The recommendations for pregnant women change, for whom screening for rubella is no longer considered necessary. The Istituto Superiore di Sanità (ISS) has in fact updated the Guidelines on Physiological Pregnancy (part 1), which specifically address infectious disease screening. Well, it is recommended that the rubeotest (which checks whether a person already has antibodies against the rubella virus and is therefore not at risk of contracting the infection) should no longer be actively offered – as screening, in fact – to all pregnant women. In any case, it will continue to be free for all susceptible women (not vaccinated or who do not know if they have been vaccinated and have not already contracted rubella in the past) who wish to do so.
The new recommendations
The new recommendations they state that:
1. Rubella screening should not be offered to pregnant women.
2. Rubella vaccination should be offered postpartum to all women who
do not have documentation of vaccination with two doses of vaccine or
3. All pregnant women must be offered information on strategies to prevent the spread of rubella in the population, on exposure during pregnancy, on free tests to verify susceptibility and on vaccination in the preconception period.
by Sandro Iannaccone
There are three reasons, well explained in the document, why it is recommended that rubella screening should no longer be offered to women at this stage of life. The first is that since July 2023 the World Health Organization (WHO) has declared that the infection is no longer endemic in Italy, since the virus has no longer been present in our country since 2021. The second is that, even in the case of infection, there is no treatment that prevents or reduces vertical transmission from mother to fetus. Third, vaccination is still contraindicated during pregnancy, but should be done before conception (at least one month later).
The risks of rubella during pregnancy
If contracted during pregnancy, rubella can be dangerous for the baby. The virus can in fact cross the placenta and pose a risk of spontaneous abortion, intrauterine death of the fetus or serious malformations: the so-called congenital rubella syndrome (CRS). If the infection occurs shortly before conception or in the first 8-10 weeks of gestation, the risk of CRS reaches 90%, while if it is contracted after the twentieth week, it is rare that it can cause malformations.
Reasons for no longer recommending screening
“It is important that women know the rationale behind the new recommendations and that the updating of the guidelines is done according to a scientifically rigorous methodology,” she tells Vaccines Serena Donati, Director of the Women’s and Developmental Age Health Department of the National Center for Disease Prevention and Health Promotion of the ISS, and coordinator of the new Guidelines. “The indication to no longer actively offer screening is certainly an important decision – continues Donati – What led us to make it? First of all we looked at vaccination coverage: since 2017 the vaccine against the rubella virus has been among the 10 mandatory vaccinations for minors and we have very reassuring coverage rates”. Specifically, the ISS reports, the vaccination rate in 18 year olds (2003 birth cohort) is 93.3% for the first dose and 89% for the second dose. Furthermore, since 2018, not a single case of congenital rubella syndrome has occurred in newborns: which means that it is highly unlikely to have cases of rubella during pregnancy and already in 2013 the incidence was very low, less than 1 case in 100 thousand live births. Furthermore, adds Donati, “we have had a robust system for the surveillance of rubella and measles cases since 2013, and since 2017 we have established a network of certified laboratories in all Regions to guarantee the reliability of diagnoses. On the one hand, therefore, we know that women of childbearing age are mostly protected by the vaccine, on the other we are able to promptly intercept any new outbreak that should arise”.
But can there be a risk for women who have immigrated from other nations where the virus is still present? “Obviously we cannot exclude it, although it is very low – replies the expert – What we are discussing, however, is the offer of population screening to all pregnant women in a country where, as we have said, the virus no longer circulates thanks to its eradication following high vaccination coverage, which also protects those who are not vaccinated. Furthermore, pregnancy is an important moment of contact with the healthcare system, in which it is possible to inform these women about the importance of testing and vaccination immediately after giving birth.”
by Letizia Gabaglio
The rubeotest remains free
If a woman does not know whether she is susceptible and therefore at risk of contracting the infection, in the preconception period and after giving birth she can get tested and vaccinated for free. Since there is no effective treatment to prevent transmission from mother to fetus during pregnancy, the only truly effective strategy remains vaccination.” If you have any doubts, therefore, the test should be done before pregnancy or after giving birth, so that you can get vaccinated. For this reason – Donati is keen to reiterate – the three recommendations must be considered as a whole and strongly support the need to provide information and offer vaccination immediately after giving birth to all women still susceptible to the infection.