Getting The Facts Straight on Rubella

“Lots of people used to die from rubella!”

I have heard this statement from many very learned people- people who have earned bachelor or advanced degrees. These people sincerely consider themselves very educated about vaccination. The irony is that, frankly, they don’t know what they are talking about.

To quote Medscape: ” Rubella is generally a benign communicable exanthematous disease. It is caused by rubella virus, which is a member of the Rubivirus genus of the family Togaviridae. Nearly one half of individuals infected with this virus are asymptomatic. ” In other words, rubella is a very mild illness and in half of all cases people who have been infected won’t even display any symptoms. Going on, the article states that in children and infants the disease generally manifests with a rash and mild cold/flu symptoms when any symptoms are present. Adults and teens may develop arthritis and more advanced infections. And while cases of rubella encephalitis were not unheard of, they were rare. Risk of death from rubella is extraordinarily low especially if you or your chid are otherwise healthy and not immunocompromised in any way. (Medscape’s chart shows the number of rubella deaths at a total of 29 in 1969- the year the vaccine was introduced.)

So why the vaccination campaign for rubella (a.k.a. German measles)?

From the Merck Manual, Professional Version: Women who are in their first trimester of pregnancy who develop a rubella infection can pass the virus on to their own unborn child causing birth defects like deafness, blindness, intellectual impairments, seizures, microcephaly (excessively small head) and motor impairments. Congenital rubella syndrome (CRS) can also cause a stillbirth or miscarriage. Or it there may be no effect on the baby at all.

The mother may have some upper respiratory symptoms from the rubella infection, or she may have no symptoms at all. Pregnancies of less than 16 weeks gestation are most susceptible to CRS, though 8-10 weeks is the time when the baby is most vulnerable. (Actress Gene Tierney contracted rubella during a WWII USO tour while she was pregnant with her first child. Her daughter was born with intellectual impairments. Reportedly, her friend eccentric millionaire Howard Hughes helped with the medical expenses related to the girl’s care.)

So there is a real reason to be concerned about rubella in pregnancy. And the vaccine is credited with eliminating rubella in the United States. The CDC declared endemic transmission of rubella to have been eliminated in the United States in 2004. This assessment was based on a review of data by an international panel of experts who agreed that rubella had been eliminated.

There are, however, a few issues still left with rubella:

1) The declaration that rubella has been eliminated was based not any widespread and ongoing testing for rubella immunity, but rather on a review of data- which probably means records of doses of the vaccine that were distributed and maybe upon some data regarding actual numbers of rubella vaccines that were administered. So elimination may be more theoretical than practical in nature.

2) If a substantial portion of rubella cases are asymptomatic it would be extremely difficult to detect cases of both vaccine failure and rubella infection without massive and ongoing testing.

3) Why does the United States persist in vaccinating people who are not at risk for CRS like infants, kindergartners and men? Well the idea here was to prevent these people from transmitting the disease to pregnant women, and to achieve “elimination” of the disease. However, going to back to point number 2 above, there are significant number of asymptomatic cases which would make it extremely difficult to detect vaccine failure and therefore truly say that anyone is immune without a massive and constant testing campaign. Anyway, a far more efficient method for vaccination is simply to perform a blood titers test on adolescent girls or women planning to become pregnant and vaccinate only those who lack immunity.



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