Of the five diseases generally recognised as causing congenital defects, viz., toxoplasmosis, rubella, cy tomegaloviral infection, herpes simplex and syphilis (TORCHES) studied in Malaysia, rubella was found to be the most important. A total of 574 children with features of congenital rubella syndrome (CRS) were examined for rubella-specific IgM (in infants four months and below), and for rubella HAl antibodies (in children six months to four-years-old), and compared with 374 normal children of the same age groups. Whereas the prevalence rate of rubella in normal children was only 1.3%, in children with CRS (multiple defects) it was 87.3%; with congenital heart disease 71.0%; with congenital cataract 64.0%; with deafness 60.1%; with rash 30.8%; with hepatomegaly 17.1%; with mental retardation 4.1 %. Congenital rubella was not important as a cause of neonatal jaundice (0.9%)
and CNS defects (0%).
A retrospective review of rubella serological results carried out in the Virus Diagnostic Unit, University Hospital Kuala Lumpur (UHKL) from January 1993 to September 1999 showed the presence of rubella infection annually which appeared to increase periodically every two to three years. There was no statistical significant difference in the rubella positive rate between male and female population aged 14 to 48 years. Congenital rubella infections (CRI) occurred in babies delivered in UHKL yearly from 1993 to 1998 with an average incidence rate of 48 per 100,000 deliveries. Peaks of rubella cases appeared to be followed by an increase in incidence of CRI cases 6 to 9 months later. The study showed that only 50.8% clinically diagnosed rubella was confirmed by laboratory finding. This study also showed an increase of rubella activity for the months of July, August and September 1999 and this may herald an increase of CRI cases in the coming millennium.