Rubella effects

In recent years concerns have been raised in the popular press about possible side effects from the MMR vaccine, which is given to infants to guard against measles, mumps and rubella. Although this has led to a drop in the levels of vaccination, the advice from health professionals continues to be in favour of vaccination, because even if the claimed side effects were shown to be true, failure to vaccinate would still statistically pose the greater health risk due to the detrimental effects of the diseases themselves. 

The rubella virus results in a self-limiting infection characterised by a rash spreading from the face, trunk and limbs. The infection commonly occurs in children. The rubella virus has the most serious effect on the fetus. Rubella occurring during pregnancy, especially during the first trimester, may result in spontaneous abortion, stillbirths or congenital malformations. 

Live attenuated virus vaccines for measles, mumps and rubella (MMR) have been combined into a single vaccine known as MMR vaccine. The MMR vaccine is effective as the single-virus vaccine composed of the respective strains and has been shown to be highly effective. The immunity induced by MMR is long lasting and may be lifelong. 

Viral Vaccination. Vaccines, agents that elicit a specific antiviral iniiiLuiie response, have been very successful against smallpox, measles, rubella, poliomyelitis, and yellow fever, all of which are generalized diseases. Vaccines against diseases caused by respiratory tract viruses, where great antigenic diversity is found, have been less effective. 

AZATHIOPRINE VACCINES i effectiveness of vaccines, t risk of adverse/toxic effects of live vaccines (e.g. measles, mumps, rubella, oral polio, BCG, yellow fever, varicella, TY21a typhoid), e.g. vaccinal infections Disseminated infection due to enhanced replication of vaccine virus in the presence of diminished immunocompetence Do not vaccinate when patients are on immunosuppressants. Vaccination should be deferred for at least 3 months after discontinuing immunosuppressants/myelosuppres-sants. If an individual has been recently vaccinated, do not initiate therapy for at least 2 weeks after vaccination... 

Medroxyprogesterone acetate and its metabolites are excreted in breast milk, so women who breastfeed should wait until 6 weeks post partum before starting Depo-Provera, when the infant s enzyme system should be more mature. Norethisterone enantate 200 mg (Noristerat) is shorter acting than Depo-Provera, 8 weeks, and is used to provide contraception after administration of the rubella vaccine, and until a partner s vasectomy has taken effect. It can also be used in the longer-term but only on a named patient basis. 

Table 2 Clinical effects of acute encephalopathy in 48 patients 2-15 days after the first dose of measles, measles-measles-mumps-rubella vaccine, and sequelae, 1970-93 -rubella, or...

Adverse effects on the nervous system that have at least temporally been associated with rubella vaccination include myehtis, myeloradiculitis (SEDA-2, 268) (SEDA-20, 292), meningomyelitis (SEDA-10,291), ence-phahtis (SEDA-5, 308), peripheral neuropathy (SEDA-12, 284), facial or peripheral paresthesia (SEDA-11, 295) (SEDA-12, 284), and carpal tunnel syndrome (SEDA-12, 284). In many of these cases the causal relation was doubtful. The authors of the report of the Institute of Medicine, National Academy of Sciences, Washington, DC (1991) entitled Adverse Effects of Pertussis and Rubella Vaccines (38) considered that there was insufficient evidence to indicate either the presence or absence of a causal relation between RA 27/3 rubella vaccine and radiculoneuritis and other neuropathies. 

However, the authors of the report of the Institute of Medicine, National Academy of Sciences, Washington, DC (1991) entitled Adverse Effects of Pertussis and Rubella Vaccines (38) considered that there was insufficient evidence to indicate either the presence or absence of a causal relation between RA 27/3 rubella vaccine and thrombocytopenic purpura. 

Howson CP, Howe CJ, Fineberg HV, editors. Adverse Effects of pertussis and rubella vaccines. A report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Washington, DC National Academy Press, 1991. 

A critical examination (4) of a report (5) of several children whose chronic bowel and behavioral abnormalities were linked to measles, mumps, and rubella (MMR) immunization can be used as an example to underline Halsey s comments. Without effective and credible systems for the detection of vaccine-associated adverse events through pharmacovigilance, for distinguishing causal reactions from coincidental reactions by pharmacoepidemiological or other studies, and for risk communication, vaccine safety concerns may confuse the media and the public. 

In the USA, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program as a federal no-fault compensation system for individuals who may have been injured by specific vaccines. This compensation program relies on a Vaccine Injury Table that lists the vaccines that are covered by the program, as well as injuries, disabilities, illnesses, and conditions (including death) for which compensation may be awarded. To better reflect current scientific knowledge about vaccine injuries, the Vaccine Injury Table was revised in 1995 and has been subsequently further modified. The latest modification, which became effective on December 1, 2004, is shown in Table 7. This revision took into account a review of the literature on specific adverse consequences of pertussis and rubella vaccines performed and published by the lOM (SED-12, 817) (SED-12, 825). In addition to the seven vaccines (diphtheria, pertussis, tetanus, measles, mumps, rubella, and poliomyelitis) included in the first Vaccine Injury Table, the 1997 revision includes hepatitis B, Hemophilus influenzae type b, and Varicella vaccines, as well as any future licensed vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) for routine administration to children (38). 

In this chapter the subject of scale-up is reviewed, which is taking small laboratory cultures (e.g. 10 ml) to industrial-scale processes (e.g. 10 000 litre), i.e. a 1 000 000-fold scale-up The aim of such scale-up is to provide more cells, and more cell product, in as efficient and cost-effective a manner as possible. Cell cultures have been used since 1954 for the production of human (e.g. polio, measles, mumps, rabies, rubella) and then veterinary (e.g. FMDV) vaccines (Griffiths, 1990a). Interferon was the next most important product to be developed, followed by monoclonal antibodies and a range of recombinant proteins. 

Kilbum DG Van Wezel AL (1970) The effect of growth rate in continuous flow cultures on the replication of rubella virus in BHK cells. Journal of General Virology 9 1-7. 

Rubella vaccine (German measles vaccine, live. Meruvax II, Merck) is a live, attenuated ruhella virus produced in human diploid cell culture. The antigen form of the vaccine is whole virus. The antigen type is protein. The vaccine i.s administered as part of the normal immunization schedule at 15 month.s. Side effects arc minimal, but there may be some soreness and pain at the site of injection and. stiffness of the joints. 

Which antiviral drugs work or how the disease is dealt with in terms of public health measures, depends, in part, on the type of virus. The DNA viruses are relatively stable in form since mutations are internally corrected, and here it is often more effective to use vaccination than chemotherapy. By these means smallpox has been eradicated. For some RNA viruses, vaccination is also effective, including poliomyelitis, rubella, measles and mumps, and some rabies strains. Other viruses mutate so rapidly that vaccination is more difTicult, e.g. influenza, the common cold, HIV. 

Howson, C.P. Fineberg, H.V. The ricochet of magic bullets Summary of the Institute of Medicine Report, Adverse Effects of Pertussis and Rubella Vaccines. Pediatrics 1992, Feb., 89 (2), 318-324. 

Adverse effects of the rubella virus vaccine tend to increase with the age of the recipient. Symptoms are similar to wild-virus infection and include lymphadenopathy, rash, urticaria, fever, malaise, sore throat, headache, myalgias, and paresthesias of the extremities. These occur 7 to 12 days after vaccination and last 1 to 5 days. Joint symptoms occur more often in susceptible postpubertal females. Arthralgia occurs in 25% of such vaccinees, and 10% will have arthritislike symptoms. These symptoms usually begin 1 to 3 weeks after vaccination and persist for 1 day to 3 weeks. A very small excess risk of chronic arthropathy exists. The vaccine may cause suppression of tuberculin skin tests for up to 6 weeks after vaccination. While the vaccine virus may be excreted in nose and throat secretions, it is not contagious. 

Tingle AJ, Mitchell LA, Grace M, et al. Randomised, double-blind, placebo-controlled study on adverse effects of rubella immunisation in seronegative women. Lancet 1997 349 1277-1281. 

Analogy. HiU gives as an example of analogy that the effects of rubella or thalidomide should aUow us to accept slighter but similar evidence with another drug or another viral disease in pregnancy. 

The historic objective of vaccination has been to induce long-lasting immunity against a disease for which the recipient is at risk. The most successful vaccination campaign eradicated smallpox as a public health problem. Particularly, vaccination against common infectious agents, including poliomyelitis, measles, mumps, and rubella, over the last 50 years has led to effective prevention of many diseases. 

---