Rubella (German measles)

Holly is now in her second trimester and prettier than she's ever been!

There's still a lot more that I could say about influenza and flu vaccines but, for the time being, I'm going to move on to rubella, a vaccine-preventable disease that can have devastating effects if acquired during pregnancy.

Rubella is the R in TORCH; a group of infectious diseases that cause severe birth defects:

• Toxoplasmosis
• Other (syphilis, viruses)
• Rubella
• Cytomegalovirus
• Herpes simplex

Rubella is caused by a virus that is transmitted by respiratory droplets. Rubella means "little red" because a rubella rash is similar to that of measles, but not as severe.

Symptoms of rubella include:

• Rash that starts on the face a spreads to the rest of the body
• Swollen lymph nodes
• Low grade fever

Infants and children may have asymptomatic ("without symptoms") infection, but still be contagious to others.

Rubella is usually benign and self-limiting but can cause arthritis and arthralgia (pain in the joints), which is more common and worse in adults. Encephalitis occurs in about 1 in 5,000 cases, more commonly in adults than children.

Congenital rubella syndrome (CRS):

Congential rubella syndrome occurs when a woman becomes infected with the rubella virus during pregnancy. The outcome of CRS is worse when the infection occurs in the first trimester of pregnancy.

Congenital rubella syndrome is typically associated with cataracts, congenital heart defects, deafness, and mental retardation but any organ system can be damaged by the virus. Maternal rubella infection can result in miscarriage or stillbirth. Birth defects associated with CRS may be present at birth or may not become apparent until years later. Babies with CRS shed large amounts of rubella virus for months after birth.

Other conditions that can result from CRS include:

• Autism
• Endocrine disorders
• Failure to thrive
• Low birth weight
• Retinopathy

Measles, mumps, and rubella vaccine (MMR):

Because we have high MMR coverage in this country, rubella and congenital rubella syndrome have been eliminated from the United States. This means that, although cases of rubella are imported from outside of this country, the rubella virus no longer circulates among the U.S. population.

CDC, 2005

Like live attenuated influenza vaccine (LAIV), MMR is a live virus vaccine that should not be given to pregnant women because of a theoretical risk of infecting the baby with vaccine viruses. MMR is usually given to children, but may be given to adults. Women of childbearing age should wait one month after receiving MMR before getting pregnant. Holly received an MMR booster before we started trying to get pregnant.

So, what if you receive an MMR vaccination and then find out you're pregnant? Don't panic. It happens. The risk of harm to your baby from the vaccine is extremely low and there is no evidence that babies whose mothers received rubella vaccine during pregnancy have been harmed.

The most common side effects of MMR vaccine are pain and redness at the injection site. Other side effects of rubella vaccine are more common in adults than in children. They include mild rubella symptoms; fever, headache, joint pain/stiffness, rash, sore throat, and swollen lymph nodes.

More information:

Centers for Disease Control and Prevention

• Rubella
• Rubella (German Measles) Vaccination

National Network for Immunization Information

• Measles, Mumps, Rubella (MMR)

American College of Obstetrician and Gynecologists

• Reducing your risk of birth defects

References:

Badilla, X., Morice, A., Avila-Aguero, M. L., Saenz, E., Cerda, I., Reef, S., & Castillo-Solórzano, C. (2007). Fetal risk associated with rubella vaccination during pregnancy. Pediatric Infectious Disease Journal, 26(9), 830-835. doi:10.1097/INF.0b013e318124a9f4.

Berger, B. E., Navar-Boggan, A. M., & Omer, S. B. (2011). Congenital rubella syndrome and autism spectrum disorders prevented by rubella vaccination – United States, 2001-2010. BMC Public Health 11(340) http://www.biomedcentral.com/1471-2458/11/340.

Centers for Disease Control and Prevention. (1998). Measles, mumps, and rubella – vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and controls of mumps. recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 47(8), 1-57. http://www.cdc.gov/mmwr/preview/mmwrhtml/00053391.htm.

Centers for Disease Control and Prevention. (2001). Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. Morbidity and Mortality Weekly Report, 50(49), 1117. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm.

Centers for Disease Control and Prevention. (2005). Achievements in public health: elimination so rubella and congenital rubella syndrome – United States, 1969-2004. Morbidity and Mortality Weekly Report, 54(11), 279-282. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm.

Centers for Disease Control and Prevention. (2005). Imported cases of congential rubella syndrome – New Hampshire, 2005. Morbidity and Mortality Weekly Report, 54(45), 1160-1161. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5445a5.htm.

Gershon, A. A. (2009). Rubella virus (German measles). In Mandell, G. L., Bennett, J. E., & Dolin, R. (Eds.). Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. (7th Ed.) pp. 2265-2288. [Electronic version] Churchill Livingstone.

Maldonado, Y. A. (2009). Rubella virus. In S. S. Long (Ed.) Principles and practice of pediatric infectious diseases (3rd Ed.) [Electronic version].

Plotkin, S. A. & Reef, S. E. (2008). Rubella vaccine. In S. A. Plotkin, W. A. Orenstein, & P. A. Offit (Eds.) Vaccines (5th Ed.) [Electronic version]