Cont.
WHO SHOULD NOT BE VACCINATED
Rubella vaccine is not known to cause special problems for pregnant women and their unborn babies, even though natural
rubella disease does cause birth defects. However, doctors usually avoid giving any drugs or vaccines to pregnant women
unless there is a specific need. Therefore, to be safe, pregnant women should not be vaccinated with rubella vaccine. If a
pregnant women is vaccinated or if she becomes pregnant within 3 month of vaccination, she should see her physician for a
thorough explanation of the risks and concerns for the unborn baby. Rubella vaccination during pregnancy is not a reason in
itself to consider interruption of the pregnancy. However, the decision whether to continue a pregnancy is always a personal
and medical decision which can only be made by the pregnant woman and her physician.
Persons with defective immune systems should not be given rubella vaccine. This includes persons with certain cancers,
leukemias, lymphomas, or persons undergoing therapy with certain cancer treatments, radiation, or large doses of steroids. A
physician should be consulted before a patient who may have a defective immune system is given rubella vaccine. On the other
hand, a person who has contact or lives in a household with an immunosuppressed person may be given rubella vaccine as
usual.
Susceptible children infected with the HIV virus, but who do not have disease caused by HIV, should receive rubella vaccine.
Persons with symptomatic HIV infection, for whom MMR vaccine is indicated, may be considered for vaccination.
Asymptomatic children do not need to be evaluated and tested for HIV infection before decisions concerning vaccination are
made.
All preparations of rubella vaccine contain trace amounts of neomycin. Persons who have experienced life threatening allergic
reactions to neomycin should not be given the vaccine. Severe allergy means an intense life-threatening reaction requiring
medical attention. A history of simple skin reaction to neomycin is not a reason to avoid receiving the vaccine unless that rash
was part of a life threatening reaction such as hives. Live rubella vaccine does not contain penicillin, so a history of penicillin
allergy is not a concern for vaccination.
Rubella vaccine given by itself can be administered with safety to persons with egg allergies. However, if the vaccine is
combined with measles and mumps vaccines, it should not be administered to persons with severe allergy to eggs. (Egg
products are used to make measles and mumps vaccines.) Persons who have egg allergies that are not life threatening in nature
can be vaccinated with MMR vaccine. If a person can eat eggs, then the allergy is not considered to be severe.
Vaccination of persons with a high fever should be postponed until recovery. However, susceptible children with mild illnesses,
such as an upper respiratory infections should be vaccinated, whether or not fever is present.
Rubella vaccine should not be given within 14 days before the administration of immune globulin (IG), or for at least 6 weeks,
and preferably for 3 months, after a person has been given IG, whole blood, or other antibody-containing blood products.
However, women may receive rubella vaccination after delivery. Persons vaccinated after receiving whole blood or other
blood products, such as Rho-Gham after delivery should be tested 6 to 8 weeks after vaccination to see if they are immune.
Persons who receive the vaccine do not transmit rubella to others, except in the case of the vaccinated breastfeeding mother.
In this situation, the infant may be infected through breast milk and may develop a mild rash illness, but serious effects have not
been reported and the infant can be vaccinated later without problems. These infants should receive rubella vaccine at 15
months of age as usual. Breastfeeding mothers without documented evidence of immunity to rubella should receive rubella
vaccine.
PREGNANCY
For the developing unborn baby, rubella can be a devastating illness with consequences that last a lifetime. Infants born to
mothers who become ill with rubella during pregnancy have an increased risk of birth defects that include hearing loss, loss of
sight, heart defects, mental retardation, and even death. By receiving the rubella vaccine, a woman can protect her unborn
child from rubella. Therefore, all women of child-bearing age should be immunized against rubella. Because it is not
recommended that rubella vaccine be given during pregnancy, vaccination should occur at least three months before
conception.
PREGNANCY AND THE RUBELLA VACCINE
While it is not recommended that pregnant women receive the rubella vaccine, some women have been inadvertently
vaccinated while pregnant. When rubella vaccine was licensed, this situation was of concern. Therefore, from 1971-1989, the
Centers for Disease Control maintained a list of reported women vaccinated during pregnancy to determine the vaccination
effects, if any, on the infants of such mothers. This list of women was called the Vaccine in Pregnancy Registry. Because
enough reports had been received and analyzed, CDC discontinued the VIP registry on April 30, 1989.
Based on data in the Vaccine in Pregnancy Registry (VIP), there is no evidence that defects consistent with congenital rubella
syndrome have occurred in offspring of women vaccinated during or close to the time of pregnancy. Therefore, the observed
risk of birth defects for vaccination in pregnancy is zero. However, since the vaccine consists of a weakened live virus, it is
theoretically possible that the vaccine could rarely damage the unborn child, although such an effect has never been observed.
It is believed that if vaccination occurs within 3 months before or after conception, there is a theoretical risk of CRS, but it is
so small as to be negligible. Inadvertent vaccination of a pregnant woman should not be a reason in itself to consider
interruption of pregnancy. However, the patient and her physician should make the final decision about continuing the
pregnancy.
In summary, rubella vaccine is not known to cause special problems for pregnant women and their unborn babies. However,
doctors usually avoid giving any drugs or vaccines to pregnant women unless there is a specific need. Therefore, to be safe,
pregnant women should not be vaccinated with rubella vaccine.
RUBELLA STATISTICS
Most cases of rubella occur in the late winter and early spring. In the pre-vaccine era, epidemics of rubella occurred every 6 to
9 years, with the last major U.S. epidemic occurring in 1964-1965. The 1964 epidemic resulted in an estimated 12.5 million
cases of rubella infection and 20,000 infants born with congenital rubella syndrome (CRS). The estimated financial cost of the
epidemic was $840 million.
Rubella and CRS have declined dramatically since rubella vaccine was licensed in 1969. Limited outbreaks continue to occur
among groups of susceptible persons in close contact with each other, for example, in schools, colleges, hospitals, and other
places of employment. Prisons have also been affected by rubella outbreaks in recent years.
Although reported rubella activity in the United States decreased after vaccine licensure, a similar decline in rubella in women
of childbearing age and in CRS cases did not occur until after the mid-1970's. This decrease in the 1980's was due to
decreased transmission among children and from children to adult contacts and increased efforts to vaccinate susceptible
adolescents and young adults, especially women.
More recently, there has been a moderate resurgence of rubella and a dramatic increase in CRS between 1988 and 1990. A
provisional total of over 1000 cases of rubella was reported in the United States in 1990. While the incidence of rubella has
declined by more than 99% since vaccine licensure, the 1990 annual total represents a four-fold increase since 1988. The
increase in rubella occurred in settings in which unvaccinated adolescents and adults congregate, such as colleges, prisons, and
the work-place. The increase was also due to rubella cases in children and adults in religious communities with low levels of
vaccination, such as Amish communities.
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