Rubella (German measles) during pregnancy

Rubella (German measles) during pregnancy

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Why do I need to be screened for immunity to rubella?

In the United States, your chances of being exposed to rubella (also known as German measles) are extremely low. But you need to know whether you're immune.

If you're not immune to rubella and you come down with this illness during early pregnancy, it could be devastating for your baby. You could have a miscarriage or your baby could end up with multiple birth defects and developmental problems. Congenital rubella syndrome, or CRS, is the name given to the pattern of problems caused when a baby is born with the virus.

So if you weren't screened for rubella immunity before you got pregnant, you'll have this blood test at your first prenatal appointment.

Fortunately, experts estimate that about 90 percent of the U.S. population over 5 years old is immune to rubella, either because they've been immunized against it or because they had the illness as a child. (People born in countries without routine rubella vaccination programs are less likely to be immune.)

By the way, German measles is not the same as regular measles (rubeola), and having immunity from one illness does not protect you from the other.

How common is rubella?

Rubella has become quite rare in the United States, thanks to a very successful vaccination program. Before the rubella vaccine was developed in 1969, a rubella epidemic in 1964 and 1965 caused 12.5 million cases of the disease and 20,000 cases of CRS in the United States. In contrast, between 2001 and 2005, there were a total of 68 reported cases of rubella and five reported cases of CRS. And in 2006, there were just 11 reported cases of rubella and only one case of CRS.

That said, rubella outbreaks have occurred sporadically in the United States over the years, so it's still crucial to have your children vaccinated and to get vaccinated yourself (when you're not pregnant) if you're not already immune.

In addition, about a third of the world's countries still lack rubella vaccination programs, so the virus remains common in many developing nations. The World Health Organization estimates that there are 110,000 cases of CRS every year.

I'm pretty sure that I got the rubella vaccine as a child, but the test says I'm not immune. Is that possible?

Yes, though it doesn't happen often. A small number of people who are vaccinated don't get an antibody response that's large enough to be detected by the screening test. It's also possible for the effect of the vaccine to wane over time.

What are the symptoms of rubella?

Rubella is an acute viral illness, but the symptoms can be pretty nonspecific, which makes it hard to distinguish from other illnesses. In up to half of the cases, the symptoms are either nonexistent or so mild that you might not know you were infected.

If you do have the typical symptoms, they start to show up about 12 to 23 days after you're exposed to the illness. You may have a low-grade fever, malaise, headache, swollen lymph nodes, joint pain and swelling, reddened eyes, and a stuffy or runny nose for one to five days before a rash erupts.

The rash lasts only a few days, usually appearing first on the face and later spreading to other parts of the body. The swollen glands and joint pain can last several weeks. You're contagious one week before the rash first appears and for another week or so after. The most contagious period is when the rash is erupting.

What should I do if I think I've been exposed to rubella during pregnancy?

Contact your healthcare practitioner right away and let her know that you think you've been exposed. Don't show up unannounced at your practitioner's office and risk infecting other pregnant women. If you need to be seen, the doctor's staff will make special arrangements so that you aren't sitting in a crowded waiting room.

If you weren't previously immune or haven't been tested yet, your caregiver will want to do a blood test immediately to check for rubella-specific antibodies. You'll have another blood test in two weeks and perhaps one more in four weeks. (Certain changes in your antibodies from when you were first tested for immunity indicate a recent infection.)

If you're already immune to rubella when you're exposed, there's a small risk of reinfection, but it's unlikely that your baby would become infected. Further testing may not be necessary, but you should still contact your caregiver to discuss your individual situation.

If you're found to have rubella in early pregnancy, you'll see a maternal-fetal medicine specialist (MFM) about the risks to your baby, and you'll need to decide whether to terminate the pregnancy. There's no known effective treatment for rubella or any way to prevent infection after exposure.

If you choose not to terminate your pregnancy, your practitioner may give you a shot of immune globulin as soon as possible after exposure in the hope of reducing your baby's risk of defects. However, the shot won't prevent your baby from becoming infected.

How can I reduce my risk of getting rubella while pregnant if I'm not immune?

Unfortunately, you can't receive the rubella vaccine if you're already pregnant. If you're not immune, you'll just need to be careful to avoid anyone with a rash or virus as well as anyone who's recently been exposed to rubella and hasn't had it before. Here are some important precautions:

  • Make sure that your children have had all their vaccinations and that anyone else in the house who's not immune gets the vaccine. (You won't catch rubella from someone who has recently been vaccinated.)
  • Avoid contact with other people if there's even one known case of rubella in your community. Stay home from work or school during the outbreak until you're informed by public health officials or your caregiver that the danger of infection has passed.
  • Definitely postpone travel plans to any part of the world where rubella is still common.

Once you give birth, be sure to get vaccinated so that rubella won't be a concern for you during your next pregnancy. You can do this while you're breastfeeding, but you'll need to wait at least 28 days after getting the shot before you start trying to conceive again, so make sure you're using birth control during this time. (If you do happen to get pregnant within 28 days of the shot, the chances that it would harm your baby are very low, but it's best to be cautious.)

What would happen to my baby if I got rubella during pregnancy?

A rubella infection can cause miscarriage, preterm birth, or stillbirth, as well as a variety of birth defects, but it depends on how far along you are when you contract the virus. The risks are highest during the early stages of a baby's development and they go down as pregnancy progresses.

If you get rubella during the first 12 weeks of pregnancy, there's a high chance (up to 85 percent) that your baby will develop CRS. The rate of CRS for a baby whose mother is infected between 13 and 16 weeks is about 54 percent, and the rate continues to go down sharply from there. After 20 weeks there's very little risk that the infection will cause a birth defect.

There's a wide range of very serious problems associated with CRS, most commonly deafness, eye defects (which may lead to blindness), heart malformations, and neurologic problems, such as intellectual disability. Other defects may also be evident at birth, or problems may surface later in infancy and childhood.

While these are terrible consequences, remember that the likelihood of your being exposed to rubella in the United States is currently extremely low. Still, it's good to know why you're being tested, what you can do to reduce the risk to yourself and your baby if you're not immune, and how you can protect yourself in the future.

Watch the video: Signs of Congenital Rubella Syndrome (June 2022).


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