Pediatrics group publishes FAQ on congenital measles

Measles
Baby in an isolette

Jacek_Sopotnicki / iStock

Late last month in Lancaster County, Pennsylvania, a mom with measles delivered a stillborn baby, who died of a ruptured spleen, what the coroner called a measles-associated death. The midwife attending the birth told the mom that the baby died because of the unvaccinated mom’s serious case of measles, per The Atlantic. 

Few pediatricians have treated a newborn with congenital measles—meaning a case in a newborn contracted from the mother—especially one with such a tragic outcome. As the measles outbreak in Pennsylvania continues and other states report cases of the highly contagious illness, the American Academy of Pediatrics (AAP) released a frequently asked questions (FAQ) document with answers on preventing, diagnosing, and treating newborns with mothers who have a measles infection. 

“There’s not a standard practice for any of this,” Adam J. Ratner, MD, MPH, a member of the AAP’s Committee on Infectious Diseases, told CIDRAP news. “That was some of the impetus behind putting out the FAQ, especially given the recent cases in Lancaster. But there were also known congenital measles cases in Canada last year during their big outbreak.” 

‘It can be dangerous’

An estimated 25% to 30% of babies with mothers who have a measles infection at birth are also infected. Babies with congenital measles can show no signs of illness, or they can have the telltale measles rash, experience multi-organ involvement, or die. “Children with congenital measles can be quite sick,” Ratner said. “We know it can be dangerous.” 

Children with congenital measles can be quite sick.

Adam J. Ratner, MD, MPH

The FAQ discusses treatment of congenital measles and notes that babies born within two weeks of their mom’s measles rash qualify for immunoglobulin antibody therapy. 

“It seems like giving immunoglobulin is helpful to children that have congenital measles,” Ratner said. “It may help make the infection somewhat milder, and it’s literally providing some of the antibodies that this child didn’t get across the placenta, because they were born to a mother who is not immune.” 

Having measles at birth also increases the baby’s risk of developing encephalitis or subacute sclerosing panencephalitis (SSPE), a devastating, rare, progressive inflammatory brain condition.

SSPE is “essentially invariably fatal,” Ratner said. “There have been cases of children who had early-life measles, including congenital measles, who have had a much shorter latency period—more like a couple of years than seven to 10 years—and have gotten SSPE. Now this is still a very small number of kids who we’re talking about, because SSPE is very rare.” 

Preventing congenital measles

Moms can protect their babies from congenital measles by receiving the measles, mumps, and rubella (MMR) vaccine. Pregnant women cannot receive the MMR vaccine, because it is a live attenuated immunization. That’s why women hoping to have children should consider vaccination prior to pregnancy. 

“We are limited in terms of our options for pregnant people who are non-immune for prevention,” Ratner explained. “If someone is pregnant and susceptible and gets exposed to someone who has a known exposure to measles, they can get immunoglobulin to help protect them against measles. But that’s the extent of what we can do.” 

 

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