RUBELLA and PREGNANCY

(German measles)

This factsheet describes how a child can be affected when a woman has rubella (often called German Measles) while she is pregnant. It also talks about some of the ways that children affected by rubella can be helped, and tells you where to go for advice and support.

What is rubella?

Prior to immunisation, rubella was a common disease of childhood. It is caused by a virus which is spread in the air as droplets - by coughing and sneezing.

When someone has been in contact with the virus it takes two to three weeks to develop. When it does, they will generally feel unwell and off-colour for the first five days, with swollen glands, and a light temperature or a sore throat. If a rash develops, it will start on the face, and spread downwards over the body and limbs, and this may cause pain and discomfort in the limbs - especially in women. Some people have rubella, but show no symptoms at all.

What happens if a woman has rubella when she is pregnant?

Sometimes the mother will not pass the rubella onto the baby. However, if she has rubella in the early stages of her pregnancy then there is a greater chance of the virus passing through the cord to the developing baby.

A child affected by rubella during pregnancy will be said to have congenital rubella. Children born with congenital rubella will have the virus circulating in their bloodstream for up to 20 months after they are born. They will normally pose no risk to others, but anyone in direct contact with children with congenital rubella is advised to be screened and immunised as necessary.

About vaccination

Most women today choose to protect themselves from rubella by being immunised before they become pregnant, and this has greatly reduced the numbers of children affected. Even if a woman has already been immunised however, it is important that she has a blood test before becoming pregnant to ensure that she is still immune. The rubella vaccine is now given to children when they are between 12 and 15 months old. This is given in combination with the vaccinations for measles and mumps - called the MMR vaccination. Children receive a booster injection before they start school.

How can rubella affect the baby?

We do not fully understand how the baby is affected by the virus. The virus seems to affect the cells of parts of the baby's body that are being developed at the time of infection. Sometimes there is insufficient blood supply which can harm organs which have developed already. However, every child is different. Some children will appear to be unaffected, but they should be followed up during childhood, particularly for hearing loss. Anyone with congenital rubella should have regular health check-ups, including vision and hearing assessments throughout their life.

Where might the damage occur?

The stage of pregnancy when the rubella infection occurs is the most important factor determining what kind of harm, if any, occurs. Rubella in the first two months of pregnancy is likely to affect the baby and may cause a number of impairments. After 18 weeks gestation, although rubella infection may be passed on to the baby, the chances of the baby being affected may be minimal. The most commonly affected organs include the ears, the eyes, and the heart.

1. The eyes

The eyes develop during the early stages of pregnancy. Several things may happen:

• Cataracts

Between three and seven weeks the eye lenses may be affected and become cloudy. A cloudy lens is called a cataract - sometimes people will use the term congenital cataracts. This means that the baby will have cloudy lens from birth. Again, the degree of cataract can vary enormously - from a small clouded area to the complete lens being affected. Sometimes one eye only will be affected- sometimes both.

• Small eye

Sometimes the size of one or both eyes will be affected, although this is quite rare.

• Colouring of the retina

Babies who are born with rubella have speckled colouring or pigment on the back of their eye, although this does not affect their sight.

• Eye movement

The eyes may jump from side to side in a flickering movement. This eye condition is known as nystagmus.

• Less common eye problems

There are several rare conditions which may affect the baby - optic atrophy, corneal haze, and glaucoma. If your child has these problems please ask your ophthalmologist (see below) for more information.

2. The heart

The heart is a complicated organ, and many different problems can be caused by the virus. These problems are best explained to you on an individual basis by your paediatrician in the hospital who will explain the difficulties your child is facing.

3. The ears

A common problem for babies affected by the rubella virus is hearing loss. This can vary considerably from mild to severe, and may affect one or both ears. The part of the ear which is damaged is the Corti. This is the inner ear or Cochlea which links the ear to the brain. The hearing loss is known as sensori neural.

The amount of hearing loss can vary a great deal, and hearing may deteriorate over a period of time.

4. Neurological problems

The rubella virus may or may not affect the child's brain, and difficulties can vary from mild to severe. If a child has any of these problems, then it is best to discuss these with a paediatrician who can offer individual advice.

Conditions that may occur:

Lethargy, irritability, learning difficulties, small head (microcephaly), large soft spot on the head, movement problems, poor balance and posture, lack of coordination seizures. Some children may have associated behaviour problems. Other rarer conditions have been associated with babies affected by rubella. If you notice anything out of the ordinary, it is best to discuss the situation with your health visitor or GP who can refer you to a paediatrician for specialist advice.

What support do children affected by rubella need?

Children who have been affected by Rubella may have to cope with an impairment of both sight and hearing, as well as other disabilities - although this will vary a great deal. Many children will have some sight and/or hearing however, and it is important to make as much use of these possible. The other senses - touch and smell in particular - must also be developed to the full.

The biggest challenges facing children affected by Rubella, will be to learn to communicate, to move around safely, and to find out about the world around them. It is vital that these children get specialist help which is geared towards their particular combination of abilities and impairments as soon as possible. Intensive one-to-one teaching developed for work with deafblind children for example, can help them to understand the human interaction that is the basis of communication. Children can learn various ways to communicate such as using symbols, objects of reference, sign language, and braille.

All children and adults affected by Rubella have the capacity to learn and achieve. But without the right kind of help, their mental and physical development may be slower because of lack of stimulation. Early intervention, with continuing intensive educational support is the key to a child's future development, although extra support may be needed throughout a person's lifetime.