Congenital rubella syndrome developing after a 1987-1988 epidemic in Japan

Abstract

Since vaccination legislation was revised in 1994, rubella vaccination has been changed from application to all junior high school girls with no history of clinical rubella to application to individual infants and junior high school students. This may decrease the vaccination acceptance rate and increase the chance of pregnant women's infection with rubella causing congenital rubella syndrome (CRS). We studied 5 children with CRS developed after a 1987-1988 epidemic in Japan to determine how their mothers were infected, and reviewed auditory findings. They were CRS-confirmed or CRS-compatible cases who met CRS diagnostic criteria formulated by the U.S. Center for Disease Control (CDC) in 1983. Two mothers had not been vaccinated because this was not legislated when they were in junior high school. Three were eligible for vaccination at 14, but 2 were not vaccinated. The children were born in 1991-1997. Complications were low birth weight in 3, delay in neck stabilization in 2, and cataract in 1. No case was serious. Ages at first ENT examination ranged from 3 months to 1 year and 8 months. ABR showed hearing loss of > or = 90 dBnHL. They started using hearing aids at 6 months to 1 year and 10 months. Tsumori mental development tests showed delays in developmental age in 2 who started auditory training after ages of 1 year and 6 months. Findings indicated that infants, students, and potentially pregnant women should be vaccinated. Complete serologic testing are important in pregnant women and fetal rubella infection should be diagnosed early by PCR.