diagnosis, and the public health response.

Abstract

Before the introduction of rubella immunisation in 1970, rubella was a common childhood infection.1 Since then, the incidence has declined, with just 269 and 365 cases (confirmed by oral fluid IgM antibody tests) in England in 2013 and 2014 respectively.2 Although usually a mild disease, rubella infection in pregnancy can cause fetal death and congenital defects known as congenital rubella syndrome (CRS).3,4 Congenital abnormalities may include deafness, cataracts, visual impairment, learning disabilities, and cardiac defects. Infection in the first trimester carries a high risk (up to 90%) of CRS in the infant.1,4 Cases of CRS have also fallen significantly: between 1971 and 1975 there were approximately 50 cases a year and 750 associated terminations.1,5 Cases are now rare, with only eight cases reported between 2002 and 2011 in the UK.6 This paper describes a case of rubella infection and CRS, and the lessons learnt around early detection and management in both primary and secondary care. In March 2015, the South-East London Health Protection Team was informed of a case of rubella infection and suspected CRS in a 17-day-old infant. The mother of the infant had been born in East Africa and had travelled to the UK at around week 12 of pregnancy. Later investigations revealed that the mother had a 2-day history of a rash-type illness shortly before arrival in the UK. She did not seek medical attention for her rash, or raise this at later appointments with healthcare professionals. The mother registered …