Congenital Rubella with Autism
The conventional diagnosis of congenital rubella is a rare occurrence of an obvious maternal exposure, resulting in an infant born with obvious signs such as cataracts, deafness, microcephaly or congenital heart disease. In this case, a mother with no known symptom, sign or exposure of rubella gave birth to a male infant without complication. The infant had no notable abnormalities at birth. The boy had developmentally delayed, and between the ages of five and seven years was diagnosed with autism. At the age of ten years, an MRI of his brain evidenced a remote stroke. Careful examination of all medical records showed that the mother had a considerable rise in her rubella titer and thus had been exposed to rubella during pregnancy. The diagnosis of congenital rubella was recognized more than ten years after the birth of the infant; congenital rubella is linked to both autism and ischemic brain injury. This case illustrates how both maternal rubella exposure and congenital rubella are likely under-recognized, and how a newborn may exhibit no outward symptoms at birth, yet the elusive diagnosis of congenital rubella is considered years later.
Congenital rubella is thought to be rare in the United States thanks to widespread vaccination. In this case, the mother, a physician born in the USA, received a single dose of MMR in 1972. A second dose of MMR was only added to the vaccine schedule in 1989; therefore, mothers born before this recommendation change may have received only one rubella vaccine and may be more likely to be non-immune. The most common way to diagnose rubella is an increase in rubella titer. The mother presented above was rubella non-immune at 10 weeks gestation, but at the time of delivery, her rubella specific IgG was elevated. The mother had no documentation of any symptom, sign or exposure related to rubella. She was not stereotypically foreign-born or unvaccinated, although in hindsight had probable exposure while working in a busy county hospital. Such exposure is doubtfully limited to healthcare workers, as countless women have jobs in public service industries. Maternal rubella exposure is likely under-recognized and under-diagnosed due to the fact that most infected individuals have few or no symptoms.
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Journal of Vaccines & Vaccination