Congenital rubella syndrome. How can we do better?
QUESTIONMy 22-year-old patient immigrated to Canada 6 years ago from a country where there are no routine immunizations. She is now at 10 weeks' gestation and was exposed to a child with rubella infection. Her immune status is unknown. Should I give her passive or active immunization? How should I follow her pregnancy? And what should I tell her about the risk for her fetus?ANSWERIf the exposure took place less than 1 week ago, blood should be sent for rubella antibody titre. If results are positive for IgG, she is immune and there is no risk for the fetus. If a patient's immune status is unknown and the time of exposure is uncertain, serum samples for rubella antibodies should be obtained 3 weeks apart. Detection of rubella-specific IgM in a sample will confirm recent infection. Your patient should be counseled about the potential risk for her fetus and referred to high-risk pregnancy clinic for follow up. If seroconversion does not take place, she requires immunization immediately postpartum before discharge from hospital.
Bar-Oz
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Division of Infections Dieases at the Hospital for Sick Children, Toronto.
Ford-Jones
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Koren
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D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002170:Canada / Q000453:epidemiology; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012409:Rubella / Q000097:blood / Q000151:congenital* / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012412:Rubella virus / Q000276:immunology; D014611:Vaccination
D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M