he live attenuated J eryl-Lynn vaccine strain is part of the MMR vaccine-measles, mumps, and rubella. This vaccine is contraindicated in pregnancy according to the CDC (McLean, 2013). No malformations attributable to MMR vaccination in pregnancy have been reported, but pregnancy should be avoided for 30 da) s after mumps vaccination. The vaccine may be given to susceptible women postpartum, and breastfeeding is not a contraindication.
his is a highly contagious RNA virus of the family Paramyxoviridae that only infects humans. In endemic areas, annual outbreaks of measles, also called rubeola, occur in late winter and early spring, transmission is primarily by respiratory droplets, and the secondary attack rate among contacts exceeds 90 per cent (Rainwater-Lovett, 2015). Resurgences in measles have been linked to clusters of vaccine-eligible but unvaccinated individuals (Fiebelkorn, 2010; Phadke, 2016). Fever, coryza, conjunctivitis, and cough are typical symptoms. he charac teristic erythematous maculopapular rash develops on the face and neck and then spreads to the back, trunk, and extremities.
Koplik spots are small white lesions with surrounding erythema found within the oral cavity. Immediate or delayed neurologi cal sequelae of measles may manifest in several forms, making diagnosis diicult (Buchanan, 2012; Chiu, 2016). Diagnosis of acute infection is most commonly performed by serological evidence of IgM antibodies, although RT-PCR tests are avail able. Treatment is supportive.
Pregnant women without evidence of measles immunity should be administered passive immunoprophylaxis with immune globulin, 400 mg/kg intravenously (Centers for Dis ease Control and Prevention, 2017d). Active vaccination is not performed during pregnancy, however, susceptible women can be vaccinated routinely postpartum, and breastfeeding is not contraindicated (Ohji, 2009).
he virus does not appear to be teratogenic (Siegel, 1973).
However, rates of spontaneous abortion, pre term delivery, and low-birthweight neonates are increased with maternal measles (Rasmussen, 2015). If a woman develops measles shortly before birth, risk of serious infection developing in the neonate is considerable, especially in a preterm neonate.
his RNA togavirus causes rubella, also called German measles, which is of minor importance in the absence of pregnancy.
Rubella inection in the irst trimester, however, poses signicant risk or abortion and severe congenital maormations. T ransmission occurs via nasopharyngeal secretions, and the transmission rate is 80 percent to susceptible individuals. he peak incidence is late winter and spring in endemic areas (Lambert, 2015).
Maternal rubella is usually a mild febrile illness with a generalized maculopapular rash beginning on the face and spreading to the trunk and extremities. hat said, 25 to 50 percent of infections are asymptomatic. Other symptoms may include arthralgias or arthritis, head and neck lymphadenopathy, and conjunctivitis. he incubation period is 12 to 23 days. Viremia usually precedes clinical signs by about a week, and adults are infectious during viremia and through 7 days after the rash appears. Up to half of maternal infections are subclinical despite viremia that may cause devastating fetal infection (McLean, 2013).