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Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
The presence of rubella-specific IgG indicates that the woman has been infected with rubella virus previously, and she is therefore unlikely to be reinfected. Her fetus is at no risk of developing congenital rubella. As rubella vaccine has been implicated in the aetiology of congenital rubella, rubella immunization is not recommended during pregnancy. The presence of rubella-specific IgG in a patient who was previously seronegative indicates recent infection, which means the fetus is at risk of developing infection. Absence of rubella-specific IgG at the end of pregnancy indicates that she is still at risk of developing rubella during subsequent pregnancies and needs to be protected against this by active immunization following delivery. A rise in rubella-specific IgM occurs soon after rubella infection.
Viral infections
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Treatment of rubella is supportive. The current recommended immunization schedule for rubella vaccine (given in conjunction with measles and mumps vaccines) is for an initial dose at 9 months, second dose at 15 months, and a third dose at 4–6 years. If rubella-specific IgM antibodies or a diagnostic rise in IgG antirubella antibodies are detected in early pregnancy, the patient should be offered prenatal counseling.
Immunisation in primary care
Published in Ruth Chambers, Kirsty Licence, AI Aynsley-Green, Looking after Children in Primary Care, 2018
Combined MMR vaccine was introduced into the UK in 1988 to replace single-measles vaccine, used since 1968. It also represented a change in policy for the control of rubella. Prior to the use of MMR vaccine, rubella vaccine was offered to schoolgirls and susceptible adult women with the aim of providing them with individual protection against rubella infection in pregnancy. Although this selective immunisation policy was partially successful, cases of congenital rubella syndrome, as well as terminations of pregnancy for proven infection or contact with a case, still occurred. This was inevitable as the vaccine strategy had no impact on the circulation of the virus in the community and women who failed to be immunised or who, very rarely, lost their immunity were at risk of infection from young children. Single antigen mumps vaccine had never been used routinely.
Infection-related stillbirth: an update on current knowledge and strategies for prevention
Published in Expert Review of Anti-infective Therapy, 2021
Samia Aleem, Zulfiqar A. Bhutta
There are numerous other viral infections during pregnancy that are well demonstrated to cause stillbirths. Vaccines are widely available for prevention of rubella, measles, mumps and chickenpox; these common childhood illnesses are leading causes of vaccine-preventable stillbirths [50]. In countries with low vaccination coverage, measles outbreaks increase the risk of stillbirths, as occurred in Namibia during the 2009–2010 measles outbreak (aRR 9.0, 95% CI 1.2, 65.5) [51]. In Sudan, where the rubella vaccine is not included in the national immunization program, 5% of women of childbearing age were found to be susceptible to the infection [52]. These highlight further the need for prioritizing vaccine coverage. Recent estimates suggest that over 80% of countries have included rubella in their national immunization schedules [53]. To build on this progress, the remaining countries should follow suit.
Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices
Published in The American Journal of Bioethics, 2020
Heidi Malm, Mark Christopher Navin
We grant that physicians may sometimes have good reasons to treat patients in ways that avoid or reduce the risks of third-party harms. As we mentioned earlier, one reason to vaccinate children against rubella is to protect fetuses, for whom congenital rubella syndrome is very serious (Wilkinson et al. 2016). However, this permissible kind of other-regarding motivation in pediatric care does not sanction an EBH-informed refusal to recommend varicella vaccine. A pediatrician ethically may recommend the rubella vaccine because this vaccine also promotes a vaccinated child’s interests, as we discuss above. The fact that fetuses benefit when we vaccinate children against rubella is an additional reason for physicians to recommend that vaccine. In contrast, if rubella vaccination harmed vaccinated children for the sake of protecting infants, then it would be wrong for pediatricians to recommend it. Likewise, it is wrong for physicians to recommend that healthy children not receive the varicella vaccine for the sake of benefiting others.12
Encouraging Vaccination Ethically: How Can Pox Parties for Grannies and Vaccine-Preventable Diseases Be Avoided?
Published in The American Journal of Bioethics, 2020
Treating children as a means for benefit of others does also have parallels with other vaccines—influenza (the flu) for example. Children are seen to be “super-spreaders” of flu to more vulnerable members of the population (the elderly, those with health conditions, pregnant women), and so this is a rationale for them to be vaccinated, with many free flu programs now targeting young children (NHS England 2017). Rubella vaccine also has an intergenerational aspect to it in that the children vaccinated who then go on to have children of their own will benefit as future parents. Intergenerational injustice gives the impression that generations are unconnected in harms and benefits, but those vulnerable elderly are our parents and grandparents, and we are part of one human species. Anna Gotlib (2014) argues, the binary narrative of opposing generational stakeholders is not so helpful, and intergenerational interdependence as a model of human relationships is preferable.