Chronic Arthritis after Rubella Vaccination
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Abstract:
In August 1991 the Institute of Medicine released a report entitled "Adverse Effects of Pertussis and Rubella Vaccines" that examined, among other relations, the relation between immunization with the RA 27/3 rubella vaccine strain and chronic arthritis. The committee spent 20 months reviewing a wide range of information sources including case series and individual case reports published in peer-reviewed journals and reported by vaccine manufacturers; unpublished case reports from physicians, parents, and other concerned persons; epidemiological studies; and laboratory studies. There were no animal studies available. The committee found that the evidence is consistent with a causal relation between the RA 27/3 rubella vaccine strain and chronic arthritis in adult women, although the evidence is limited in scope. Proving that rubella vaccination can cause chronic arthritis will require a better understanding of pathogenetic mechanisms and additional well-designed studies. We briefly describe the committee's evaluative methods and present the evidence underlying its conclusion.Keywords:
Rubella vaccine
Rubella virus vaccine (attenuated strain HPV-77) caused no reactions and showed no communicability when given to 14 Chinese orphans 2 to 6 years of age. Although the proportion of children demonstrating hemagglutination inhibition antibody by 39 days after immunization was low (7 of 12), protection from infection was demonstrated when a rubella epidemic swept the orphanage. Rubella developed in only 1 of 14 children 2 1/2 months after immunization while there were 20 cases of rash among 55 nonimmunized children of the same age. Results of this study suggest that the vaccine does not alter the disease in persons already in the incubation period of natural rubella.
Rubella vaccine
Rubella virus
Incubation period
Attenuated vaccine
Hemagglutination assay
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Rubella is often thought of as a disease of childhood that has few complications. However, congenital rubella resulting from transmission from mother to baby during pregnancy can result in multiple severe defects. There are concerns about the uptake of the MMR vaccine and that any outbreak of rubella would affect disproportionately minority groups in the UK who may not have had the vaccine. Helen Bedford explains.
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MMR vaccine
Congenital rubella syndrome
Measles-Mumps-Rubella Vaccine
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Congenital Rubella
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Despite the availability of rubella vaccine the incidence of the congenital rubella syndrome has been increasing in certain regions of Canada. Perhaps this is not surprising in view of the known irregular cyclic activity of rubella virus in a community and the fact that the percentage of seropositive women of childbearing age has not changed appreciable since the vaccine was introduced. Clearly vaccine is not being administered to sufficient numbers of women at risk. Until a much higher percentage of women of childbearing age possess rubella antibody, the costly problem of congenital rubella syndrome is likely to be with us. Common rubella problems relate to four categories: the exposed pregnant woman, laboratory diagnosis, the infant with suspected congenital rubella and the vaccine. One of the most common questions about the vaccine is the following: Can recently vaccinated individuals disseminate vaccine and infect seronegative contact? The answer is No.
Rubella vaccine
Congenital rubella syndrome
Rubella virus
Congenital Rubella
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One hundred and thirty-three pregnant women who delivered at St Thomas' Hospital, in 1990 were noted to require rubella vaccination post partum. Fifty-three (39%) had completed a telephone questionnaire in order to determine reasons for susceptibility to rubella. Laboratory reports confirmed that 92 women were rubella seronegative and 27 had low levels of antibody. Of the 53 women interviewed, 25 gave a history of one or more rubella immunizations, 20 had no history of immunization and vaccination history was unknown for eight. Eleven of the 20 unvaccinated women had not been at school in the UK between 11 and 14 years of age. Eighty-seven per cent of the patients' general practitioners had no knowledge of their patients' rubella antibody status. Ninety-four per cent of the 133 women received rubella vaccine post partum. The Department of Health guidelines should be more vigorously implemented in order to identify and immunize remaining rubella susceptible women of child-bearing age. Susceptibility among women with a history of rubella immunization suggests that the seroconversion rate following rubella immunization in clinical practice may be lower than in vaccine trials.
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Seroconversion
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To date, Takahashi, Matsuura, and TO-336 strains of live-attenuated rubella vaccine have been used in Japan. Japan implemented a single-dose rubella vaccination program until 2006. However, few reports are available on the persistence of immunity after this vaccination program. We collected 276 serum samples from January 2009 to December 2011 at Okafuji Pediatric Clinic and assessed the immune status of these samples against rubella virus during 1-10 years after vaccination with a single dose of Takahashi rubella vaccine. Regional outbreak of rubella did not occur during 1999-2011. The collected serum samples were tested for antibodies against the rubella virus by performing a standard hemagglutination inhibition (HAI) test. Our results showed that all the tested serum samples contained antibodies against the rubella virus 10 years after the vaccination. Geometric mean titer of HAI antibodies was 1:180 and decreased to 1:68 at 10 years after the vaccination. The levels of HAI antibodies decreased logarithmically with time after the vaccination. In conclusion, vaccine-acquired immunity after vaccination with a single dose of live-attenuated Takahashi rubella vaccine was retained for at least 10 years when rubella was under regional control.
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Antibody titer
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Rubella virus infection during pregnancy is an important cause of blindness, deafness, congenital heart disease, and mental retardation of the foetus. Multiple sero-surveys of rubella antibody among reproductive aged females of Bangladesh showed that 20-30% of them remain susceptible to rubella as rubella vaccination is yet not included in our national immunization program for adolescent and adult girls. The present study was designed to conduct a sero-survey among unmarried girls of 16 to 25 years to assess their serological status in terms of natural rubella infection and vaccinate the rubella susceptible individuals with a single dose of rubella vaccine to evaluate the immunogenicity of the vaccine. A total of 344 randomly selected unmarried, apparently healthy college students were enrolled and investigated for rubella IgG and IgM antibodies at the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Girls who were found to be negative for both rubella IgG and IgM were vaccinated with a single dose of rubella vaccine and tested for rubella antibody after four to six weeks of vaccination. Quantitative analysis of rubella IgG showed that a total of 68.87% study population had protective rubella antibody, 29.36% were susceptible to rubella and 1.74% experienced recent rubella infection. After vaccination, rubella antibody positivity was found to be 100% among 99 (98.02%) of 101 vaccinated girls who were tested for anti rubella IgG. There was statistically significant increase (p <0.001, Paired t Test) in anti-Rubella IgG titres among pre-vaccination and post-vaccination sera. The findings of the study showed that it is mandatory to include young girls in the national immunization programme and immunize them with a single dose of rubella vaccine which was found to be 100% effective.
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We present an extremely rare case of rubella that developed after rubella vaccine administration. A 54-year-old man complained of back and neck pain for some days. He presented with generalized rash and arthralgia that had persisted for two days before his visit. His vital signs were normal, and arthralgia had disappeared during an examination, but lymphadenopathy in the left posterior neck and pink papules were observed throughout the body. He had received his first Rubella vaccination 17 days before this visit and had attended a crowded festival. Owing to the rubella epidemic in that prefecture, we performed a rubella antibody test and polymerase chain reaction assay using blood, urine, and pharyngeal swab specimens. Rubella IgG and IgM antibody titers were 3 and 1.48, respectively. The pharyngeal swab yielded positive results for the 1a vaccine strain. Therefore, he was diagnosed with rubella due to rubella vaccination. His symptoms improved eventually. His clinical course was uncomplicated. Symptoms resolved within one week without specific treatment. The vaccine rubella strain is not as highly infectious as wild-type rubella strains. If rubella symptoms appear after vaccination, it must be investigated whether these are vaccine-specific adverse reactions, wild-strain rubella onset, or other eruptive viral infections.
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We followed students in eight elementary schools for rubella antibody from 1993 to 1996 (602 pairs) and 1996–9 (588 pairs) in Gyeonggi Province, Korea. We tested rubella IgG and administered rubella vaccine to the children with the titres <10 IU/ml. The loss rates of rubella IgG during the follow-up periods were 14·3 and 15·8%, respectively. Among vaccinated groups, the loss rate was 18·8%, which was significantly higher than 13·8% of the mixture of natural and vaccine-induced immunity groups. The group that had the lower preceding antibody titre had a higher loss rate of 24·8% compared to 7·2% for the group whose titre was 40 IU/ml or above. In a multivariate analysis, age and gender were not related to antibody loss rate. Under this higher rubella antibody loss rate, in order to prevent congenital rubella syndrome, the immunization for women at childbearing age appears necessary until rubella can be eliminated or controlled.
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Congenital rubella syndrome
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Rubella hemagglutination inhibition (HI) antibody responses were measured before and after immunization with HPV-77 DE/5 vaccine in 7 adult females with recurrent arthritis following rubella immunization and 24 hospital personnel studied prospectively while undergoing routine rubella immunization. The only distinctive serologic characteristic observed in all subjects developing rubella arthritis was a preimmunization HI titer of < 1 :8. No association was observed between the development of arthritis after immunization and prolongation of rubella HI IgM responses or elevation of rubella HI IgG responses.
Rubella vaccine
Hemagglutination assay
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Rubella vaccine
Rubella virus
Persistence (discontinuity)
Congenital rubella syndrome
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