Management of Rubella Outbreaks in Hospitals

To the Editor.—  We suggest an additional control measure to those outlined by Greaves et al in a recent article in The Journal (1982;248:861). Their recommendations for control of a hospital rubella outbreak included the following: (1) vaccination of nonpregnant personnel who neither have proof of serological immunity nor prior rubella vaccination, (2) exclusion of exposed susceptible personnel from work during their potentially communicable period, and (3) exclusion of susceptible pregnant personnel from work until the outbreak is controlled.The protection provided by this approach is incomplete in one crucial respect. Susceptible employees with unrecognized exposures may be incubating rubella, and their infectivity would not be altered by immunization. There is no provision to protect pregnant patients from such employees under the presented recommendation. There are two additional problems with relying completely on an emergent hospital-wide rubella immunization program. First, large-scale immunization programs take at least several days to institute.