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Rubella during pregnancy can cause miscarriage, stillbirth or congenital rubella syndrome (CRS) — low birth weight and birth defects such as deafness, cataracts, heart defects and intellectual disabilities. The risk of CRS runs from 10% to 90%, highest when infection comes in the first trimester. Thanks to high MMR vaccine coverage, rubella stopped spreading endemically in the United States in 2004. A case in Kansas showed how easily it can still slip through.
The case
| When (2017) | |
|---|---|
| 17 days before her rash | the woman's unvaccinated brother, 22, stays with her after returning from India, where rubella circulates; a rash on his legs is diagnosed as poison ivy. She is 15 weeks pregnant |
| Dec. 6 | she goes to an emergency department with palpitations, a burning, itchy rash and fever |
| Dec. 9 | a second ER tells her it's an allergic reaction |
| after that | an internet search makes her suspect rubella; her obstetrician refers her to a primary care provider |
| Dec. 12 | the provider sends blood for rubella IgM testing |
| Dec. 14 | the test is positive; the provider tells her but doesn't notify the health department. A school nurse hears of it at pickup and alerts the Johnson County Department of Health and Environment |
The woman, 27 and born in the U.S., was 19 weeks pregnant at diagnosis. She had declined vaccination by personal choice, and had tested not immune early in the pregnancy. She hadn't traveled. CDC testing of her and her brother showed low-avidity IgG — a sign of recent infection.
Tracing contacts
Of about 120 contacts, three were unvaccinated: her 11-year-old daughter, a hospital staff member and a coworker. All three were told to avoid pregnant women for 23 days, and the daughter and staff member stayed out of school and work for 21 days. The staff member got the MMR vaccine before returning.
The baby
A high-risk obstetrician followed her through the pregnancy; all follow-up tests were negative. In May, she delivered a full-term, apparently healthy baby. The baby's heart, skeleton, head, hearing and eyes checked out normal. The baby's first rubella IgM was positive, so the infant was treated as infectious until two rounds of specimens, 30 days apart, tested negative for the virus. With no birth defects, the baby met the criteria for congenital rubella infection, not CRS, and continued to see an infectious disease specialist.
Lessons
- Health care workers should all have proof of MMR vaccination or immunity, as ACIP recommends.
- Providers should check women of childbearing age for rubella immunity and recommend vaccination.
- Pregnant women who aren't immune should be vaccinated right after delivery — this woman's first birth was a missed chance.
- When a pregnant woman has a rash illness, ask about international travel — hers and her contacts'.
- Providers need to report suspected vaccine-preventable diseases promptly.
Sources
Based on Tiffany Wallin, Elizabeth Holzschuh and Caitlin Kintner (Johnson County Department of Health and Environment), "Notes from the Field: Rubella Infection in an Unvaccinated Pregnant Woman — Johnson County, Kansas, December 2017," MMWR, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain; rewritten in hubnx's own words.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
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