Confronting Rubella

The story of how Nepal protected its people from rubella and congenital rubella syndrome

At first glance, infection with rubella virus doesn’t seem so threatening. The symptoms are usually mild, starting with a low-grade fever and a rash on the face and neck, which later extends to other parts of the body. The patient can also experience nausea, a mild form of conjunctivitis and swollen lymph glands, but generally these symptoms pass in a few days, and leave no lasting effect. And many people do not have any symptoms at all.

Why, then, the drive against rubella, if it is just a passing illness? The reason is powerful: if a pregnant woman is infected, the virus can infect the foetus with devastating results. This can lead to foetal death or severe birth defects through what is known as congenital rubella syndrome (CRS). A child with CRS will suffer a lifelong burden of disabilities, and may have a defective heart, sight impairment, hearing impairment, thyroid dysfunction or type 1 diabetes mellitus. Yet, had the mother been vaccinated in childhood, she would not have caught rubella and the child would have been born free of these congenital disabilities.

Rubella is an acute viral infection that is highly contagious. It spreads through airborne droplets when an infected person coughs or sneezes, generally affecting children and young adults. It is also transmitted through the placenta leading to devastating effects in the unborn fetus. Rubella was first identified in 1814 by George de Maton, but CRS was not recognized until the 1940s, when the ophthalmologist Norman Gregg linked congenital cataracts in Australia with intrauterine rubella infection.

This booklet tells the story of how Nepal has taken steps to ensure that its children are free from this scourge.

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