Surveillance of rubella in England and Wales has included immunoglobulin M testing of oral (crevicular) fluid from reported case-patients since 1994. The need for laboratory confirmation to monitor rubella elimination is emphasized by poor sensitivity (51%, 95% confidence interval 48.9%–54.0%) and specificity (55%, 95% confidence interval 53.7%–55.6%) of the clinical case definition. During 1999–2008, oral fluid from 11,709 (84%) of 13,952 reported case-patients was tested; 143 (1.0%) cases were confirmed and 11,566 (99%) were discarded (annual investigation and discard rate of clinically suspected rubella cases was 2,208/100,000 population). Incidence of confirmed rubella increased from 0.50 to 0.77/1 million population when oral fluid testing was included. Oral fluid tests confirmed that cases were more likely to be in older, unvaccinated men. Testing of oral fluid has improved ascertainment of confirmed rubella in children and men and provided additional information for assessing UK progress toward the World Health Organization elimination goal.

A review of published literature was undertaken to investigate the maternal and fetal effects of measles infection in pregnancy and to inform the need for post-exposure prophylaxis. There is no evidence to support an association between measles in pregnancy and congenital defects. However, the need for effective post-exposure protection is supported by studies suggesting a high risk of severe maternal morbidity, fetal loss and prematurity. Measles in late pregnancy can also lead to perinatal infection in the infant, which may be associated with a high mortality and the risk of subacute sclerosing panencephalitis. UK guidance recommends using human normal immunoglobulin for susceptible pregnant women exposed to measles. Although there is no direct evidence that this will reduce the complications of measles in pregnancy, it may attenuate disease and therefore reduce the rate of complications. Measures to identify women likely to be susceptible include assessment of age, vaccination history, and/or antibody testing.

This study suggests that many infants being born in the UK will become susceptible to measles before 6 months and will be able to respond to vaccine between 6 and 9 months of age. It is proposed that current guidance is changed to recommend passive immunisation with human normal immunoglobulin for most infants exposed to measles below 6 months of age. For infants aged 6 months or over exposed to measles, vaccination with MMR may be given.

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