About Vaccination - Rubella (German Measles)

When I take Willow to the Pediatrician and she gets any kind of shots, the doctor gives us a pamphlet with information on the shots. So, since everyone is all up in arms about the links between vaccinations and things like autism, I thought I'd take an in-depth look at the vaccinations. Next in line is the Rubella Vaccination.

The United States' Centers for Disease Control and Prevention (CDC) Vaccinations and Immunizations section has a recommended immunization schedule that you can download. They also have a lot of great information for each and every vaccination so this is where I will start in my search for information. Here is their pamphlet on the MMR Vaccination.

The Rubella (MMR) Vaccination is given in two doses. The first dose can be administered when your child is between 12 and 15 months of age and the second when the child is between 4 and 6 years old. These are the recommended ages. But children can get the second dose at any age, as long as it is at least 28 days after the first dose. This vaccination is may be given at the same time as other vaccinations.

Note: A “combination” vaccine called MMRV, which contains both MMR and Varicella (chickenpox) vaccines, may be given instead of the two individual vaccines to people 12 years of age and younger.

First, what exactly is Rubella?


Rubella is sometimes called German measles or three-day (3-day) measles. Rubella is not the same as measles (rubeola). These conditions share some characteristics, but they're caused by different viruses.

Rubella and measles are both contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either illness. However, rubella is neither as infectious nor usually as severe as measles, which is why rubella is also called three-day measles. There is one important exception: If a pregnant woman contracts rubella, especially during her first trimester, the virus can cause death or serious birth defects in the developing fetus.

Why get vaccinated? Rubella is spread from person to person through the air, by coughing, sneezing or breathing. The greatest danger from rubella is to unborn babies. If a woman gets rubella in the early months of her pregnancy, there is an 80% chance that her baby will be born deaf or blind, with a damaged heart or small brain, or mentally retarded. This is called Congenital Rubella Syndrome, or CRS. Miscarriages are also common among women who get rubella while they are pregnant. The last major rubella epidemic in the United States was in 1964–1965, when about 12.5 million people got the disease and 20,000 babies were born with CRS. Several years later a vaccine was licensed, and the disease has been disappearing ever since. Today there are fewer than 20 cases reported each year.

How about a brief History of Rubella? Rubella was first described in the mid-eighteenth century. Friedrich Hoffmann made the first clinical description of rubella in 1740, which was confirmed by de Bergen in 1752 and Orlow in 1758.

In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known as Rötheln (from the German name Röteln), hence the common name of "German measles". Henry Veale, an English Royal Artillery surgeon, described an outbreak in India. He coined the name "rubella" (from the Latin, meaning "little red") in 1866.

It was formally recognized as an individual entity in 1881, at the International Congress of Medicine in London. In 1914, Alfred Fabian Hess theorized that rubella was caused by a virus, based on work with monkeys. In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.

Now that we know about Rubella, how was the vaccination Developed?

First, you should know that the MMR Vaccination is actually a combination of three vaccines; Measles, Mumps, and Rubella. Like the DTaP vaccination, it inoculates against three diseases.

The component viral strains of the MMR vaccine were developed by propagation in animal and human cells. The live viruses require animal or human cells as a host for production of more virus.

For example, in the case of mumps and measles viruses, the virus strains were grown in embryonated hens' eggs and chick embryo cell cultures. This produced strains of virus which were adapted for the hens egg and less well-suited for human cells. These strains are therefore called attenuated strains. They are sometimes referred to as neuroattenuated because these strains are less virulent to human neurons than the wild strains.

The Rubella component, Meruvax, is propagated using a human cell line (WI-38, named for the Wistar Institute) derived in 1961 from embryonic lung tissue. This cell line was originally prepared from tissues of aborted fetuses, raising religious objections.

MMR II is supplied freeze-dried (lyophilized) and contains live viruses. Before injection it is reconstituted with the solvent provided.

The MMR vaccine is administered by a subcutaneous injection.The second dose may be given as early as one month after the first dose. The second dose is not a booster; it is a dose to produce immunity in the small number of persons (2-5%) who fail to develop measles immunity after the first dose. In the U.S. it is done before entry to kindergarten because that is a convenient time.

The more common symptoms of Rubella are:

• Children with rubella usually first break out in a rash, which starts on the face and progresses down the body.


• Older children and adults usually first suffer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection before they develop a rash.
  


• Adult women often develop pain and stiffness in their finger, wrist, and knee joints, which may last up to a month.


• Up to half of people infected with rubella virus have no symptoms at all.

Now, on to the vaccination itself.

Some people should not get MMR vaccine or should wait.

• People should not get MMR vaccine who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or to a previous dose of MMR vaccine.


• People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting MMR vaccine.


• Pregnant women should wait to get MMR vaccine until after they have given birth. Women should avoid getting pregnant for 4 weeks after getting MMR vaccine.


• Some people should check with their doctor about whether they should get MMR vaccine, including anyone who:
  


• Has HIV/AIDS, or another disease that affects the immune system


• Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer.


• Has any kind of cancer


• Is taking cancer treatment with x-rays or drugs


• Has ever had a low platelet count (a blood disorder)
  


• People who recently had a transfusion or were given other blood products should ask their doctor when they may get MMR vaccine

Mild problems:

• Fever (up to 1 person out of 6)


• Mild rash (about 1 person out of 20)


• Swelling of glands in the cheeks or neck (rare)


• If these problems occur, it is usually within 7-12 days after the shot. They occur less often after the second dose.

Moderate Problems:

• Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)


• Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)


• Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe problems:

• Serious allergic reaction (less than 1 out of a million doses)


• Several other severe problems have been known to occur after a child gets MMR vaccine. But this happens so rarely, experts cannot be sure whether they are caused by the vaccine or not.


• These include:
  


• Deafness


• Long-term seizures, coma, or lowered consciousness


• Permanent brain damage

Note: The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about 1 person in 20 and fever in about 1 person in 5. Seizures caused by a fever are also reported more often after MMRV. These usually occur 5-12 days after the first dose.

As you may or may not know, the MMR vaccination is the vaccination at the center of the claim by many parents whose children suffer from autism that vaccinations are the cause. Claims of a connection between the vaccine and autism were initially raised in a 1998 paper in the respected British medical journal The Lancet. After it was discovered that Andrew Wakefield, the paper's lead author, had received major funding from British trial lawyers seeking evidence, ten of the paper's twelve coauthors retracted its interpretation of an association between MMR vaccine and autism. It was also discovered that Wakefield had previously filed for a patent on a rival vaccine using technology that lacked scientific credibility, and that Wakefield knew but did not publish test results that contradicted his theory by showing that no measles virus was found in the children tested.

Following the initial claims, multiple large epidemiologic studies were undertaken. Reviews of the evidence by the Centers for Disease Control, the Institute of Medicine of the National Academy of Sciences, the UK National Health Service, and the Cochrane Library all found no link between the vaccine and autism. The Cochrane Library's systematic review also concluded that the vaccine has prevented diseases that still carry a heavy burden of death and complications, and that the lack of confidence in the vaccine has damaged public health.

I found an awesome website that lists the package inserts and ingredients for all available vaccinations (e.g. provided by MERK or GlaxoSmithKline). It's called the World Association for Vaccine Education. You can find their page on the Rubella Vaccine here.


More Information:

• Guide to Contraindications to Vaccination (a Contraindication is a condition or factor that increases the risks involved in using a particular drug, carrying out a medical procedure, or engaging in a particular activity.)


• Parents Guide to Childhood Immunization


• Division of Environmental Health and Communicable Disease Prevention pamphlet on Rubella


• VaccineInformation.org - The Immunization Action Coalition works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public that enhance the delivery of safe and effective immunization services. The Coalition also facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies.


• Facts for Parents About Vaccine Safety from the AAP


• Adult Immunization Schedule

And since there are those people that are concerned about links of vaccinations to neurological disorders and the like I thought I'd include some of their links as well:

Generation Rescue is an international movement of scientists, physicians and parent-volunteers researching the causes and treatments for autism and mentoring thousands of families in recovering their children from autism.

The Thinktwice Global Vaccine Institute was established in 1996 to provide parents and other concerned people with educational resources enabling them to make more informed vaccine decisions. Thinktwice encourages an uncensored exchange of vaccine information, and supports every family's right to accept or reject vaccines. Thinktwice's Rubella page.


I asked my pediatrician if she had a lot of parents who were choosing to NOT vaccinate their children. She said she could count on one hand the total number and that she, of course, recommends AGAINST not vaccinating your children.

Previously:
Hepatitis B Vaccination Information
Rotavirus Vaccination Information
Diphtheria Vaccination Information
Tetanus Vaccination Information
Pertussis (Whooping Cough) Vaccination
Haemophilus influenzae type b (Hib) Vaccination Information
Pneumococcal Conjugate Vaccination Information
Polio Vaccination Information
Influenza (Flu) Vaccination Information
Measles Vaccination Information
Mumps Vaccination Information


Next week: Varicella