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Gregg's congenital rubella patients 60 years later

Med J Aust 2002; 177 (11): 664-667.

Summary

Background: In 1941, a Sydney ophthalmologist, Norman McAlister Gregg, correctly identified the link between congenital cataracts in infants and maternal rubella early in pregnancy. Fifty of Gregg's subjects with congenital rubella, born in 1939–1944, were reviewed in 1967 and again in 1991. We reviewed this cohort in 2000–2001, 60 years after their intrauterine infection.

Methods: The subjects underwent full clinical assessment, plus pathology tests, an ophthalmological and cardiological review (including electrocardiography and echocardiography) and HLA histocompatibility testing.

Results: Since they were first seen in 1967, 10 have died (cardiovascular causes [4], malignant disease [4], AIDS [1], and hepatitis C-related cirrhosis [1]). All surviving men came for review (19) and 13 women (eight women declined). Echocardiography showed mild aortic valve sclerosis in 68%. The prevalence of diabetes (22%), thyroid disorders (19%), early menopause (73%) and osteoporosis (12.5%) was increased compared with the Australian population; 41% had undetectable levels of rubella antibodies. The frequency of HLA-A1 (44%) and HLA-B8 (34%) antigens was increased, and the haplotype HLA-A1, B8, DR3, said to be highly associated with many autoimmune conditions, was present in 25%.

Conclusions: This cohort of people with congenital rubella has illuminated our understanding of viral teratogenesis.

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  • Jill M Forrest1
  • Fiona M Turnbull2
  • Gary F Sholler3
  • Richard E Hawker4
  • Frank J Martin5
  • Margaret A Burgess6
  • Trevor T Doran7

  • 1 Royal Alexandra Hospital for Children (trading as The Children's Hospital at Westmead), Westmead, NSW.
  • 2 Australian Red Cross Blood Services, Sydney, NSW.

Correspondence: jillf@chw.edu.au

Acknowledgements: 

We thank the 50 subjects, their families and their doctors, and all the staff and departments at the Royal Alexandra Hospital for Children (trading as The Children's Hospital at Westmead) who cooperated in the study, particularly Dr Christopher Cooper, Dr Rohit Manokumar and Dr Adam Steinberg.

The complete clinical findings in the 32 subjects, including HLA antigen status, are available from the authors.

Competing interests:

None identified.

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