Public Health England (PHE) has issued guidance on the investigation, diagnosis and management of viral illness, or exposure to viral rash illness, in pregnancy.
The guidelines address the management of women who present with viral rash illness in pregnancy or have had contact with a viral rash illness. Recommendations are also provided on the management of susceptible women in the first 20 weeks of pregnancy who are working in occupational settings that may suggest increased risk of exposure, current antibody screening recommendations and inadvertent immunisation in pregnancy.
Advice on assessing immunity to rubella has been updated and the 10 IU/mL threshold for IgG antibody levels has been removed. The presence of antibodies at any level is sufficient to confirm immunity, the guidelines state.
The section on antibody screening for rubella has also been updated to note that universal antenatal screening is no longer offered. A section has been added on the management of a neonate born to a mother with rubella infection during pregnancy.
The guidelines include recommendations on the management of inadvertent shingles immunisation in pregnancy. Unlike inadvertent immunisation in pregnancy with other live vaccinations, for which only reporting is encouraged, inadvertent vaccination with the live shingles vaccination should be treated as an exposure and assessed according to guidance on exposure to shingles.
A section has been added on the potential for restrictions to the use of varicella zoster immunoglobulin (VZIG) for pregnant women during times of VZIG shortage.
The guidelines updates and consolidates previous guidance published in 2011.