Notes from the Field: Rubella Infection in an Unvaccinated Pregnant Woman — Johnson County, Kansas, December 2017

Abstract

A 27-year-old pregnant woman in Johnson County, Kansas, USA, received a diagnosis of rubella in December 2017. She was 19 weeks pregnant and had not been vaccinated against rubella because of personal choice. She had tested negative for rubella by IgG serology during her first trimester of pregnancy. On 6 December, she visited a hospital emergency department complaining of palpitations, a burning itchy rash and fever. On 9 December, she visited a second emergency department and was told she was having an allergic reaction. After conducting an Internet search, she suspected her symptoms might be caused by rubella and contacted her obstetrician, who referred her to a primary care provider. On 12 December, the primary care provider submitted a blood specimen for rubella IgM testing, which was positive on 14 December. When she was 15 weeks pregnant (17 days before her rash onset), her unvaccinated brother stayed in her home after returning from India, a country with endemic rubella transmission. Her brother had a rash on his lower extremities that was diagnosed as poison ivy. Specimens from the patient and her brother were rubella IgG-positive with low avidity, indicating recent infection. An obstetrician followed her for the remainder of her pregnancy. All follow-up testing was negative, and she delivered a full-term, apparently normal, infant in May. The infant's initial rubella IgM was positive, and 2 sets of nasopharyngeal and urine specimens, obtained 30 days apart, were negative for rubella RNA. Based on test results and the absence of congenital defects, indications were that this infant met the criteria for congenital rubella infection. The infant will continue to be followed by an infectious disease specialist.