Rubella Prevention and Treatment

Vaccination

The Centers for Disease Control and Prevention (CDC) recommends administering one dose of MMR vaccine to individuals without evidence of immunity 1
Individuals vaccinated with MMR before the first birthday should be revaccinated with two doses of MMR at appropriate intervals, as per CDC guidelines 1
MMR vaccine is contraindicated in pregnancy, severe immunosuppression, and those with severe allergic reactions to previous doses, according to the CDC 2

Immune globulin (IG) is NOT effective for preventing rubella infection after exposure and should not be used routinely for post-exposure prophylaxis, except in specific cases 1
For individuals ≥12 months of age without evidence of immunity, MMR vaccine should be administered immediately, and if exposure occurred more than 72 hours prior, IG 0.25 mL/kg (maximum 15 mL) intramuscularly should be given within 6 days of exposure 1
The following populations should receive specific post-exposure prophylaxis:
If exposed within 3 weeks of receiving standard IGIV dose (100-400 mg/kg), additional IG is not needed, but if exposed more than 3 weeks after IGIV, consider an additional dose 1, 3
For those receiving IG, observe for signs of measles for 28 days as IG may prolong the incubation period 4

Severely immunocompromised patients should not receive MMR vaccine and should receive IG prophylaxis regardless of vaccination status, with a dose of 0.5 mL/kg (maximum 15 mL) intramuscularly or consider intravenous immune globulin (IGIV) at 400 mg/kg 1
Healthcare workers without evidence of immunity should be offered the first dose of MMR vaccine and excluded from work from day 5-21 following exposure, while those with documentation of 1 vaccine dose may remain at work and should receive the second dose 4

Record all post-exposure prophylaxis administration and ensure that infants or others receiving MMR before the routine schedule still receive routine MMR doses at appropriate intervals 1, 4
Delaying intervention can reduce the effectiveness of post-exposure prophylaxis, so act immediately upon learning of exposure 1
Misinterpreting immunity status can lead to inadequate prophylaxis; consider serologic testing if time permits, but do not delay PEP while awaiting results, as recommended by the CDC 4
The 72-hour window for vaccine and 6-day window for IG are evidence-based cutoffs, and earlier administration within these windows likely provides better protection 1