If a pregnant woman contracts rubella during the first 17 weeks of pregnancy, the risk of her newborn developing congenital rubella is as high as 80%, which can lead to spontaneous abortion, intrauterine death, and severe fetal malformations. In the past, patients and clinicians in Italy were frightened by this risk. However, thanks to widespread population vaccination, the World Health Organization declared endemic transmission of rubella in Italy eliminated in 2021. The Italian National Institute of Health has taken note of this and in its recently updated guidelines for the management of physiological pregnancy, guidelines for the management of physiological pregnancy are no longer recommended. Offer rubella testing to all pregnant women.
rubeo test
The Rubeo test is an assay to detect antibodies in the blood produced by vaccination or past rubella infection, and is traditionally part of the test package that all doctors prescribe to pregnant women in the first trimester. Masu. According to the previous version of the guidelines, if a woman is unvaccinated, has never had the virus, and tests show she is at risk, she should be tested at 17 weeks pregnant. Need to repeat. The aim is to detect rubella contracted during pregnancy and to provide multidisciplinary counseling to women if they are at high risk of severe fetal damage. However, if you become infected after 17 weeks, the risk of congenital hearing loss is minimal. There is no treatment to prevent vertical transmission if infected during pregnancy.
The previous guidelines also recommended that women at risk of infection be scheduled for postpartum vaccination to protect future pregnancies. Rubella vaccination is contraindicated during pregnancy because rubella vaccine may be teratogenic.
Recommendation updates
In the early 1990s, universal vaccination of newborns against rubella was introduced in Italy. In 2017, it became one of the 10 mandatory childhood vaccinations. In June 2022, the Ministry of Health reported a vaccination rate of 93.8% for children aged 24 months, a first vaccination rate of 93.3%, and a second vaccination rate of 89.0%. Second vaccination in the 2003 birth cohort.
“Rubella is a notifiable disease, and in 2013 the new national surveillance system detected 1 case of congenital rubella per 100,000 newborns. No cases have been reported since 2018. “No,” said Vittorio Basebi, a gynecologist with the Society of Perinatal Technology and Science. Coordinator of the Technical and Scientific Committee, Advisory Board of Emilia-Romagna, which developed the latest guidelines. “Thanks to widespread vaccination, the infection is no longer widespread in Italy. Based on these data, we have decided to no longer offer screening to pregnant women.”
The recommendation to offer rubella vaccination postpartum to women with two doses or no evidence of previous infection remains confirmed.
Patients born overseas
How should I care for a pregnant woman born in a country where the rubella vaccine is not widely available? She is more likely to be infected than the average Italian. “On the other hand, this virus is no longer prevalent in our country, so the chances of contracting the virus during pregnancy are very small, unless you have recently traveled to your home country or come into contact with a family member who recently arrived in Italy. ” said Basevi. “The guidelines speak of offering screening tests to all pregnant women. It is up to the attending physician to decide in a particular case whether to adopt what science and good conscience deem appropriate. .”
This article has been translated from italian universitypart of the Medscape Professional Network.