Congenital Rubella Syndrome: Symptoms, Causes, Diagnosis, Treatment & Prevention 

Introduction

Rubella, often known as German measles, is usually a mild viral infection in adults, but it can seriously affect a developing baby during pregnancy¹. In this article, we will discuss congenital rubella syndrome, including its symptoms, causes, diagnosis, treatment options, and prevention methods. 

What Is Congenital Rubella Syndrome?

Congenital rubella syndrome (CRS) is a condition in which a baby develops multiple health problems after rubella virus infection during pregnancy. Rubella is a contagious disease that spreads through respiratory droplets. It mainly affects children and young adults. The infection can also pass from the mother to the developing baby through the placenta, especially if the mother becomes infected during the first few months of pregnancy¹.

The infection can interfere with the normal development of the baby’s organs, leading to problems with the eyes, ears, heart, brain, and other parts of the body¹. The severity of CRS depends on the stage of pregnancy at which infection occurs and how early the baby is exposed to the virus. If the mother is infected early in pregnancy, particularly during the first trimester, the baby is more likely to develop CRS². 

How Does Congenital Rubella Syndrome Occur?

CRS occurs when the rubella virus passes from a pregnant woman to her developing baby during pregnancy, especially in the first trimester. The infection develops stepwise as shown below: 

• Maternal Infection: A pregnant woman can get rubella by contact with an infected person, who spreads the virus through coughs and sneezes¹.
• Spread of the Virus in the Body: The virus infects the mother’s respiratory tract, including the nose and throat. It then enters the bloodstream and multiplies in lymphoid tissues. 
• Transmission to the Baby: As the virus spreads throughout the mother’s body, it can reach different organs, including the placenta (the organ that supplies oxygen and nutrients to the developing baby). From there, it can pass to the developing baby. 
• Impact on Baby’s Development: The virus enters the baby’s bloodstream and may affect the development of different organs, such as the heart, eyes, ears, and brain, increasing the risk of birth defects. 
• Baby Born with CRS: Depending on when the infection happened and how severely the baby was impacted, the newborn may develop hearing loss, eyesight issues, heart defects, developmental delays, or other health complications³.

Causes of Congenital Rubella Syndrome

The main cause of CRS is infection with the rubella virus during pregnancy and passing of the virus to the developing baby. Factors that increase the risk of maternal infection include: 

• Lack of Immunity: Women who have not developed immunity, either because they were not vaccinated or have never had rubella, may be more susceptible to infection. 
• Exposure to Infected Individuals: Close contact with a person who has rubella can increase the chance of getting the infection¹.
• Delayed Vaccination: Women who do not receive the appropriate rubella vaccination before becoming pregnant are at risk of infection^1,4.

Symptoms of Congenital Rubella Syndrome

The symptoms of CRS can vary from one baby to another. Some symptoms are present at birth, while others appear later in life³. The most common CRS symptoms include: 

• Hearing loss 
• Vision problems³
• Heart defects 
• Low birth weight⁵ 
• Developmental delays and learning difficulties^3,5
• Enlarged liver and spleen 
• Reduced platelet count⁵
• Yellowing of the skin and eyes (jaundice) 
• Sleeping more than usual³
• Skin rash (at birth)⁵
• Purple or red spots on the skin (purpura)⁶ 
• Small head size⁵

How Is Congenital Rubella Syndrome Diagnosed?

CRS is usually diagnosed in the baby using more than one test or procedure. The following are the most common ones recommended by doctors: 

• Medical History: The doctor will enquire whether the mother had a rubella infection, a rash or fever, or was exposed to rubella while pregnant¹.
• Physical Examination of the Baby: The baby is checked for signs of CRS, such as hearing loss, heart problems present at birth, congenital glaucoma, purpura, jaundice, cataracts, inflammation of the brain and surrounding tissues (meningoencephalitis), and other related findings⁶.
• Rubella IgM Antibody Test: The doctor might recommend this test to detect the IgM antibody, which is produced by the baby’s body against the rubella virus. These antibodies can remain detectable for up to 6 months after birth. Since IgM antibodies do not cross the placenta, their presence in a newborn usually indicates the infection. However, the test results should be interpreted along with RT-PCR results, the baby’s symptoms, and any history of rubella exposure, as there is a chance of the result being false-positive⁷.
• Rubella IgG Antibody Test: The doctor may recommend this test in suspected CRS cases to detect rubella-specific IgG antibodies. A single IgG test cannot confirm CRS because these antibodies may have passed from the mother to the baby during pregnancy. The doctor may recommend serial IgG testing to look for persistently high antibody levels. However, the results are read along with the baby’s symptoms and other tests, such as the RT-PCR test^7,8.
• Rubella RT-PCR Test: The doctor might recommend this test in suspected CRS cases. Both respiratory (such as throat) samples and urine samples are collected for accuracy. RT-PCR is very useful when IgM or IgG test results are unclear. 
• Other Tests: The doctor might also recommend hearing tests, eye examinations, heart imaging (echocardiogram), and brain imaging to identify complications associated with CRS⁸.

Note: RT-PCR is most accurate when performed early in the baby’s life because the amount of virus decreases over time. If the test is negative but CRS is still suspected, the doctor may recommend further evaluation or repeat testing, if appropriate.  

Treatment of Congenital Rubella Syndrome

Because CRS has no cure⁹, treatment usually focuses on managing symptoms, preventing complications, and supporting healthy growth and development. The following are common CRS treatment approaches suggested by doctors for different conditions: 

• Heart Defects: Treatment may include medicines, catheter-based procedures, or surgery in severe cases, depending on the type and severity of the defect and the baby’s overall condition¹⁰.
• Hearing Loss: Hearing aids, cochlear implants (when appropriate), and speech therapy (to help improve communication)¹¹.
• Eye Problems: Surgery for conditions such as cataracts, glaucoma, etc¹².
• Developmental Delays: Early intervention, including physical therapy, occupational therapy (which helps improve daily living skills), and speech therapy to support a child’s development and improve everyday functioning^6,13.
• Regular Follow-Ups: Ongoing check-ups to help monitor children with CRS for delayed or progressive health problems and allow early identification and management of complications¹⁴.

Complications of Congenital Rubella Syndrome

CRS can lead to several long-term health problems that affect the heart, eyes, ears, brain, and other organs, such as: 

• Permanent hearing loss (hearing impairment) 
• Vision problems such as cataracts, glaucoma, or retinal problems (contributing to long-term vision difficulties) 
• Seizures 
• Intellectual disability (some children may have long-term difficulties with learning, thinking, and problem-solving) 
• Delayed physical and mental development 
• Hepatitis (liver inflammation) 
• Hepatosplenomegaly (enlarged liver and spleen) 
• Bone abnormalities or damage 
• Diabetes 
• Thyroid disorders 
• Progressive rubella panencephalitis (a rare condition where rubella infection causes ongoing brain inflammation)³

Prevention Tips for Congenital Rubella Syndrome

CRS is a preventable condition. The following measures can help reduce the risk: 

• Get vaccines such as the measles, mumps, and rubella (MMR) before getting pregnant to protect against rubella infection^1,5.
• Vaccinate children and infants to help reduce the spread of the disease to pregnant women¹⁵. 
• Check immunity status, especially for women who are planning to become pregnant, to determine whether they have adequate protection against rubella before conceiving¹⁵.
• Avoid close contact with anyone who has rubella or related symptoms. 
• Practise good hand hygiene to reduce the spread of infections. 
• Inform the doctor immediately in case of being exposed to rubella during pregnancy. 

Why Is Rubella Vaccination Important?

Rubella vaccination is the best protection against rubella infection and CRS. It lowers the chance of infection in women of reproductive age and helps protect babies from rubella-related complications during pregnancy by supporting immunity against the virus^1,14. Vaccine-induced immunity is usually lifelong¹⁴. Widespread vaccination can also reduce new cases and limit the spread of rubella, which helps prevent CRS. 

Women who are not immune should receive the rubella vaccine before becoming pregnant¹. The vaccine is not advised during pregnancy because it contains a live, weakened virus. It is recommended to wait at least 4 weeks after receiving the rubella vaccine before trying to conceive⁹.

When Should You Consult a Doctor?

Consult a doctor in the following situations: 

• Pregnant and suspected exposure to rubella 
• Develop a rash, fever, or swollen glands during pregnancy¹
• Planning to get pregnant and unsure about the immunity status 
• A newborn has symptoms such as hearing problems, not responding to sounds, vision problems, jaundice, low birth weight, developmental issues, or a purple skin rash^3,5. 

Early medical evaluation can support timely diagnosis, management, and long-term care. 

Conclusion

CRS is a preventable condition that can cause serious health problems in babies when a mother gets infected with rubella during pregnancy. Early diagnosis, regular monitoring, and supportive treatment can help manage complications and improve the child’s quality of life. Rubella vaccination before pregnancy remains the most effective way to prevent the infection in mothers and infants. 

Frequently Asked Questions (FAQs)

References

1. Rubella. 2026. Available from: https://www.who.int/news-room/fact-sheets/detail/rubella 

2. Congenital Rubella Syndrome (CRS). 2022. Available from: https://www.dshs.texas.gov/sites/default/files/IDCU/investigation/electronic/EAIDG/2022/Congenital-Rubella-Syndrome-CRS.pdf 

3. Mawson AR, Croft AM. Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism. IJERPH. 2019;16(19):3543. doi:10.3390/ijerph16193543. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6801530/

4. Rubella. 2020. Available from: https://www.nfid.org/infectious-disease/rubella/ 

5. Congenital rubella. 2025. Available from: https://medlineplus.gov/ency/article/001658.htm 

6. Rubella, Congenital Syndrome (CRS) 2010 Case Definition. 2021. Available from: https://ndc.services.cdc.gov/case-definitions/rubella-congenital-syndrome-2010/ 

7. Chapter 15: Congenital Rubella Syndrome. 2026. Available from: https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-15-congenital-rubella-syndrome.html 

8. 5.1 Congenital Rubella Syndrome (CRS). 2020. Available from: https://archive.cdc.gov/www_cdc_gov/ncbddd/birthdefects/surveillancemanual/chapters/chapter-5/chapter5-1.html 

9. Pregnancy and Rubella. 2025. Available from: https://www.cdc.gov/rubella/pregnancy/index.html 

10. Congenital Heart Defects. 2025. Available from: https://medlineplus.gov/congenitalheartdefects.html 

11. Chen MM, Oghalai JS. Diagnosis and Management of Congenital Sensorineural Hearing Loss. Curr Treat Options Peds. 2016;2(3):256-265. doi:10.1007/s40746-016-0056-6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5222593/

12. Congenital Rubella Syndrome. 2026. Available from: https://eyewiki.org/Congenital_Rubella_Syndrome 

13. Liu S, Zhu M, Yi C, Zeng D. Early rehabilitation interventions for global developmental delay in children: a narrative review. Front Pediatr. 2025;13:1576324. doi:10.3389/fped.2025.1576324. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12287077/

14. Leonor MC, Muriam Afzal, Mendez MD. Rubella. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559040/ 

15. Prevention of congenital rubella syndrome. Paediatrics & Child Health. 1999;4(2):155-157. doi:10.1093/pch/4.2.155. Available from: https://academic.oup.com/pch/article-abstract/4/2/155/2655829

16. Rao M IS, Kasi SG, Dhir SK, et al. Indian academy of pediatrics (IAP) advisory committee on vaccines and immunization practices (ACVIP): Recommended immunization schedule (2023) and update on immunization for children aged 0 through 18 Years. 2024. Available from: https://indianpediatrics.net/epub012024/FTA-00592.pdf 

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