Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

that conception is delayed for 4 weeks a er vaccination. If conception occurs within 4 weeks a er vaccination this is not regarded as an in- dication for termination of pregnancy 1 . e vaccine is contraindicated in immune compromised patients, in patients who have had a severe allergic reaction to the vaccine previously, pregnant women, allergy to neomycin or any other component of the vaccine or someone with a intercurrent illness 7 . Adverse reactions to the measles vaccine include pain at injection site, fever between 7-12 days post vaccination and a maculopapular rash between 7-10 days post vaccination 7 . ese symp- toms are usually mild. Very rare adverse reactions include encephalitis (1 in 2 million), febrile seizures in children (1 in 3000) and anaphylaxis (1 in 1 million) 7 . If a pregnant patient has contact with a person with a suspected measles infection or if she presents with some symptoms suggestive of measles infection, it should be established if she was immunized or if she had measles infection before. If the patient had the vaccination it should be established if she had one or two doses, preferably docu- mented 1 . A patient with exposure should be asked about the symptoms of measles and also the timeline. e examination should focus on the clinical stigmata of measles infection and its complications. Non-medical management: Once measles has been con rmed, counsel the patient and partner regarding the maternal and fetal complications. Mothers must be counselled regarding the signs and symptoms of complications so that they may present early should they develop 5 . Medical management: is largely involves symptomatic treatment in patients who are immune competent as well as close monitoring of the patient. In well, pregnant patients intramuscular IgG may be given as post exposure prophylaxis within 6 days of exposure, to reduce the severity of the illness 1,2,5 . Where another exposure occurs more than 3 weeks a er the rst, a second dose may be given. In patients that are immune compromised, IV IgG should be administered as post exposure prophylaxis within 72 hours of exposure. e dose of IVIgG is 400mg/kg 2 . Where exposure is recognized late, it may be given within 6-18 days of exposure. If there was a suspected infection and serological con rmation is not possible, the 2019 American College of Obstetricians and Gynaecologists recommends IVIG to all women who are not immune to measles 8 . Non-pregnant patients can receive the vaccine in the rst three days a er the exposure. Women who are found to be non-immune to measles should be o ered the measles vaccine a er delivery 1 . e measles vaccine is safe in breastfeeding. Breastfeeding does not a ect the immune response to the measles vaccine and it does not adversely a ect the neonate. Passive immunity of measles to the breastfeeding neonate has not been well studied 1 . References: 1. Kachikis A & Oler E, Shree R, Adams Waldorf K, Hitti J, Eckert LO. Measles and the MMR vaccine: recommendations around pregnancy, including the periconception and postpartum periods: obstetric consensus statement. University of Washington, revised April 2019. Available at http://providerresource.uwmedicine.org/reproductive-perinatal-and- neonatal-care. [Accessed 8 May 2019] 2. The 2019 Measles Outbreak: CDC Recommendations and ACOG Practice Advisory - The ObG Project [Internet]. The ObG Project. 2019 . Available from: https://www.obgproject.com/2019/05/01/the-2019-measles- outbreak-the-latest-cdc-recommendations-and-acog-practice-advisory/ 3. Paules, C., Marston, H. and Fauci, A. (2019). Measles in 2019 — Going Backward. New England Journal of Medicine, pp.1-3. 4. Laksono, B., de Vries, R., McQuaid, S., Duprex, W. and de Swart, R. (2016). Measles Virus Host Invasion and Pathogenesis. Viruses, 8(8), p.210. 5. Le Polain, O. (2017). Guidelines on Post-Exposure Prophylaxis for measles. Public Health England, pp.1-15. 6. Chen S. Diseases & Conditions - Medscape Reference [Internet]. Emedicine .medscape.com. 2019 [cited 15 July 2019]. Available from: http://emedicine.medscape.com?article /966220- overview?src=iphone&ref=email 7. Nicd .ac.za . (2019). [online] Available at: http://www.nicd.ac.za/assets/ files/NICD_Vaccine_Booklet_D132_FINAL.pdf [Accessed 8 May 2019]. 8. Practice Advisory: Management of Pregnant and Reproductive-Aged Women during a Measles Outbreak - ACOG [Internet]. Acog.org. 2019 . Available from: https://www.acog.org/Clinical-Guidance-and- Publications/Practice-Advisories/Management-of-Pregnant-and- Reproductive-Age-Women-during-a-Measles-Outbreak?IsMobileSet=false O&G Forum 2019; 29: 12 - 13 REVIEW O&G FORUM Visit our website: www.ihpublishing.co.za OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 13