A Simple Guide for Rubella Immunity Testing During Pregnancy
A seemingly mild disease can sometimes cause worrying complications. Rubella is one such infection that presents itself with mild symptoms for a short duration but can also cause serious consequences in one set of the population.
Most people know rubella as ‘German measles’ because of the striking similarities in the clinical findings of measles and rubella. For a while, rubella was considered an innocent infection until a correlation between it and severe birth defects was made. Rubella immunisation has long been part of the routine vaccine schedule for all children worldwide as recommended by the WHO. However in a statistical report by the WHO in January 2018, the proportion of children vaccinated worldwide have stalled at 86%, which means that close to 20 million children are not immunised as they should each year. It is also regularly screened for in adults, particularly women of child bearing age.
Rubella and its Biomarker: Rubella IgG and IgM Antibodies
This acute infectious disease is caused by the Rubella virus that spreads through air droplets. If infected, one typically experiences low-grade fever, a measles-like rash and swelling of the lymph nodes (behind the ear). The signs and symptoms of the disease usually last for a period of 2-3 days before subsiding completely.
Rubella immunity (through vaccination or past infection) is determined by a lab test that measures the level of rubella IgG antibodies in your blood. If the test is positive, it generally means that you are immune to rubella infection. Current or recent infection is usually diagnosed clinically by your doctor with your symptoms and signs, aided by a laboratory test called rubella IgM antibody test. Usually the IgM antibody is detected within 3 days after onset of rash. If the test result is positive, it means that you have a rubella infection.
Why Should You Get Screened for Rubella Immunity?
Getting screened for rubella is essential especially if you’re a woman, because of the risk of a baby being exposed to virus in first trimester (even beyond) and developing the congenital rubella syndrome. The significance of the virus lies in this syndrome. Congenital rubella syndrome (CRS) causes birth defects in a child involving the heart (abnormal ducts that require surgery), brain (abnormal development) and eyes (cataracts).
Women who are infected with rubella virus in the first trimester of pregnancy have a 90% chance of transmission to the unborn child. There is a high probability of child being born with CRS (85%), stillbirth, and/or preterm birth.
This is a highly contagious virus, and anyone who has a fever and rash, who has been in contact with or traveled through an endemic region should be screened for their immune status and potential infectiousness. Any pregnant woman must screen for their rubella IgG (immune status), and if negative, be alert and stay away from infected people or regions- especially in the first trimester. Women should not be immunised during pregnancy. If you are planning for pregnancy and are not immune to rubella, then the best advice is to get immunised and wait for at least one month before trying to get pregnant. See your doctor about this.
What if I’m Not Immune?
Anyone who is not immune to rubella can get vaccinated at any age. There are few contraindications for the live attenuated vaccine, and if you do fall into this group then see your doctor regarding other ways to prevent rubella infection: HIV positive population, active rubella infection, untreated tuberculosis, leukaemia, immunocompromised individuals, active fever, malignant lymphoma, disease of gamma globulin, pregnancy.
Thanks to the rubella vaccination regimes, rubella outbreaks is now a thing of the past in regions of the world with high vaccine coverage. The rubella RA 27/3 vaccine (live attenuated strain) is the most commonly used vaccine (other strains are used in China and Japan). In children, the rubella vaccine is given in combination with the vaccines for mumps and measles (known as the MMR vaccine) at the age of 12-15 months. The second dose is given at 4-6 years of age.
For non-immune pregnant women exposed to the virus, there’s no effective treatment for rubella or any way to prevent infection after exposure. If a rubella infection is confirmed and you choose to continue with your pregnancy, your practitioner may give you a shot of immune globulin as soon as possible after exposure in the hope of reducing your baby’s risk of defects. This however does not prevent transmission of virus to the unborn child. Remember to inform the doctor that you have been exposed to rubella, and don’t show up unannounced and place the other pregnant women exposed. Your doctor will make special arrangements.
Pregnant women who are not immune should be highly vigilant of being away from exposure to the virus. All children and adults in the house should be vaccinated if not done so already. Stay away from an outbreak at school or work until being told that it is all clear. Definitely postpone any travelling to endemic regions (see your doctor about this). Get vaccinated after delivery, to ensure that for future pregnancies you are better prepared.
Ideally every woman planning for pregnancy should get their rubella IgG test done, and if negative should have the vaccine and wait for a month before trying to get pregnant.
Lifestyle Changes to Boost Your Immunity
The rubella virus can cause serious harm in patients that are immunocompromised. These individuals have a higher risk of contracting and spreading the infection.
To improve the status of your immunity, some lifestyle modifications and dietary changes can help. Broadly, a healthy lifestyle promotes a powerful immune system. Getting a diet rich of fruits and vegetables, avoiding alcohol and smoking, and exercising regularly to maintain a healthy weight are all components of a healthy lifestyle. It is also a good idea to add multivitamins and mineral supplements to meet the daily requirements.
Finally, stress also plays a major role in disturbing the immune system. It is important to engage in healthy social activities to prevent mental stress and hence, boost immunity.
Rubella, although highly communicable, is a preventable disease. Play your part in eliminating this disease worldwide by ensuring you and the people around you are immunised. Special care to protect the spread of disease to pregnant women is also essential and should be made the first priority.
If you’re interested in learning more about rubella and why you should find out if you are immune, read on more about it in our biomarker post here!