Key result
Congenital rubella syndrome is linked to ~58% higher odds of left-to-right shunt lesions.
Why the study?
The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied and requires detailed description.
Observational (n=4,578)
Yes
Odds Ratio: 1.58 (95% CI 1.15–2.17)
Structural heart defects are present in three-quarters of infants with congenital rubella syndrome, with complex defects significantly increasing mortality risk.
High cardiac defect prevalence in CRS supports routine echocardiography in suspected cases; observational surveillance extends phenotype data but leaves causal links open.
Background: The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016-22. Methods: Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as 'Simple' or 'Complex' as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings: Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15-2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42-2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26-3.30). Interpretation: Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding: Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.
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Gunasekaran et al. (2023) conducted an observational in Congenital rubella syndrome (n=4,578). Laboratory confirmed congenital rubella syndrome vs. Seronegative discarded cases was evaluated on Left to right shunt lesions (OR 1.58, 95% CI 1.15-2.17). Laboratory confirmed congenital rubella syndrome in infants was associated with higher odds of left to right shunt lesions compared to seronegative cases (OR 1.58; 95% CI 1.15-2.17).
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