Rubella and pregnancy: What you need to know

Blair Atuhomugisha is three and a half years old. His mother Linda Byabazaire suffered from German measles (rubella) when she was three weeks pregnant. She developed a rash on her hands and the lymph nodes at the back of her ears were swollen. When she asked her mother what the problem could be, she advised her to go to hospital in order to get proper diagnosis.
“I went to several hospitals and although the doctors carried out several tests, they failed to pinpoint the exact problem. They said I had a virus but were sure which one. Therefore, I could not receive any treatment though the symptoms disappeared two weeks later,” she says.
Byabazaire continued with her pregnancy and everything was normal until when she gave birth. “My child weighed only 1.9kg. This was way lower than my first born’s but it did not scare me because I knew with time he would gain weight,” she says adding: “I was, however, worried about his eyes that kept closed after birth. Two weeks later, I realised he had cataract so I took him to Georgina Eye clinic in Bugolobi, Kampala, where the doctor recommended an immediate operation.
At two weeks, Blair was too young to undergo the operation to remove the cataract so the doctor recommended waiting until he was five weeks old. Within these days of waiting, Byabazaire noticed several other abnormalities on her son.

“He was not gaining weight like other children and whenever he would sleep, it was hard for him to get out of his sleep even when the environment was so loud. He would not respond to sound,” she recalls.

Diagnosis
During one of her several hospital visits for consultation and inquiries on what to do, Linda met Dr Charles Karamagi, a general practitioner at Family Doctors Clinic in Ntinda, Kampala. “He inquired about the conditions I suffered when pregnant and after several tests, he said Blair was suffering from rubella syndrome and recommended that I take him to Mulago Hospital to check the condition of his heart,” Byabazaire says.
At four weeks, he was diagnosed with a mild PDA; an opening on the heart which the doctor said would close with time. With this, the doctor had said he was fit for the cataract surgery that was done a week later.
“As he grew older, we realised that he is not only unable to see in the eye that was operated on but also his response to sound did not develop. While at home, we communicate using signs or touching him. Since I have now known his behavioural pattern, I know when he is angry, hungry or tired,” she remarks.

Effects
He was taken to Kampala Audiological Centre where the doctor performed hearing tests and an MRI scan which revealed that he was profoundly deaf because his cochlea did not develop well.
“He has association problems since he cannot talk or hear. He keeps to himself. He is very aggressive when he needs something since he cannot express himself. It is very painful because we cannot help him,” his mother says. She adds: “The doctors recommended that he gets cochlea implants as soon as possible to enable him hear and be able to communicate and play with other children.
This would cost about Shs120m which we do not have and need support from well-wishers.

About the disease
Rubella, also called German measles is a contagious viral infection that can be spread to another person when an infected person coughs or sneezes. It can also spread by direct contact with an infected person’s respiratory secretions, such as mucus. Dr Anna Akullo, the immunization programme coordinator at Uganda Peadiatrics Association, says it can also be transmitted from pregnant women to their unborn children through the bloodstream. The disease affects both children and adults but it is more severe in adults and causes detrimental complications to a pregnant mother.
Congenital Rubella Syndrome (CRS) is a condition that occurs to a developing baby in the womb whose mother is infected with the rubella virus. When a pregnant woman contracts rubella, she is at risk of getting a miscarriage or stillbirth and her unborn baby is at risk of developing severe birth defects with devastating, lifelong consequences. Some babies become deformed as a complication for the disease. Akullo says it is possible to detect children with congenital rubella syndrome because most of the symptoms manifest at birth or a few months after birth.
The most common birth defects from Congenital Rubella Syndrome can include: low birth weight, deafness, cataracts, liver and spleen damage, heart defects, intellectual disabilities and skin rash at birth. “Although some of these symptoms can be treated, there is no cure for Congenital Rubella Syndrome, he says. In the developed countries, women usually get vaccinated for Rubella before they are pregnant and if they get the disease during pregnancy, the doctors would advise a termination because of the way the disease affects the unborn child,” she says.

Treatment?
There is no vaccination for rubella for pregnant women in Uganda currently but according to Dr Justus Mwesigire, a peadiatrician at the Surgery Clinic in Naguru, the country plans to add rubella vaccination to the routine child immunisation this year.
“We are not able to do anything for the mothers that have the virus already because it has no cure but we plan to save the next generation from Rubella. Next year (2019), we plan to introduce the Rubella vaccine as part of the routine vaccination for all the immunisable diseases among children,” says Dr Mwesigire.
The vaccine will be free and the children will get it as part of the routine immunization. It will be an injection that has a combination of measles, mumps and rubella given after the child turns a year old.
In developed countries, women who are planning to become pregnant get Measles, Mumps and Rubella (MMR) vaccine four weeks before they get pregnant.
Pregnant women should not get MMR vaccine because the MMR vaccine is weakened live virus vaccine. If you get rubella while you are pregnant, it is important that you contact your doctor immediately.Byabazaire wishes there was a vaccine for pregnant women so that no more children will suffer from rubella syndrome since it is also difficult to diagnosis.