Risk of rubella in nonimmune pregnant woman

1. Avoid exposure to suspected rubella cases (most important)

• Avoid close contact with anyone who has:
  • Fever with rash
  • Known rubella infection
  • Suspected viral exanthem
• Avoid visiting households where:
  • A child has a recent rash illness
  • Rubella outbreak is suspected

Particularly important exposures to avoid:

• Schools
• Day-care centers
• Pediatric outpatient clinics
• Crowded gatherings during outbreaks

This is especially critical during:

• First trimester (highest CRS risk)

2. Household precautions

Family members should:

• Ensure children are fully vaccinated with MMR Vaccine (Measles–Mumps–Rubella)

Important point:

• Vaccinated children do not pose a risk to the pregnant woman
• The vaccine virus is not transmitted to contacts

So vaccinating household members is protective, not risky.

3. Avoid travel to outbreak areas

If there is a known outbreak of Rubella:

• Use masks in crowded places if exposure risk exists

4. Immediate action after suspected exposure

If exposure occurs:

• Contact obstetrician immediately
• Do serologic testing:

Tests:

• Rubella IgG
• Rubella IgM
• Repeat IgG in 2–3 weeks

This helps detect:

• Seroconversion
• Recent infection

5. Understand that vaccine cannot be given during pregnancy

MMR Vaccine is:

• Live attenuated vaccine
• Contraindicated in pregnancy

So:

• No vaccination during pregnancy
• Vaccination should be done after delivery

6. Postpartum vaccination

If non-immune:

• Give MMR Vaccine after delivery
• Safe even if breastfeeding
• Avoid pregnancy for 1 month after vaccination

This prevents risk in future pregnancies.

Risk of CRS by gestational age

Gestational age	Risk of CRS
<11 weeks	~80–90% (very high)
11–16 weeks	~10–20%
16–20 weeks	Low but possible
>20 weeks	Very low risk

Classic features of Congenital Rubella Syndrome

Key anomalies include:

• Congenital Heart Defects - Especially Patent Ductus Arteriosus
• Cataract
• Sensorineural Hearing Loss

Other possible features:

• Microcephaly
• Growth restriction
• Hepatosplenomegaly
• Thrombocytopenia

If she is a healthcare worker or teacher

Extra caution needed:

• Check immunity status early in pregnancy
• Avoid working with children with rash illness
• Use protective measures if exposure risk is unavoidable