Epidemiology and Risk Factors. Since the rubella vaccine became available in 1969, rubella and the neurological complications of rubella have been due primarily to periodic outbreaks of the disease. The neurological syndromes associated with rubella virus infection include (1) the congenital rubella syndrome, (2) acute encephalitis complicating rubella, (3) postrubella polyradiculoneuritis, and (4) progressive rubella panencephalitis. y , y Acute encephalitis is a rare complication of rubella infection, with a reported incidence of 1 in 5000 to 1 in 24,000 cases. y Postrubella polyradiculoneuritis complicates rubella in an estimated 4 percent of patients. Only five cases of acute postrubella polyradiculoneuritis have been reported in the last 30 years. y The most common neurological complication of rubella infection is the congenital rubella syndrome. The gestational age at the time of infection determines the risk of fetal anomaly. y The risk of congenital rubella syndrome is greatest when infection occurs during the first trimester. Progressive rubella panencephalitis is a slow virus disease of the central nervous system that has many clinical similarities to subacute sclerosing panencephalitis caused by measles virus and is an uncommon late-onset manifestation of congenital rubella. y
Pathogenesis and Pathophysiology. The rubella virus is a single-stranded RNA virus. Infection is acquired by droplet inhalation; viral replication occurs in the nasopharynx with a subsequent viremia. The CNS is infected in the course of the viremia. Maternal viremia during the first trimester of pregnancy can infect the placenta and spread to the fetus. y Disease in the fetus exposed to this virus during the first trimester is severe. y
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