http://bmj.com/cgi/content/full/325/7364/596/b
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EDITOR
We
have diagnosed congenital rubella infection in another infant since publication
of our two other cases as a lesson of the week.1
The infant was born to a Sri Lankan primiparous woman who had lived in the United Kingdom for six years and had not travelled abroad in the recent past or had contact with rubella. The mother was susceptible to rubella on routine antenatal testing at 12 weeks' gestation. The infant was born at 34 weeks' gestation with intrauterine growth restriction and thrombocytopenia but no other serious sequelae.
The infant and mother both tested positive for rubella IgM. The mother gave a clear history of a transient, non-itchy rash at 26 weeks' gestation. We could not find any social or community link between this mother and those in our two previous cases.
Rubella is highly infectious. In a recent case report from another London hospital rubella virus was nosocomially acquired by an infant being cared for in the same neonatal nursery as an infant with the congenital rubella syndrome.2 As we know that at least three infants are excreting rubella virus in north west London, we now test for rubella IgM in all infants with severe intrauterine growth restriction (birth weight <3rd centile).
We believe that rubella infection may be underdiagnosed, given the recent decline in uptake of measles, mumps, and rubella (MMR) vaccination and the existence of at least five cases of congenital rubella infection in areas of London with large numbers of immigrant women from countries where rubella is endemic and childhood vaccination is not routine. A review of antenatal screening data from maternity units in north London showed that 23% of primiparous women of Sri Lankan origin were susceptible to rubella on routine antenatal screening testing in 1996-9 (P Tookey, personal communication).
A high index of suspicion and appropriate investigation of any suspicious rash in pregnancy are needed if the devastating effects of the congenital rubella syndrome are to be prevented from again becoming widespread in the United Kingdom. Clear guidelines on the management of, and exposure to, rash in pregnancy are contained in a report fom a working party of the Public Health Laboratory Service.3
Primary healthcare workers and midwives need to be aware of the need for
targeted immunisation before pregnancy and for extra vigilance,
particularly in women of childbearing age who have recently arrived
from countries where rubella is endemic.
Roslyn M Thomas
Nilesh M Mehta
Northwick Park Hospital, Harrow HA1 3UJ
ros.thomas@nwlh.nhs.uk
| 1. | Mehta NM, Thomas RM. Antenatal screening for rubellainfection
or immunity? BMJ 2002; 325: 90-91[Full
Text]. (13 July.) |
| 2. | Sheridan E, Aitken C, Jeffries D, Hird M, Thayalasekaran P. Congenital rubella syndrome: a risk in immigrant populations. Lancet 2002; 359: 674-675[Medline]. |
| 3. | Morgan-Capner P, Crowcroft N. Guidance on the management of, and exposure to, rash illness in pregnancy (including consideration of the relevant antibody screening programmes in pregnancy). Report of a Public Health Laboratory Services working group. London: PHLS, 2000. |
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infection
or immunity?.
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