Editorial comment

Measles is not dead! Outbreaks in the UK and the USA, persistent endemic measles in Africa and Asia fuelled by malfunctions of the immunisation infrastructure because of inadequate resources or by wilful rejection of childhood immunisations contribute to the longevity of measles. Sarampion, the red or hard measles, continues to challenge the obstetric clinician by threatening the life of mother and fetus and the outcome of pregnancy for susceptible females. The papers by Manikkavasagan and Ramsay (2009) are timely and important. It is a reminder that old infectious pathogens do not simply fade away.

The challenge is for obstetricians to identify patients at risk, especially when measles is circulating in the community or in the region. The generation of women born before 1970, when widespread vaccination in Europe and North America dramatically reduced the prevalence of measles, is nearing the end of its natural fertility. The majority of these women experienced exposure to wild measles virus and many born between 1965 and 1970 were vaccinated with attenuated measles virus vaccines. Their immunity to measles is likely to be secure. For North American and European women born after 1970, clinicians need to determine their history of childhood infections and immunisations.

Memory, mobility and maintenance of medical records determine access to this important information. Many patients do not remember the specifics of vaccinations or of their childhood illnesses. Many have moved away from their parents and their paediatricians and often do not have copies of their childhood medical records or remember the names and addresses of their paediatricians. Membership in religious, philosophical or cult groups which reject vaccinations can be an important indicator of potential susceptibility to measles and to other childhood infections but not all members of these groups are willing to divulge their connections and in contemporary medical practice direct questioning about ethnic and religious background is considered inappropriate. For women that spend childhood in developing countries, accurate information about illness and immunisations may be impossible to obtain.

Routine testing for the presence of antibody against childhood viruses in all women with incomplete histories for infection and immunisation can be expensive. However, testing for antibody to rubella and varicella has become standard practice in North America because of the risks for fetal infection and maternal morbidity. Perhaps it is time to include testing for antibody against measles as part of the standard prenatal evaluation. Once susceptible women have been identified, then when measles does occur in the community, immunoglobulin can be administered and postpartum immunisations with live attenuated virus vaccine can be completed, with patient consent.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.