(pregnant). INVESTIGATION OF RUBELLA IN PREGNANT WOMEN OF UNKNOWN RUBELLA IMMUNITY STATUS 11/27/2007 2 S.R.Tabatabaei MD,MPH - PIRC.

Slides:



Advertisements
Similar presentations
Hepatitis A to E: An Overview
Advertisements

ALLOIMMUNIZATION IN PREGNANCY
Rubella( German measles )
IMMUNIZATION Immunization??? Reduce mortality and morbidity of mathernal and baby.
Pertussis Disease Pertussis (‘whooping cough’) is a bacterial infection affecting the respiratory system, caused by the organism Bordetella pertussis.
Congenital Viral Infections
Kate Hooks.  A Common Consultation  AIMS:  To distinguish rashes which may have complications from those which do not.  To develop a management strategy.
Perinatal Varicella By Rafat Mosalli MD FAAP FRCPC.
Infections in Pregnancy Jonathan Schaffir, MD Associate Professor Dept of Obstetrics & Gynecology The Ohio State University College of Medicine.
RUBELLA aka. The German measles Stephanie Mejia AP bio.
Rubella and Rubella Vaccine
Measles, Mumps and Rubella Ch 10, 11 & 12
Toxoplasmosis in pregnancy
TOXOPLASMOSIS.
DR.MOHAMMED ARIF ASSOCIATE PROFESSOR CONSULTANT VIROLOGIST HEAD OF THE VIROLOGY UNIT Cytomegalovirus (CMV)
Varicella Zoster Virus Herpesvirus (DNA) Primary infection results in varicella (chickenpox) Recurrent infection results in herpes zoster (shingles) Short.
Chickenpox in Children, Adults and Pregnancy: What to do?
Measles and Measles Vaccine
Measles and Measles Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases Centers.
MEASLES RUBEOLA OR MORBILLI Department of infectious disease WANG JINGYAN.
Prenatal Infections Infections that affects the fetus: Genital Herpes Simplex Virus Varicella Zoster Syphilis Rubella Toxoplasmosis Parvovirus Cytomegalovirus.
CHLAMYDIA, RUBELLA AND CMV (ELISA). Abortion Defined as delivery occurring before the 28 th completed week of gestation Fetus weighing less than 500g.
Measles and Measles Vaccine
5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees
Herpes Viruses Herpes zoster
5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees
Rubella by Lena Zadruzynski Anatomy / Physiology 6 th hour Mr. Weidert.
RUBELLA. WHAT IS RUBELLA A rash (small, fine pink spots) that starts on the face and spreads to the torso, then to the arms and legs with low fever. Rubella.
Cytomegalovirus Infection and Pregnancy
Acquired immunity Expected learning:
Rubella in Pregnancy Max Brinsmead MB BS PhD January 2015.
Measles Highly contagious viral illness First described in 7th century Near universal infection of childhood in prevaccination era Common and often fatal.
Viral infections with exanthem exanthem is widespread rash with fever.
CMV In Pregnancy Leili Chamani. MD. MPH. Specialist In Infectious Diseases Department Of Reproductive Health Avesina Research Center (ARC)
Rubella and Rubella Vaccine
RUBELLA GERMAN MEASLES. Introduction Rubella, commonly known as German measles, is a disease caused by Rubella virus. The name is derived from the Latin,
Parvovirus Infection and Pregnancy Max Brinsmead MB BS PhD May 2015.
Rubella Anatomy Paige Hopper. (German Measles) RUBELLA Rubella is a contagious viral disease, with symptoms like mild measles. It can cause fetal malformation.
paramyxo.ppt Paramyxoviruses paramyxo.ppt.
Viruses Causing Maculopapular Rash
Viral Hepatitis Program Management of Babies Born to HBsAg- Positive Mothers Vickie Weeast Perinatal Hepatitis B Case.
Neonatal Varicella Infants whose mothers develop varicella in the period from 5 days prior to delivery to 2 days afterward. High mortality Transplacental,
Irina Tabidze, MD, MPH and Chicago Dept of Public Health
MEASLES RUBEOLA OR MORBILLI Department of infectious disease.
Varicella and Varicella Vaccine
Quick Insights on Some Viral Issues Dr. Haya Al-Tawalah Clinical Virologist.
HYPOTHYROIDISM. INTRODUCTION  Hypothyroidism is defined as a deficiency in thyroid hormone secretion and action that produces a variety of clinical signs.
MMR is meant to prevent three types of diseases the first is Mumps. Mumps is a viral disease that spreads from person to person by sneezing or coughing.
CONGENITAL RUBELLA SYNDROME Infectious and Tropical Pediatric Division Department of Child Health Medical Faculty, University of Sumatera Utara.
Presentation on Rubella
Fahareen-Binta-Mosharraf
Rubella and Rubella Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease Control and.
Mumps and Mumps Vaccine
Management infant born with mother Chickenpox
Varicella & Pregnancy Dr S. Asadi Infectious diseases specialist
. Parvovirus B19 Yvonne Cossart, an Australian virologist working in London in the mid-1970s the name comes from parvum, the Latin word for small contains.
Rh(D) Alloimmunization
Measles.
Infant born with mother Tuberculosis
Dr. Wulan M. Soemardji, SpOG
German measles & Infectious parotitis
COMMUNICABLE DISEASES
RUBELLA AND OTHER CONGENITAL VIRAL INFECTIONS
RUBELLA & PREGNANCY DR. S .Asadi Infectious diseases specialist
Togaviridae and Flaviridae
ASPEK VIRUS RUBELLA.
Rubella Dr hab.n. med. Ewa Majda - Stanisławska
RUBELLA Dr.T.V.Rao MD.
By Dr. Satti Abdulrahim Satti Consultant Pediatrician
Presentation transcript:

(pregnant)

INVESTIGATION OF RUBELLA IN PREGNANT WOMEN OF UNKNOWN RUBELLA IMMUNITY STATUS 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 Rubella is the first virus demonstrated as a teratogen.  Humans are the only natural host of rubella virus(EXCLUSIVELY) 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 3

 What happened when a pregnant woman exposed to RUELLA? 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 4

 When a pregnant woman is exposed to rubella What should we do? 11/27/ S.R.Tabatabaei MD,MPH - PIRC

Gregg was the first to describe the 3 characteristic manifestations of CRS: -heart disease -cataracts -deafness 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 6

11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 7

 Why?  Maternal Infection  Maternal viremia  Intrauterine Transmission  CRS 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 8

 The most important determinant of fetal infection & fetal defects is: GESTATIONAL AGE 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 9

 When will a pregnant mother get VIREMIA ?  Maternal immunization : - vaccine-related - Previous Infection Re-infection: 2%, especially <12 wk, CRS(rare) Lit. Review: 30 Re- infection in adults and children 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 10

 What happened for mother when she exposed to RUELLA?  Immunity(+) “ (-): -nothing -Infection -subclinical, symptomatic 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 11

 The incubation period :14–21 days  The prodromal phase :mild catarrhal symptoms  2/3 of infections: subclinical  The most characteristic sign is retroauricular, posterior cervical, and postoccipital lymphadenopathy (No other disease causes the tender enlargement of these nodes)  An enanthem appears in 20% of patients just before the onset of the skin rash. It consists of discrete rose-colored spots on the soft palate (Forchheimer spots)  Lymphadenopathy is evident at least 24 hr before the rash appears and may remain for 1 wk or more.  RASH: It begins on the face and spreads quickly. Its evolution is so rapid that the rash may be fading on the face by the time it appears on the trunk. During the second day the rash may assume a pinpoint appearance, especially over the trunk, resembling that of scarlet fever. Mild itching may occur. The eruption usually clears by the third day. Desquamation is minimal.  Rubella without a rash has been described. 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 12

 maculopapular rash  lymphadenopathy  fever  arthropathy (up to 60% of cases) 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 Maternal rubella during pregnancy can result in: -miscarriage, -fetal death, -congenital rubella syndrome -Late sequels years later -placental infection ± persistent fetal infection -no infection(counseling?) 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 14

 The most important thing is: GESTATIONAL AGE  Fetal Inf. (Miller & colleagues) 90% <11 wk G.A 67% % % Third trimester 100%(last month of pregnancy)  Congenital defect: 90% if maternal infection < 11wk (<8wk,first month) 33% wk 11% % Uncommn >16 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 15

 Why this happen? The placenta is a relatively effective barrier to fetal infection from 12-28wk but it is not so effective in the first & third trimesters Particularly in the last month of pregnancy 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 16

 Cellular & tissue damage in the infected fetus: -Tissue necrosis due to vascular insufficiency -Reduced cellular multiplication time -Chromosomal breaks -Production of a protein inhibitor causing mitotic arrests in certain cell types 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 17

 The most distnctive feature of congenital rubella is: CHRONICITY ONCE THE FETUS IS INFECTED EARLY IN GESTATION The virus persists in fetal tissue until well beyond delivery 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 18

 CRS is not a static disease  ¾ of infected infants show NO apparent involvement at birth but experience consequences years later Sonography (NL?) conselling 11/27/2007 S.R.Tabatabaei MD,MPH - PIRC 19

Recommendation: all rashes in pregnancy be investigated 11/27/ S.R.Tabatabaei MD,MPH - PIRC

11/27/ S.R.Tabatabaei MD,MPH - PIRC

1-A blood specimen should be obtained as soon as possible for specific IgG and IgM antibody 2-A single positive IgG test indicates rubella immunity 3-A significant rise in IgG Ab (paired sera) or positive IgM Ab test indicates recent infection 4-Negative IgG and negative IgM on first testing should be retested (the first specimen should be reanalyzed along with the second specimen ) 5-Positive IgG titers and negative IgM to determine if they acquired immunity before pregnancy or infection during pregnancy 11/27/ S.R.Tabatabaei MD,MPH - PIRC Rubella in Pregnant Women

Note that in reinfection, IgM is usually absent or only present transiently at a low level 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 1- IG  2- VACCINE  3- Termination of pregnancy  4- NOTHING 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 No recommendation for routine use in pregnant women  0.55 mg/kg IG (IM): 1- ↓ viral shedding 2- ↓ Rate of the viremia Points: 1-The absence of clinical signs in a woman who has received IM-IG does not guarantee that fetal infection has been prevented 2-Adminstration of IG eliminates the value of IgG-Ab testing to detect maternal infection but IgM-Ab can be used. 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 Immunizatoin of non-pregnant women within 3 days of exposure  Because if the exposure did no result In infection, immunization will protect them in the future.  Pregnancy within 28 days (3 months) of immunization  The MMR vaccine must be offered to IgG negative women postpartum 11/27/ S.R.Tabatabaei MD,MPH - PIRC

BUT in pregnant women:  A small % of offspring in such acses had signs of infection, but no defects.  Rubella vaccine during pregnancy ≠ termination 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 Shed small amount of virus from the pharynx (7-28 days after immunization)  NO evidence of transmission of the vaccine virus  NO Risk for mother 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 The only effective way to prevent CRS is to terminate the pregnancy  But it is not an easy decision  Why? Evaluation of mother/baby 11/27/ S.R.Tabatabaei MD,MPH - PIRC

 Since 1968, a highly effective live attenuated vaccine has been available with 95% efficacy  Universal vaccination is now offered to all infants as part of the MMR regimen  Some countries continue to selectively vaccinate schoolgirls before they reach childbearing age.  Both universal and selective vaccination policies will work provided that the coverage is high enough. 11/27/ S.R.Tabatabaei MD,MPH - PIRC

Antenatal screening:  All pregnant women attending antenatal clinics are tested for immune status against rubella.  Non-immune women are offered rubella vaccination in the immediate post partum period. 11/27/ S.R.Tabatabaei MD,MPH - PIRC

Vaccination of women In child-bearing age 11/27/ S.R.Tabatabaei MD,MPH - PIRC

11/27/2007S.R.Tabatabaei MD,MPH - PIRC 33 الگوریتم نحوه برخورد با خانم باردار در مواجهه با روبلا * بلافاصله گرفتن نمونه و بررسی از نظر IgG و IgM اختصاصی * کنار گذاشتن یک نمونه فریز شده برای تست های احتمالی بعدی + - recent infection احتمال بیشتر مصون است + نمونه مجدد 3-2 هفته بعد و چک همزمان آن با نمونه اول نمونه مجدد 6 هفته بعد از مواجهه و چک همزمان با نمونه اول Inf رخ نداده است - IgGIgM + -

11/27/2007S.R.Tabatabaei MD,MPH - PIRC 34

11/27/2007S.R.Tabatabaei MD,MPH - PIRC 35