Immunizations
Micha de Winter, Mariëlle Balledux, José de Mare, Ruud Burgmeijer in Screening in Child Health Care, 2018
Rubella (German measles) is an acute viral infection that often develops with atypical symptoms or even subclinically. In itself, the disease does not constitute significant health (or health care) problems for either the individual or society. However, a primary infection in a pregnant woman can, even if the disease develops subclinically, result in serious deformities of the foetus. The risk of deformity depends on the stage of pregnancy and ranges from approximately 80% in the first month to about 10% in the fourth month. Such pregnancies often end in abortion or stillbirth. If a live child is born it may present a complex of symptoms known as the congenital rubella syndrome (CRS). CRS is characterized by deafness (87%), cardiovascular disorders (46%), mental retardation (39%), and cataract or glaucoma (34%). The death risk during the first year of life is 10% to 20% (Kuipers 1985). Until 1974, approximately 100 children with CRS were born per year. Since 1974, all 11-year-old girls have had the opportunity of being immunized against rubella. Serological field studies carried out before the introduction of immunization showed that, by that age, 70% to 80% of girls had built up natural immunity (Houwert-de Jong et al. 1982, Van Druten et al. 1984a, b).
Neurology and neurosurgery
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
Mental retardation can be defined as a performance more than 2 standard deviations below the mean. It follows that 3% of the population will fall in this category. The majority of mildly retarded individuals are at the lower end of the socioeconomic scale. Mental retardation can be prevented by diet in many metabolic diseases: examples are phenylketonuria and galactosaemia. Rubella immunization should not be carried out in pregnant women as rubella embryopathy, although rare, has been observed following immunization during pregnancy. Although early treatment of congenital hypothyroidism will result in normal development in most patients, it does not prevent mental retardation in all cases.
Infections
Anne Lee, Sally Inch, David Finnigan in Therapeutics in Pregnancy and Lactation, 2019
Rubella (German measles) is caused by an RNA virus. It has an incubation period of 14–21 days and is infective from about one week before, until four days after, the appearance of any rash. It is usually a mild childhood infection, characterised by a generalised rash that may be preceded by upper respiratory symptoms and posterior cervical lymphadenopathy. In adults, a transient arthralgia may occur as the rash begins to fade. Frequently there is no rash. In the UK, the incidence of rubella in pregnancy is very low, as most women are immune. Thirty-two cases of rubella occurring during pregnancy were reported in England and Wales in 1996, and only three cases in 1997. The high maternal immunity rates are largely due to the selective immunisation programme for schoolgirls and women introduced in 1970. In 1988, MMR vaccination for all children at 13 months was introduced, and since 1996 an additional dose of MMR has been given with the diphtheria, tetanus and polio pre-school booster. Although rubella is a mild illness for the mother the effect on the fetus can be catastrophic, resulting in miscarriage, stillbirth, intrauterine growth retardation or severe malformations. Live-born infected infants most commonly present with cardiac defects, neurological abnormalities (microcephaly, cerebral palsy, mental handicap), ocular defects (cataract, microphthalmia, retinitis), deafness, hepatosplenomegaly, jaundice and purpura. Even in those not clinically affected at birth, virus may persist in the lens of the eye and the middle ear, leading to progressive cataract and deafness. The risk of major fetal malformations is highest if infection occurs during the first trimester, approaching 100% for infection occurring within the first 11 weeks of gestation. After 17 weeks gestation the risk is negligible. The risk of fetal infection is probably negligible with periconceptional maternal rubella, with no reported cases of fetal infection when the mother’s rash appears before, or within 11 days after, the last menstrual period. Identification of rubella infection during pregnancy can be difficult. Many viruses can cause a similar rash to rubella and asymptomatic infection commonly occurs. In one study, in 25% of cases of congenital rubella there was no maternal history of illness, rash, or contact with rubella. In 15% of cases there was a history of maternal contact with rubella but without any apparent illness afterwards. If rubella is suspected, or if maternal exposure to rubella occurs, serology should be checked as soon as possible.
The status of rubella IgG antibody titer between antenatal and postnatal among pregnant non-immune to rubella
Published in Human Vaccines & Immunotherapeutics, 2021
Irfana Rasool, Ayesha Azad, Saeed Baradwan, Muhammad Salman Bashir, Dania Al-Jaroudi
ABSTRACT Background: The infection of rubella in pregnancy is worrisome due to the fact that it causes miscarriages, congenital defects, and Congenital Rubella Syndrome (CRS). The purpose of this study was to determine the status of Rubella IgG antibody levels both during the antenatal and postnatal periods among pregnant women nonimmune to rubella and the incidence of exposure to rubella in pregnancy. Methods: This was a prospective cohort study that included 4770 pregnant, who attended the obstetric clinics and delivered in Women’s Specialized Hospital, King Fahad Medical City, between January and December 2015. The study utilized the following measures for rubella screening tests (IgG and IgM) during the antenatal and postnatal period. Pregnant women with recent rubella infection (IgM antibody positive), history of rubella infection, or had immunity against rubella (IgG antibody concentration ≥10 IU/ml) were excluded from the study. Results: The prevalence of pregnant women nonimmune to rubella was 6.3% (n = 301). The majority (93.7%) were immune (IgG antibody concentration ≥10 IU/ml). No patients tested positive for rubella (IgM +ve). Overall, The Median (IQR) Rubella (IgG) in the antenatal period (6.3 (8.30–5.00) IU/m) was significantly less in comparison to the postnatal period (5.0 (6.40–5.00) IU/m). The difference was statistically significant, p <.001. Conclusion: There is a significant decrease in the Rubella (IgG) titer between antenatal and postpartum periods, and we report a very low incidence of rubella infection and CRS among pregnant women nonimmune to rubella.
Rubella Immunity and Morbidity: Effects of Vaccination in Finland
Published in Scandinavian Journal of Infectious Diseases, 1988
Pentti Ukkonen, Carl-Henrik von Bonsdorff
The occurrence of rubella antibodies and frequency of virologically proven rubella infections in different age groups were analyzed in a large serum material (about 60000 sera) collected both before and after the start of nationwide vaccination of children against measles, mumps and rubella in Finland in 1982. The combined live vaccine significantly raised the rubella immunity of children and shifted rubella infections to older ages. In 1986, 91–98% immunity was found in the 2-10-year-old children so far covered by the vaccination programme; no rubella cases were diagnosed in this age group. We also demonstrated that another rubella vaccine given to about 60% of 13-year-old girls since 1975 both raised the immunity and reduced the occurrence of rubella in the vaccinated population. It is concluded that the rubella vaccinations, especially the combined vaccine given to small children, are effective, although the total number of reported rubella cases in the whole population did not decrease significantly during the study period.
Rubella Antibodies in Infants whose Mothers had Rubella during the Second and Third Trimesters of Pregnancy
Published in Scandinavian Journal of Infectious Diseases, 1971
16 infants whose mothers had rubella during the second and third trimesters of pregnancy were tested repeatedly for rubella antibody. In 11 babies the rubella antibodies disappeared within 6 months after birth, in 2 others they declined to low titers within 1 year, but in 3 babies the titer of rubella antibodies remained unchanged or increased slightly during the first year of life. The total IgM concentrations were slightly increased in some infants examined soon after birth, but rubella-specific IgM antibodies could not be demonstrated in any of the babies. All attempts to isolate rubella virus were negative. One infant with permanent rubella antibodies has been chronically ill since birth, all the others have been clinically normal. The possibility of transient or chronic fetal infection following maternal rubella in the second or third trimester of pregnancy is discussed.
Related Knowledge Centers
- Disease
- Arthropathy
- Gland
- Incubation Period
- Measles
- Rubella Virus
- Congenital Rubella Syndrome