From the Guidelines
Pregnant healthcare staff should avoid caring for patients with active measles infections and should only care for patients with shingles if they are immune to varicella.
Key Considerations
- For measles exposure, pregnant staff should have documented immunity through vaccination or previous infection, as measles can cause severe illness during pregnancy with increased risks of premature labor, miscarriage, and birth defects 1.
- If immunity status is unknown, serologic testing should be performed to determine the risk of measles infection 1.
- For shingles exposure, standard precautions including proper hand hygiene and wearing gloves when touching lesions are essential, and airborne precautions are recommended for disseminated shingles 1.
- Non-immune pregnant staff should avoid contact with patients who have active shingles lesions, particularly if the lesions are widespread or not contained, and varicella zoster immune globulin (VZIG) should be administered within 10 days of exposure to prevent varicella infection 1.
Recommendations
- Healthcare facilities should have policies in place to protect pregnant staff while ensuring adequate patient care, including ensuring that all healthcare personnel are immune to measles and varicella 1.
- Pregnant staff who are not immune to measles or varicella should be vaccinated or removed from patient care to prevent the risk of infection and complications 1.
- In the event of exposure to measles or shingles, pregnant staff should be closely monitored for signs and symptoms of infection and provided with post-exposure prophylaxis as needed 1.
From the Research
Risk of Infection for Pregnant Staff
- Pregnant healthcare workers may be exposed to infectious diseases, including shingles and measles, while caring for patients 2, 3, 4.
- The risk of infection varies depending on the disease, and it is essential to evaluate each disease separately to determine the risk to the pregnant worker and the unborn child 2.
- Certain infections, such as varicella (chickenpox), can be associated with increased maternal morbidity, mortality, and adverse perinatal outcomes 3.
Preventive Measures
- Primary prevention through vaccination is crucial for pregnant healthcare workers 3, 5.
- Vaccines for measles, mumps, rubella, varicella, and herpes zoster are recommended for adults, including pregnant healthcare workers, to protect against serious illnesses 5.
- The measles, mumps, and rubella (MMR) vaccine and the varicella vaccine are recommended for all adults who do not have immunization or contraindications, with two doses separated by 4 weeks 5.
- The herpes zoster vaccine is recommended for all adults aged 60 years or older, unless they have contraindications 5.
Infection Control Precautions
- Pregnant healthcare workers need to be educated about specific occupational risks and recommended infection control precautions 3, 4.
- Infection control programs should focus on isolating the disease, not the employee, and should be based on a thorough understanding of the mechanisms of disease transmission 4.
- Transfer to alternative assignments or work restriction based on pregnancy alone is rarely necessary, and a more generic approach to infection control should be taken 4.