Rubella vaccination during pregnancy - United States, 1971-1988

Article Abstract:

Since live attenuated measles (rubella) vacine has been available, the Immunization Practices Advisory Committee of the Public Health Service has advised against the immunization during pregnancy. This warning is made because of theoretically possible effects on the development of the fetus. The Centers for Disease Control established the Vaccine in Pregnancy (VIP) registry to record all women who had received rubella vaccine within 3 months of becoming pregnant. From its inception to 1979, none of 290 infants born to 538 women entered into the registry showed defects associated with congenital rubella syndrome (CRS). In 1979, another vaccine was licensed, and again concerns regarding inoculation of pregnant women were raised. During the period from 1979 to 1987, an average of 30 women a year were enrolled in VIP. Outcomes of pregnancy are known for 254 of 272 susceptible women included in the VIP registry. None of 212 live-born infants had defects which suggest CRS. Blood tests were performed on 154 of the newborn infants. Three of them (2 percent) were normal but had signs of a low-grade infection. Their mothers' blood showed similar levels of anti-rubella antibodies. Follow-up testing at 2 months showed a drop in the antibody level, suggesting that this represented a passive immunity (i.e., the antibody had crossed the placental membrane from its origin in the mother). Although the risk of CRS is low, it is still prudent to advise against immunization of pregnant women. Practice dictates that all women should be asked about pregnancy before immunization because of the theoretical risk to the fetus. If vaccination has occurred within 3 months before or after pregnancy, the risk of CRS is negligible. Certainly, inadvertent vaccination of pregnant women should not in itself be a reason to terminate the pregnancy.

Health aspects, Research, Pregnant women

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Increase in rubella and congenital rubella

Article Abstract:

Rubella, also called German measles, is a viral disease characterized by red areas on the skin and enlarged lymph nodes. The disease can be transmitted from a pregnant mother to the unborn fetus, which is associated with birth defects such as congenital rubella syndrome (CRS), still-birth, and miscarriage. Since 1988, there has been a two-to-three-fold increase in the incidence of rubella. In 1990 alone, there were 1,093 reported cases of rubella, the largest number reported in one year since 1982. These case reports came from 38 different states and the District of Columbia. The incidence of rubella increased mainly in the West and Midwest. However, even with this increase, cases of rubella have been reduced by 98 percent since before the development of a rubella vaccine. In 1990, California reported a four-fold increase in the number of rubella cases. Amish communities in Ohio, New York, and Minnesota have also reported increases in the number of rubella cases. Between 1988 and 1989, the greatest increase in rubella cases was reported to occur in individuals over 15 years and in those under one year of age. Between 1988 and 1990, the greatest increase in rubella cases was reported among individuals between 15 and 29 years of age, and among those over 30 years of age. During 1990, 26 different outbreaks of rubella were classified as being related to settings in which unvaccinated adults congregated (prisons, colleges, workplaces) or to religious communities without rubella vaccination. In 1990, there were 10 cases of CRS reported in the US. These findings show a need for improving the level of rubella vaccination, especially in women of childbearing years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Demographic aspects, Disease transmission, Pregnancy, Rubella in pregnancy

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The Eradication of Rubella

Article Abstract:

A doctor who works for the company that makes rubella vaccine believes rubella can be eradicated. Rubella is the medical term for German measles. In the US and most European countries, all infants receive the measles-mumps-rubella (MMR) vaccine followed by a booster shot when they begin school. Most rubella in the US is transmitted by people from countries that do not routinely vaccinate their children. This is the case in many developing countries. However, rubella vaccine is relatively inexpensive and costs can be reduced even more by providing the vaccine in combination with others.

Usage

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