Public Health England hosts the UK National Screening Committee

Rubella Susceptibility Screening

in Pregnancy

Ms Hilary Goodman

Rubella infection

2 Rubella Susceptibility Screening in Pregnancy

• humans only known host

• transmission by airborne droplet spread

• virus mainly circulates in spring and early

summer

• peak age of infection 4 to 9 years

• mild, often asymptomatic and easily

confused with other infections/rashes

• incubation period 14 to 21 days

• infectious period one week either side of

rash onset

• congenitally infected infants infectious for

much longer

Rubella in pregnancyPossible outcomes include:

• spontaneous abortion

• uninfected infant

• infant with congenital rubella infection but no apparent rubella defects (CRI)

• infant with congenital rubella and associated rubella defect(s)

(commonly known as Congenital Rubella Syndrome, CRS)

3 Rubella Susceptibility Screening in Pregnancy

Background• 1970 introduction of rubella vaccination; aim to directly protect women of

childbearing age

• adjunct screening for rubella susceptibility in pregnancy introduced at same

time; aim to find at risk women and offer postnatal vaccine

• selective vaccination of older girls and susceptible women provides

individual protection without changing epidemiology

• 1988 introduction of MMR triple vaccination

• 2003 infectious diseases in pregnancy screening programme

• 2003 UK NSC review showed rubella susceptibility not meeting criteria

4 Rubella Susceptibility Screening in Pregnancy

2012 UK NSC reviewRecommendation that screening for rubella susceptibility does not meet

UK NSC criteria for a screening programme due to:

• low UK incidence

• false reassurance

• not the optimum intervention

• more effective to ensure protection prior to pregnancy

5 Rubella Susceptibility Screening in Pregnancy

JCVI and DHJoint Committee for Vaccination and Immunisation

Considered UK NSC review in 2012 and suggested either:

• continuation of screening programme with protocol changes

• replacement of rubella screening with vaccination history (preferred option)

• selective testing

Department of Health and UK NSC

Following the UK NSC consultation it was agreed to:

• discontinue antenatal screening for susceptibility

• introduce opportunistic vaccination history in postpartum period

• strengthen current immunisation catch up policy

6 Rubella Susceptibility Screening in Pregnancy

Confirmation of rubella cessation

7 Rubella Susceptibility Screening in Pregnancy

“The decision to end rubella susceptibility screening in

pregnancy in England is based on a rigorous assessment of

the evidence and expert clinical advice. This will free up busy

midwives so they can spend more time looking after a new

mother and her baby.

“Screening for rubella in pregnancy does not give any

protection to the unborn baby in that pregnancy. The best

preventative measure a woman can take to protect herself

from rubella is to ensure she is immunised with the MMR

vaccine before she gets pregnant.”

Dr Anne Mackie, PHE Screening Director, March 2016

Rubella cessation strategy

Collaborative approach (PHE screening and immunisation, NHSE and DH):

• vaccination status check

• vaccination offer

• Every Contact Counts!

• programme of professional awareness

Strategy also protects women from measles contributing to WHO commitment

to eradicate measles and rubella by 2020.

8 Rubella Susceptibility Screening in Pregnancy

Challenges• effective communication on process

• reasons for cessation

• reassurance for stakeholders

9 Rubella Susceptibility Screening in Pregnancy

Rash awareness• need for health professionals and

women to be aware of rare but

continuing risk of rubella in pregnancy,

particularly for foreign-born women

• improve awareness of rash illness in

pregnancy and appropriate

management (PHE guidelines)

• multidisciplinary policy on management

of rash and rash illness in pregnancy

• part of trust training plans

• robust referral pathway

10 Rubella Susceptibility Screening in Pregnancy

References• Tookey P. BPSU British Paediatric Surveillance Unit Annual Report 2013-14.

Congenital rubella 2013-2014:[p10]. Oct 2014.

• Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the

WHO European Region Update December 2012.

11 Rubella Suseptibility Screening in Pregnancy