Clinical Review Lesson of the week

Antenatal screening for rubella—infection or immunity?

BMJ 2002; 325 doi: (Published 13 July 2002) Cite this as: BMJ 2002;325:90
  1. Nilesh M Mehta, specialist registrar,
  2. Roslyn M Thomas, consultant paediatrician (
  1. Neonatal Intensive Care Unit, Northwick Park Hospital, Harrow HA1 3UJ
  1. Correspondence to: R M Thomas
  • Accepted 11 December 2001

Rubella vaccination among schoolgirls and susceptible women in the United Kingdom since 1970 has dramatically reduced the number of cases of congenital rubella syndrome and terminations of pregnancies related to rubella infection.1 In 1988 the combined measles, mumps, and rubella vaccine was introduced for children aged 12-15 months. Reported cases of congenital rubella syndrome declined significantly, with only a few notified cases of infection among immigrants and in infants whose mothers acquired the infection while travelling overseas in early pregnancy. Immune status of pregnant women is determined by routine antenatal screening for rubella IgG antibody, so that susceptible women can receive postpartum vaccination.

We report two infants with congenital rubella syndrome whose mothers had recently arrived from abroad. Both mothers had a rash in early pregnancy in their country of origin, which was not elicited when they booked for antenatal care in the United Kingdom.

Case reports

Case 1

A 22 year old primiparous Sri Lankan woman had routine antenatal screening tests at 20 weeks' gestation, soon after her arrival in the United Kingdom. The laboratory reported presence of rubella IgG antibody, “consistent with immunity.” The infant was born with severe symmetrical intrauterine growth restriction, purpura, thrombocytopenia, and a patent ductus arteriosus. Cranial ultrasonography showed bilateral periventricular calcification (fig 1). Skeletal radiographs showed linear radiolucencies in the metaphyses of the long bones and lucent areas in the …

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