Do we still need rubella immunity screening?

Italy has cancelled rubella immunity screening in pregnant women, so should Australia do the same?

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Pregnant women in Italy will no longer be screened for rubella immunity thanks to vaccination coverage and the elimination of endemic transmission of the disease.

So could Australia see an end to rubella immunity screening in pregnancy?

Sydney paediatric infectious diseases physician Professor Cheryl Jones said, “we’re not quite at that point yet”.

Australia’s screening recommendation would not change as there was still a risk of transmission through overseas travel, the Dean and Head of the Sydney Medical School at the University of Sydney told TMR.

“Rubella is a vaccine-preventable disease, but importantly it causes significant harms to the unborn fetus if the mother has rubella during pregnancy,” she said.

“Congenital rubella syndrome has devastating consequences which, if the baby survives, has lifelong significant heart, eye and other defects that the survivors have to live with.”

Professor Jones said the number of rubella cases in Australia had dropped significantly and outbreaks were well controlled in Australia, because the “classic rash” helped with identification.

She conceded there was no longer endemic transmission causing congenital rubella syndrome.

“[But], having said that … when there are groups in a community who are not vaccinated and travellers come into that community from outside, that’s where your risks of transmission are,” she said.

Professor Jones said women who were born overseas, not vaccinated and living in Australia could be exposed to the disease either in Australia or when returning overseas to visit family.

“We have occasional reports through the Australia paediatric surveillance unit of congenital rubella babies with either suspected or confirmed syndrome, particularly in that group,” she said.

Professor Jones said there was also a small group of women who were born in Australia and chose not to be vaccinated or had missed vaccination.

“Screening for rubella immunity in pregnancy is very easy to do as a large panel of screening for other infectious diseases,” she said.

“It gives us an opportunity for conversation about vaccination after this particular pregnancy is delivered.”

Professor Jones said even though the rubella vaccine had not been shown to be harmful if given during pregnancy, most doctors delayed giving it until after delivery as a precaution.

Australian guidelines recommend screening all pregnant women for rubella immunity at the first antenatal visit to identify those at risk of contracting the disease, so they can be advised to avoid people with symptoms of rubella and to allow postnatal vaccination to protect future pregnancies.

Gynaecologist Dr Vittorio Basevi, co-ordinator of the Technical-Scientific Committee that developed the updated Italian guidelines, said congenital rubella had not been reported in Italy since 2018.

“Thanks to extensive vaccination coverage, the infection no longer circulates in Italy. Based on these data, we decided not to offer screening to pregnant women anymore,” he told Medscape.

But women would still be offered rubella vaccination after delivery if they had not had two previous doses or infection, he said.

Dr Basevi said the probability of unvaccinated women contracting the virus during pregnancy was small, unless women had recently travelled to another country or had contact with unvaccinated people.

“The guidelines refer to offering screening to all pregnant women. In specific cases, it is up to the treating physician to adopt the conduct they deem appropriate,” he said.