Pregnant & Not Immune to Measles - Opinions, Please!

[TheTwentyfifth]

I'm 14 weeks pregnant and found out through routine OB blood work that I am no longer immune to measles. I received MMR as a child and am still immune mumps and rubella.

I work as an RN on a med-surg unit in large, public hospital in the Los Angeles area. My OB is willing to give me a note taking me off patient care for the remainder of my pregnancy. There have been recent confirmed cases of measles in LA but no serious outbreaks due to our high herd immunity from strict vaccination laws.

What would you do if you were me? Go off patient care entirely to limit possible exposure, or just take caution as to the admitting diagnoses and signs/symptoms patients present with when receiving assignments and avoid possible measles cases? Just typing that seems daunting, let alone having to scrutinize every assignment I receive.

I am also claustrophobic and canNOT wear an N95 mask my entire shift for the next 6 months. A couple minutes, fine, but not all shift.

I am torn as to what I should do. Exposure is unlikely, but carries with it the risk of my baby dying or being born infected. And we tried very hard for this baby. I've lost 4 pregnancies, am advanced maternal age, and don't want to take any unreasonable risks with this baby.

What would you do in my shoes, seasoned nurses? I also haven't told work I am pregnant yet and wanted to wait until I am at least 20 weeks due to all my miscarriages.

I've always thought it was silly when pregnant staff refuse isolation patients or get taken off patient care altogether just as a precaution (with no real issues) but now I'm feeling torn.

Thank you for any and all opinions.

[myoglobin, ASN, BSN, MSN]

In my opinion take the time off and maximize your social psychological health. Just the additional physiological/psychological stress from the worry (and work) of nursing might be less than optimal. Also, your age/history places you in a high risk category. Unless finances absolutely dictated otherwise I wouldn't even consider working given the facts that you listed. You should also maximize your diet and exercise routine, and consider doing gentle yoga/breathing exercises while you are off from work. Make sure to activate FMLA so that your job is safe.

[llg, PhD, RN]

You might want to repeat the measles titer -- just to be sure you really aren't covered with immunity. One lab test could be wrong.

But ... if there is a decent chance that you are not immune to measles, I would take the time off and limit your exposure to places where you might pick it up. Given your history, I wouldn't want to take any chances.

[klone, MSN, RN]

On 7/11/2019 at 11:24 AM, myoglobin said:

Make sure to activate FMLA so that your job is safe.

FMLA only allows for 12 weeks per year. She's looking at 20+ weeks, and that's BEFORE she has the baby.

[AnnieNP, MSN, NP]

Quote

Repeat the blood work, then if you need to, stay home and enjoy your pregnancy and prepare for your little one.

[Jory, MSN, APRN, CNM]

I understand your fears, but I think taking you off patient care for the rest of your pregnancy because of a theoretical risk of measles when there isn't a case in the hospital....may not be viewed as a reasonable accommodation by HR.

Fact: You are more likely to get measles out in the community than you are in the hospital, especially if there are no cases.

My suggestion: Don't worry about this, but still get the booster postpartum.

Did your titers register at all or were they just low? More than one infectious disease physician has told me that if your titers register AT ALL, your body more than likely still has the ability to fight off the disease...some theorize the antibodies have little incentive to increase in the absence of an infection.

Titers are based on statistics....lower titers means you are at higher risk than someone with higher titers to contract a disease.

Something else to ease your mind: Most colleges in recent years require MMR boosters because the effectiveness of the vaccine does decrease. But....would you get a booster if you weren't a college student? Probably not...nor have most people received one.

[myoglobin, ASN, BSN, MSN]

Having lost 4 pregnancies alone and being older places her at risk. I cannot speak for her but for me nursing in the hospital is a traumatic experience on a weekly if not daily basis and would not optimize her risks.

[turtlesRcool]

I get the desire to avoid any potential infection, but are you really safer to take the time off? Will you spend the rest of your pregnancy at home or will you be going to the grocery store, library, etc. during that time? If someone has been exposed, there's still a good chance that person is out in public touching the same tomatoes you are. People are infectious 4 days before the rash appears, so you may well come into contact with that person simply walking around in public areas.

I'm not saying this to scare you, but to help put the relative risk into perspective. The hospital is full of sick people, but if you're careful about the assignments you accept, you should be at no more risk there than out in the community.

I had two pregnancies in which my titers came back that I was not immune to Rubella. Only in my middle pregnancy (which was less than a year after my first and covered by the booster I got before leaving the hospital with ODS) was I able to relax. The immunity had worn off by my 3rd pregnancy - guess it just doesn't "take" well in my system. So I do know the fear of "what if," but I don't think the risk of contagion is worse at work than in the community.

[CommunityRNBSN, BSN, RN]

9 hours ago, Jory said:

Fact: You are more likely to get measles out in the community than you are in the hospital, especially if there are no cases.

This is the bottom line for me. In the hospital, measles cases will be identified and isolated quickly. That is not the case at the grocery store or the subway.

[myoglobin, ASN, BSN, MSN]

Just a respite from the gut wrenching stress of working as a bedside nurse can only be a positive thing for health and hence pregnancy. There are many days in ICU nursing where I would prefer prison to the stress of the job. Also, we frequently take care of clients on isolation that require we wear masks or in some cases we later learn of patients who should have been on isolation, but were not (in two cases for TB).

[turtlesRcool]

5 hours ago, myoglobin said:

Just a respite from the gut wrenching stress of working as a bedside nurse can only be a positive thing for health and hence pregnancy. There are many days in ICU nursing where I would prefer prison to the stress of the job. Also, we frequently take care of clients on isolation that require we wear masks or in some cases we later learn of patients who should have been on isolation, but were not (in two cases for TB).

Perhaps, but the stress of not having a paycheck for an extended period is also a factor.

If OP's pregnancy goes full term, and then she takes off 12 weeks to be with the baby, that's 38 weeks out of work, and most will be without pay, even if OP has her sick time saved up. Some families can absorb the loss of income; for others it would create a hardship. Most of us work for financial reasons.

Alternately, OP may find herself having less time with her newborn because she has to get back to work.

All this is assuming OP works at some place that will keep her job for her if she takes off the better part of a year. Some places won't, even without pay, so that's another potential stressor.

[Leader25, ASN, BSN, RN]

On 7/11/2019 at 12:48 PM, TheTwentyfifth said:

am torn as to what I should do. Exposure is unlikely, but carries with it the risk of my baby dying or being born infected. And we tried verrrry hard for this baby. I've lost 4 pregnancies, am advanced maternal age, and don't want to take any unreasonable risks with this baby.

This is why I feel pregnant women do not belong working in a hospital floor.It is not worth it to risk a pregnancy.I have seen too many babies messed up by problems during pregnancy and some of them permanent disabilities,prolonged stay,suffering proceedures,not to mention divorce,infertility.

Stay home.