Some Current Issues Relating to Rubella Vaccine

Abstract

At the time of licensure in 1969, available data indicated that rubella vaccines were safe, noncommunicable, and effective. Since vaccine virus could cross the placenta and infect the fetus, cautious use of the vaccines in childbearing-age women was recommended. Over the past 15 years, additional information about the vaccines has been accumulated. This article provides an update of data on (1) the risk and degree of joint symptoms following vaccination and revaccination, (2) the duration of vaccine-induced immunity, (3) the protective effect of low levels of vaccine-induced antibody, and (4) the risks to the fetus following maternal vaccination. The data support continued vaccination of all young children as well as increased efforts to vaccinate susceptible adolescents and young adults, especially women. Only by more effective vaccination of the latter can elimination of congenital rubella syndrome be hastened.

Rubella in the United States: toward a strategy for disease control and elimination

“…Although the observed risk of congenital malformations after rubella vaccination with RA 27/3 is zero, the theoretical risk may be as high as 1P6% ( Table 2). The risk is substantially less than the estimated 20-50% risk of CRS associated with natural rubella infection of women during the first trimester of pregnancy [12]. Reasonable precautions, however, should still be taken to preclude vaccination of pregnant women, including asking women if they are pregnant, excluding those who say they are, and explaining the theoretical risks to the others.…”

Vaccines and immunotherapies for the prevention of infectious diseases having cutaneous manifestations

“…However, a study of 321 women who had received the rubella vaccine 3 months before or after conception revealed no congenital malformations compatible with congenital rubella infection. 26 Immunization is also contraindicated in immunosuppressed patients, although it can be administered to individuals with asymptomatic HIV infection as well as to persons with mild immunosuppression. In healthy individuals, minor illnesses with or without fever are not a contraindication to vaccination.…”

“…64 These joint symptoms typically begin within the first 3 weeks after vaccination and remit within 11 days. 26 The knees and the fingers are most frequently involved, but any joint may be affected. 63 Hepatitis A virus.…”

Making Vaccination Policy: The Experience with Rubella

“…Clinical studies showed that rubella vaccine induced antibodies at lower levels than those produced bella-like symptoms. The most troublesome of these were arthralgia and arthritis [17]. These were uncommon in children by the natural disease.…”

“…U.S. recommendations. The U.S. recommendations atprotect the fetus, even in the presence of reinfection [17]. However, some thought otherwise, and this issue was a subject tempted to achieve epidemic control by large-scale immunization programs in children aged §1 year to puberty.…”