A Case Series Analysis of Congenital Rubella Syndrome Cases in Los Angeles County Over the Last 15 Years

Background: CRS is a fully preventable disease caused by specific clinical manifestations in babies born to mothers infected with rubella virus. Since the recommendation of the 2^nd MMR in 1989, CRS cases in Los Angeles County (LAC) have decreased overall; however, several confirmed cases have recently been identified.

Objectives: To analyze CRS cases in LAC by identifying missed opportunities, maternal factors, and other factors affecting clinical and diagnostic picture of a CRS baby.

Methods: Information on CRS cases from 1994-2009 was collected from hospital medical records, laboratory reports, and case investigation notes.

Results: Four confirmed cases of CRS were identified in 1997, 1998, 2003, and 2008; one which died postnatally.  All mothers had limited prenatal care during pregnancy. All mothers travelled abroad during their pregnancies, half during their first trimester. Three mothers had a history of previous pregnancies, yet had no evidence of rubella immunity. Two mothers did not have symptoms that could have been detected by medical providers. Only one mother had proof of MMR vaccination.  Another mother was employed as a healthcare worker but was not completely vaccinated despite having multiple opportunities to do so.

Conclusions: Multiple approaches towards preventing CRS among all women of childbearing age should be implemented by various types of health care practitioners; including travel medicine clinics, OB/GYN’s, and primary care providers.  Emphasis should be based upon educating all women regardless of pregnancy status, about the importance of adequate prenatal care, potential risks of foreign travel, recommended vaccinations, and establishing evidence of rubella immunity at multiple healthcare exam visits.