Handbook of congenital malformations / edited by Alan Rubin.

Date:
1967
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Handbook of congenital malformations / edited by Alan Rubin. Source: Wellcome Collection.

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    RUBELLA {continued) or second day of rash and can occasionally be found for as long as a week thereafter. Antibody is rarely detected until after the onset of the rash, but it is nearly always found in the serum within two weeks after the eruption appears. The complement fixation test is especially reliable in acute infection. Paired sera (acute and con¬ valescent) should always be tested simultaneously. Prevalence: Epidemics of rubella occur at approximately six to seven year intervals in the United States. It has been estimated that 20,000 to 30,000 damaged infants were born in this country as a result of the 1964 epidemic. The infection is spread by the respiratory route, probably by droplet inhalation. Studies of epidemics in virgin communities have revealed that among susceptible individuals rubella is as infectious as regular measles (rubeola). Thus the susceptible, heavily exposed person will usually be infected. In a study of 30,000 pregnancies in the Collaborative Perinatal Research Study, the frequency of clinical German measles during nonepidemic years was found to be 1 per 1000 pregnancies and rose during the 1964 epidemic to 22 per 1000. Serologic studies detected a 3.8 per cent attack rate among pregnant women in the study dur¬ ing the time of the epidemic, with 2.6 per cent having clinical disease. These figures indicate a 2:1 ratio of clinical to subclinical infection in this study group. Treatment and Outlook: The treatment of infants with malforma¬ tions due to congenital rubella includes repair of the structural defects (aspiration or extraction of cataracts; ligation of the ductus arteriosus), supportive treatment for the acute illness during infancy, and isolation as needed to protect hospital personnel. Hyperimmune gamma globulin, human interferon, new antiviral agents, and immune lymphocytes may eventually be helpful but are as yet unproven. The risk of transmission to individuals in contact with infected infants can be estimated according to the patient's age but is best evaluated by repeated throat cultures for virus isolation. The prevention of the congenital rubella syndrome is based on avoidance of exposure, prompt diagnosis of maternal exposure, and therapeutic abortion in certain cases. Active immunization is the ideal means for preventing maternal infection. A coordinated program of research is now under way to develop an inactivated as well as an attenuated vaccine. Both types are essential. Killed vaccine would be used to provide short-term protection for women of child-bearing age, while the live, attenuated virus would be given to prepubertal girls for long-lasting immunity. Hopefully, both will be available before the next epidemic occurs in the United States. Another means of prevention is by the purposeful exposure of young girls to German measles. This is a two-edged sword, since a child with German measles, which is often subclinical, represents a risk to the pregnant woman. It is particularly dangerous because of the great likelihood of contact between a pregnant woman and young children and because the chance of embryopathy is greatest early in 358