Although it is a mild childhood disease, the infection of the pregnant women, especially during the first 16 weeks, results in abortion, the death of the fetus in the uterus or congenital anomalies.

Between 2002-2003 Romania faced an epidemic of rubella, with 115,000 cases of rubella, with an incidence of 531 cases in 100,000 inhabitants. There were suspected 150 cases of CRS (Congenital Rubella Syndrome), and 7 were confirmed by positive serology for IgM.

A, Marine M, Pistol A, Nagarajan D, Lama E, Uzicanin A, Reef S. A Large Rubella outbreak, Romania-2003. Euro Surveill 2004; 9:7-9.

In 2011-2012 Romania faced a new rubella epidemic that affected over 20,000 people. In the case of pregnant women, the rubella virus can infect and replicate in the placenta, and the prognosis of fetal infection correlates with the age of pregnancy.

The infection of the fetus in the first trimester of pregnancy causes fetal malformations because this period corresponds to fetal organogenesis, or the death of the fetus in uterus or spontaneous abortion.

If the infection of the fetus occurs in the second trimester, when the immune system of self recognition has not yet been formed, the rubella virus will be tolerated immunologically, persisting in the body in the form of chronic infection, the congenital evolutionary rubella.

Riscul transmiterii rubeolei și riscul malformativ în relație cu vârsta sarcinii la care a avut loc seroconversia

RS, Duszak. Congenital rubella syndrome - major review. Optometry. 2009;80:36-43.

In the case of late mother’s infection, although the malformative risk is 0, there is a risk of chronic fetal infection and congenital evolutionary rubella.

In a prospective study conducted on a number of 1,016 cases of rubella in pregnant women, only 40% were able to continue the pregnancy until the term.

Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982; 2:781.

In 2014, in Romania, have been were reported 30 cases of rubella and no deaths. Of the 30 cases of rubella: 22 were confirmed with the laboratory, 7 were classified as possible on the basis of clinical criteria and 1 case was probably classified.

Since the last epidemic of rubella in 2003, the incidence has started to increase at the end of 2011.

The distribution of rubella cases according to the immune status was the following: 18 unvaccinated cases, 8 cases were vaccinated with a dose of ROR (rubeola-mumps-rubella vaccine) and 4 cases were vaccinated in a history of two doses of ROR. The 18 unvaccinated cases were recorded at the following age groups: Under 1 year-7 cases; 1-4 years-4 cases; 10-14 years-1 case; 20-24 years-2 cases; 30-34 years-3 cases; 40-44 years-1 case. Of the total cases of rubella a probable case of rubella was recorded in a pregnant woman in Bucharest which refused to collect the second sample; the age of pregnancy being 13 weeks.

Within the surveillance system of the Congenital Rubella syndrome (SRC), in 2014, a number of 31 suspected IRC/SRC cases from 12 counties, classified as: 2 cases confirmed of SRC, 28 probable SRC cases and 1 disproved case were reported.

In 2014, from the living newborns two deaths from the casses CRS classified as possible were reported in the congenital rubella syndrome surveillance system.

In a study, carried out in Italy in 2008-2012, 160 cases of rubella in pregnant women were reported, with 62 newly infected newborns, 31 voluntary abortions, a spontaneous abortion and one newborn death (stillbirth) (Giambi C, Filia A, Rota MC, et al. Congenital rubella still a public health problem in Italy: Analysis of national surveillance data from 2005 to 2013. Euro surveillance: Bulletin Europeen sur les malady transmissibles = European communicable disease Bulletin. 2014 Dec; 20 (16).

A total of 60 rubella patients were included in the study (33 of them were diagnosed with rubella before 12 weeks of gestation (group 1) and 27 after 12 weeks (Group 2)). In the first group were reported 5 abortions and 4 fetuses death. IgM antibodies were present in the case of 7 newborns (Andrade JQ, Bunduki V, Curt SP, et al. Rubella in pregnancy: intrauterine transmission and perinatal outcome during a Brazilian epidemic. Journal of clinical virology. 2006 Mar 31; 35 (3): 285-91).

National surveillance in Australia highlighted 5 cases of congenital rubella in the period 2004-2013, compared with the period 1993-2013 when there were 34 confirmed cases.

(Khandaker G, Zurynski Y, Jones C. Surveillance for congenital rubella in Australia since 1993: Cases reported between 2004 and 2013. Vaccine. 2014 Nov 28; 32 (50): 6746-51).