Management

• none. Treatment if necessary is supportive (1). Prophylaxis by active immunization
  
  
• antenatal screening identifies mothers who will require vaccination during the puerperium. From October 2003, sero-negative women of child-bearing age and health workers who need to be protected against rubella will be offered the combined measles-mumps-rubella (MMR) vaccine (2). However pregnancy should be avoided for at least one month after receiving rubella-containing vaccine because the vaccination is live
  
  
• if rubella infection is suspected during pregnancy then expert advice should be consulted. The diagnosis should always be confirmed - via virus isolation, or antibody tests showing seroconversion or specific IgM. All pregnant women with suspected rubella or exposed to rubella must be investigated serologically, irrespective of a history of immunisation, clinical rubella or a previous positive rubella antibody test (3). Therapeutic abortion is generally recommended after proven infection during the first trimester. The doctor must counsel her as to the risks associated with congenital rubella syndrome
  
  
• vaccination with live attenuated virus is contraindicated during pregnancy and expert advice should be consulted regarding management.
• Human normal immunoglobulin (HNIG)
  • gammaglobulin is used as subcutaneous or intramuscular injection (4)
  • should only be used if termination of pregnancy is unacceptable and not for protection of pregnant women exposed to rubella (3)
  • if gamma globulin is given soon after exposure there may be a reduced incidence of clinical infection. However there may still be subclinical infection present and the fetus may still become infected. The value of gamma globulin given to pregnant women who are exposed to rubella is disputed. There is a minimal rise in antibody after the gamma globulin injection is given; this however does not cause difficulty in interpretation of subsequent serological tests

Infected infants excrete virus for months and are a source of infection.

Reference:

• (1) Health Protection Agency (HPA). General Information on Rubella (German Measles)
• (2) Department of Health (September 26th 2003). Protecting women against rubella: switch from rubella vaccine to MMR. PL/CMO/2003/7, PL/CNO/2003/8, PL/CPHO/2003/5
• (3) The Green Book. Immunisation against infectious disease. HMSO. London 1996.
• (4) Health Protection Agency (HPA). Immunoglobulin handbook: Chapter 5 – Rubella.
• (5) Christie AB (1987) Infectious Diseases - Epidemiology and Clinical Practice, 4th edn. Churchill Livingstone.