Consider congenital rubella syndrome in infants with compatible signs, particularly immigrants from countries without rubella control programs, the Centers for Disease Control and Prevention advised.
In 2004, a 10-week-old infant born to a mother who had emigrated from Côte d'Ivoire was brought to a New Hampshire emergency department with fever, vomiting, irritability, and poor feeding. While hospitalized, the infant—who had been born with a cataract in her left eye—was diagnosed with microcephaly, patent ductus arteriosus, bilateral hearing impairment, hepatosplenomegaly, and failure to thrive (MMWR 2005;54:1160–1).
Congenital rubella syndrome was suspected and confirmed by positive rubella IgM and positive urine and nasopharyngeal cultures. The genetic sequence was found to be that of a wild-type rubella virus similar to one found in Uganda in 2001, the CDC said.
Soon after conception, the mother had come into contact with refugees from one of four transit centers in Cote d'Ivoire where there had been a rubella outbreak during February-April 2004. She had reported no history of symptoms of acute rubella infection such as rash, fever, lymphadenopathy, or arthralgia. However, subclinical infections are estimated to occur in up to 50% of rubella cases.