A pediatric patient is admitted with a low-grade fever, sore throat, and a rash that started on the face and spread to the rest of the body. The IP is asked to restrict healthcare workers entering the room. Who should be restricted?

• A. Pregnant HCWs who are not immune to rubella
• B. Nonpregnant HCWs who are immune to rubella
• C. All HCWs regardless of rubella immunity
• D. HCWs with a history of chickenpox

Answer: (A)

Rubella infection during pregnancy poses a serious risk to the fetus, including congenital rubella syndrome with birth defects. Because the rubella vaccine is a live vaccine and cannot be given safely during pregnancy, immunity cannot be established or boosted in a pregnant staff member at that time. To protect the fetus, pregnant healthcare workers who are not immune should be restricted from entering the room of a patient with rubella.

Nonpregnant healthcare workers who are immune can care for the patient with standard precautions; those who are not immune would ideally be vaccinated when not pregnant, but the immediate precaution focuses on protecting pregnant staff. A history of chickenpox does not confer immunity to rubella, so it doesn’t determine restriction in this scenario.