How Rubella Can Affect Children’s Cognitive, Behavioral Growth

Jehangir Khan Tareen

Multan: Rubella is a mild exanthematous infection that resembles a mild form of measles and can potentially lead to fetal infection and birth defects.

According to Dr Imran Rafiq, Senior Medical Officer at Nishtar Medical University (NMU), rubella is only moderately contagious compared to measles. Before the introduction of the Measles-Mumps-Rubella (MMR) vaccination, rubella incidence was highest in the spring among children aged 5 to 9 years.

Previously known as the “third disease,” rubella follows measles and scarlet fever as the third exanthematous infection in childhood. 

Most individuals develop lifelong protection against rubella through MMR vaccination. Reinfections are often asymptomatic but can lead to a rise in antibody levels in previously vaccinated individuals.

Congenital rubella, though rare, can occur if a vaccinated mother is reinfected. The disease spreads through droplets, with patients being most contagious when the rash is erupting. The virus can be shed from up to 10 days before the rash appears and for up to two weeks afterward.

The rash may be immune-mediated, appearing as immunity develops and viral levels decrease. Infants with congenital rubella can shed significant amounts of the virus for several months. The incubation period for rubella ranges from 12 to 23 days.

Postnatal rubella is typically mild, with symptoms including malaise, fever, anorexia, and a maculopapular rash that starts on the face and moves downward. This rash may be accompanied by swollen cervical and posterior auricular lymph nodes, coryza, and conjunctivitis, lasting 3 to 5 days.

Complications are uncommon but can include arthritis (more common in women), hemorrhagic manifestations (more common in children), and low platelet count. Congenital rubella can be severe, particularly in early pregnancy, leading to fetal death, premature delivery, or various congenital defects.

The risk of severe outcomes is higher the younger the fetus is at the time of infection. In the first two months of gestation, there is up to an 85% chance of multiple defects or spontaneous abortion. This risk drops to around 30% in the third month and 10% in the fourth month, with no risk after 20 weeks of gestation.

Temporary defects may include low birth weight, low platelet count, enlarged liver and spleen, hepatitis, meningitis, and jaundice. Permanent defects can involve hearing loss, cardiac abnormalities, microcephaly, inguinal hernia, cataracts, and glaucoma.

Developmental defects, such as myopia, mental retardation, diabetes, and language disorders, may become apparent as the infant grows.

Diagnosis can be confirmed by positive IgM rubella or a significant rise in IgG levels. Women of childbearing age should be vaccinated before pregnancy and should avoid becoming pregnant for three months following vaccination.