Congenital Rubella in Florida, 2025: A Baby Infected Before Birth

At a glance

• Known before: rubella in early pregnancy can cause miscarriage, fetal death and a pattern of birth defects called congenital rubella syndrome (CRS). Rubella was declared eliminated from the United States in 2004, but it remains a leading cause of vaccine-preventable birth defects worldwide.
• Found here: a baby with CRS was born in Florida to a mother from a country that hadn't yet introduced rubella vaccine. She was likely infected in her first trimester, while visiting her home country.
• What follows: women aged 15–49 without proof of rubella immunity should be offered a rubella-containing vaccine before pregnancy, and clinicians should think of rubella in anyone with fever and rash after travel where it's common.

The baby

In July 2025, a Florida hospital reported suspected CRS to the Florida Department of Health (FDOH): a boy, 6 days old, born at 40 weeks.

• At birth: small for gestational age — 6.48 lbs (2,940 g), against a typical 7.72 lbs — with microcephaly (a small head).
• First day: breathing distress, bluish skin (cyanosis), low platelets and a widespread rash; admitted to the neonatal intensive care unit (NICU), where doctors also found a heart defect (patent ductus arteriosus), cataracts and hearing problems.
• Confirmation: blood tests on day 4 found rubella IgM antibodies; nose swabs on day 6 tested positive for rubella virus by PCR at the state lab.

On day 12 he moved to another hospital for advanced care and heart surgery, and went home after 40 days, with referrals to specialists.

The mother

She was a 23-year-old South African citizen living in Florida since 2023. She'd had all the childhood vaccines South Africa recommended — but South Africa didn't add rubella vaccine to its routine schedule until 2024, so she was presumably unvaccinated.

• Travel: she visited South Africa in June 2024 and returned to Florida on September 25.
• Illness: on October 12 an urgent care center saw her for cough, congestion, swollen neck glands, joint and muscle aches and a rash; rubella wasn't considered, and she was told she had an unspecified virus.
• Pregnancy: confirmed a month later, on November 11; on November 26 she was about 9 weeks, 4 days along. On December 11, prenatal screening found rubella antibodies — evidence of past infection or vaccination. Her prenatal care was good, and at 20 weeks ultrasound showed the fetus was small.

Investigators concluded she was most likely infected in the first 3 weeks of pregnancy. CDC's genotyping found rubella genotype 2B, closely related to strains circulating in South Africa in 2024.

Stopping spread

Babies with CRS are considered infectious until age 12 months, or until two negative PCR tests taken 1 month apart. The baby was kept under contact precautions; FDOH advised his outpatient providers, and on October 28 testing showed he was no longer infectious. All 22 hospital staff who had close contact with him were immune.

Why it matters

Rubella usually causes a mild fever and rash after 12–23 days of incubation, and 25%–50% of infections cause no symptoms. But in pregnancy — especially the first trimester — it can cause CRS. Rubella and CRS were declared eliminated from the United States in 2004, yet travel-related infections still occur. Despite a decade of progress, 16 countries still leave rubella vaccine out of their routine childhood schedules, and rubella remains endemic in South Africa, which had a large outbreak of about 10,000 cases in 2024.

CRS is preventable. Women of reproductive age without proof of rubella vaccination — such as the measles, mumps and rubella (MMR) vaccine — or other evidence of immunity should be vaccinated before pregnancy, and clinicians should consider rubella in unimmunized patients with fever and rash, especially after travel.

Sources

Based on "Notes from the Field: Congenital Rubella Syndrome — Florida, 2025," by Mohammad Alak and colleagues of the Florida Department of Health, AdventHealth for Children and CDC, Morbidity and Mortality Weekly Report, CDC; a work of the United States government in the public domain. The 16 countries were, as of December 31, 2025: Afghanistan, the Central African Republic, Chad, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea-Bissau, Liberia, Madagascar, Niger, Nigeria, Somalia and South Sudan.