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Background: Since rubella was eliminated in 2004, four cases of congenital rubella syndrome (CRS) have been reported in the United States. In June 2009, the New Jersey Department of Health and Senior Services (NJDHSS) was notified of a 6.5 month old child suspected of having CRS born to a woman with documented measles, mumps, and rubella (MMR) vaccination.
Objectives: To describe the resulting epidemiologic case investigation
Methods: The epidemiologic and laboratory investigation involved the local health department, NJDHSS, and CDC. A standard case investigation was conducted, including confirmatory laboratory testing. Criteria for reporting were based on the CDC/CSTE case definition.
Results: A newborn male infant was noted to have microcephaly, a petechial rash, pulmonic stenosis, a patent ductus arteriosis, and intracranial calcifications. Clinicians considered CRS at birth; however, testing was not completed until 6.5 months of age. At that time, the infant’s rubella immunoglobulin M (IgM) was 7.2 (positive: >1.0). At 12 months of age, testing at CDC confirmed the presence of rubella IgM, but rubella RNA was not detected. The mother had received MMR vaccination in 2003 as documented in medical records. Her rubella immunoglobulin G (IgG) testing at 4 months gestation was > 400 (positive > 9). The mother denied rash illness, ill contacts, or contact with international travelers in the first 4 months of pregnancy.
Conclusions: CRS occurs very rarely in children of women with a history of immunization or documented immunity. Delays in diagnostic testing and reporting hindered the public health contact investigation in this case in NJ. Rubella elimination relies upon early case recognition and detailed contact investigation, timely isolation of affected patients, and maintenance of high levels of immunity in the population. Clinicians should remain vigilant to the possibility of rubella and CRS, and notify public health authorities immediately when CRS is suspected.