Organism Rubella virus, a member of the Togaviridae family of viruses.

Clinical features Infection in the adult is generally mild, presenting with a maculo-papular rash of short duration, fever, conjunctivitis and cervical lymphadenopathy. Some 20-50% of the infections are subclinical. However, if the woman is pregnant, especially in the first 10 weeks of pregnancy, her developing fetus will suffer from congenital rubella syndrome (CRS). The congenital defects are more severe if the infection is acquired earlier in pregnancy, resulting in stillbirth in the first few weeks. Otherwise a range of congenital defects can result, including cataracts, glaucoma, deafness, heart defects and microcephaly. Milder defects will develop between the 11th and the 16th weeks and after the 20th week of pregnancy, there is no further risk.

Diagnosis is by detecting IgM from serum or saliva and is important if infection in a pregnant woman is suspected.

Transmission The virus is transmitted in droplets from the nasopharynx by the airborne route or direct contact. Most infections are acquired from children and adults during an outbreak, but infants with CRS can produce virus from pharyngeal secretions and urine for up to 1 year so are a potent source of infection.

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