We deal with vaccinations. Part 15. Rubella

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

1. Rubella in children is an even more trivial disease than mumps. However, rubella can be dangerous for pregnant women in the first trimester.

Unlike whooping cough, where adults and children are vaccinated to protect babies, in the case of rubella, in contrast, babies are vaccinated to protect pregnant women. Or rather, babies are vaccinated to protect unborn babies.

2. CDC Pinkbook

Rubella is asymptomatic in 50% of cases. In adult women, rubella is usually accompanied by arthralgia (joint pain) and arthritis.

Rubella very rarely has complications. Complications are more common in adults than in children.

Rubella in the first trimester of pregnancy can lead to birth defects in the fetus or spontaneous abortion.

In the 1980s, 30% of rubella cases were reported in adults (15-39 years old). After the introduction of the vaccine, 60% of cases are recorded in 20-49 years old (median age 32 years).

35% of post-pubertal women develop acute arthralgia after vaccination, and 10% develop acute arthritis.

Although one dose of the vaccine is sufficient for rubella immunity, children should receive two doses of MMR. Well, simply because a separate rubella vaccine is no longer produced.

There is insufficient evidence of how the immune system responds to a second dose of mumps and rubella vaccine.

3. Rubella (Banatvala, 2004, Lancet)

Rubella is usually indistinguishable from parvovirus B19, herpes simplex type 6, dengue fever, group A streptococcus, measles, and other viral diseases. Therefore, laboratory confirmation is necessary for a correct diagnosis.

Rubella can be contracted again. The chance of re-infection after vaccination is higher than after a common illness.

Strain RA27 / 3, which has been used in all rubella vaccines since 1979 (except Japan and China, which use their own strains), was isolated in 1965 from an aborted fetus. RA stands for Rubella Abortus (i.e. fetus aborted due to maternal rubella), 27/3 means the third tissue (kidney) of the 27th fetus. In the previous 26 fetuses aborted due to rubella, the virus was not detected. The isolated virus is weakened by passing it serially 25-30 times through the aborted lung cells (WI-38).

4. Studies of immunization with living rubella virus. Trials in children with a strain cultured from an aborted fetus. (Plotkin, 1965, Am J Dis Child)

It goes into more detail about how the virus was isolated, how the vaccine was made, and how it was tested on orphans in Philadelphia.

In addition to the subcutaneous administration of the vaccine, nasal administration was also tried, but it was less effective.

Clinical trials for a nasal vaccine are also reported here, here and here. The subcutaneous route of vaccine administration appears to have been chosen at the end because the nasal vaccine requires more virus and because the subcutaneous vaccine is easier to administer.

5. Rubella vaccines: past, present and future. (Best, 1991, Epidemiol Infect)

The first attenuated rubella vaccine, HPV77. DE5, appeared in 1961. And it was called that because it was weakened through 77 serial passes through the kidney cells of green monkeys, and then 5 more times through the fibroblasts of duck embryos. Duck fibroblasts were added because it is believed that there are fewer foreign viruses and other infections in avian embryos than in monkey kidneys. This vaccine was widely used in the United States and Europe in the 1970s, and the first MMR vaccine (MMR1) contained this strain. Today MMR-II is used, which was licensed in 1988.

Another rubella virus strain, HPV77. DK12, was attenuated instead of duck fibroblasts by 12 serial passes through canine kidney cells. This vaccine was licensed in 1969, but discontinued after a few years because it caused too many side effects (severe arthritis in children that lasted up to three years).

The RA27 / 3 strain caused arthropathy (joint damage) that lasted more than 18 months in 5% of women, joint pain in 42%, and rash in 25%. One study found that joint pain was less common in those who were vaccinated within 6-24 days of the onset of menstruation, and another study found that joint pain occurred most frequently in those who were vaccinated within seven days of the onset of menstruation. …The authors recommend vaccinating in the last 7 days of the cycle.

Little research has been done on the role of cellular immunity in rubella. The transformation of lymphocytes was lower after inoculation than after natural rubella.

Rubella boosters are not particularly effective. In people with low antibody counts, booster shots resulted in only a slight increase in antibody count, while 28% had no increase at all.

6. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles-mumps-rubella-varicella vaccine to children aged 11-21 months. (Knuf, 2010, Eur J Pediatr)

MMR and MMRV, unlike non-living vaccines, must be given subcutaneously, not intramuscularly. But since few people know how to give subcutaneous injections, this study tested what would happen if MMRV was given intramuscularly, and concluded that this is also possible. Well, in any case, in the first 42 days after the injection, everything was fine.

7. Viral infections during pregnancy. (Silasi, 2015, Am J Reprod Immunol)

There are many viruses and bacteria other than rubella that, if infected during pregnancy, increase the risk of birth defects or spontaneous abortion. For example, herpes, chickenpox, cytomegalovirus, hepatitis, influenza, parvovirus B19, syphilis, listeria, toxoplasma, chlamydia, Trichomonas, etc. But most of them are not vaccinated, so few are afraid of them.

8. Rubella in Europe. (Galazka, 1991, Epidemiol Infect)

In 1984, the WHO European Office decided to eradicate rubella by the year 2000 (as well as measles, polio, neonatal tetanus and diphtheria).

Since the introduction of MMR in Poland, Finland and other countries, rubella incidence has shifted from children to adolescents and adults.

There are three vaccination strategies:

1) One dose of MMR at 15 months for all children (US)

2) One dose of rubella vaccine only for girls 10-14 years old who have not been ill (UK)

3) Two doses of MMR at 18 months and 12 years for all children (Sweden)

The selective vaccination strategy (as in the UK), although it has led to a decrease in rubella incidence in pregnant women, leaves 3% of women unprotected. Therefore, the WHO decided to completely eradicate rubella, and for this to vaccinate infants.

Mathematical models predict that less than 60-70% vaccine coverage will increase the number of rubella-susceptible adults.

9. Increase in congenital rubella occurrence after immunization in Greece: retrospective survey and systematic review. (Panagiotopoulos, 1999, BMJ)

Rubella vaccination began in Greece in 1975, but coverage was below 50%. This has led to the fact that the number of pregnant women susceptible to rubella is constantly increasing. As a result, in 1993 there was a rubella epidemic in Greece, and 6-7 months later, the largest epidemic of congenital rubella syndrome in the history of the country (25 cases). Before that, congenital rubella syndrome was very rare in Greece.

In addition, adults began to get sick with rubella. If before the start of vaccination the average age of patients was 7 years, then in 1993 the average age was already 17 years. Although the total number of rubella cases in 1993 was lower than in 1983, the number of patients aged 15 years and older increased.

10. Evolution of surveillance of measles, mumps, and rubella in England and Wales: providing the platform for evidence-based vaccination policy. (Vyse, 2002, Epidemiol Rev)

Here, among other things, there is a graph of the number of rubella susceptible women of childbearing age in England from 1985 to 1998, which shows that the number is not changing much. The solid line is women who have not yet given birth, and the dotted line is those who have already given birth.

Rubella vaccination in England was introduced in 1970 for girls 11-13 years old, and MMR was introduced in 1988.

11. Global seroprevalence of rubella among pregnant and childbearing age women: a meta-analysis. (Pandolfi, 2017, Eur J Public Health)

In 2012, WHO decided to eradicate rubella by 2020.

Since rubella, as well as congenital rubella syndrome, is very difficult to diagnose, the actual number of cases can be 10-50 times higher.

The authors performed a meta-analysis of 122 rubella susceptibility studies in pregnant women and women of reproductive age.

In Africa, 10.7% of women do not have antibodies to rubella, in the Americas - 9.7%, in the Middle East - 6.9%, in Europe - 7.6%, in Southeast Asia - 19.4%, in the Far East - 9%. In total, 9.4% of pregnant women and 9.5% of women of reproductive age in the world do not have antibodies to rubella, while the WHO goal is a susceptibility of 5% or less.

At the same time, in Africa, until 2011, no country had vaccinated against rubella, in the Americas, by 2008, almost all countries were vaccinated, and in Europe, all countries were vaccinated.

The US federal government is spending $ 4 billion a year to increase vaccination coverage for adolescents and adults.

12. Immunogenicity of second dose measles-mumps-rubella (MMR) vaccine and implications for serosurveillance. (Pebody, 2002, Vaccine)

2-4 years after MMR, 19.5% of children had measles antibodies below the protective level, 23.4% of children had mumps antibodies below the protective level, and 4.6% of children had rubella antibodies below the protective level.

41% of children did not have protection from at least one disease, which means that a second dose of the vaccine is needed. Similar results were found in other studies in the UK and Canada.

Repeated MMR vaccination leads to an increase in the level of antibodies against measles and rubella, but after 2-3 years it decreases to the pre-vaccination level. Similar results have been reported in other studies in Finland and elsewhere.

The authors conclude that the level of antibodies in the blood correlates poorly with the level of protection against disease.

13. Epidemiology of measles, mumps and rubella in Italy. (Gabutti, 2002, Epidemiol Infect)

In Italy, from the 70s to the 90s, the number of measles cases decreased among children and increased significantly among adolescents and adults.

The incidence of mumps has increased significantly among children under 14 years of age, and has remained virtually unchanged among adults. Perhaps this is due to the fact that in Italy the Rubini strain was used, which turned out to be very ineffective. This strain was replaced in 2001.

The number of rubella cases among children increased in the 1980s and then declined again. Among adolescents and adults, the incidence of rubella increased significantly in the 1980s and remained high thereafter.

Among children 2-4 years of age, 59% had antibodies against measles and rubella, but only 32% had antibodies against all three diseases. Among 14-year-olds, only 46% had antibodies to all three diseases. Among 20-year-olds and older, 6.1% had no measles antibodies, 11.7% mumps, and 8.8% 15-year-olds and older had no rubella antibodies.

The incidence of rubella has not changed in recent decades, despite the fact that rubella vaccination was introduced in Italy for girls in the early 1970s. On the contrary, insufficiently high vaccination coverage, which does not lead to the eradication of the disease, leads, as in the case of measles, to the fact that the disease is shifted into adulthood, which in the case of rubella is much more dangerous, due to the risk of contracting the disease during pregnancy.

The authors conclude that the WHO goal of eradicating measles, mumps and rubella has not been achieved and that insufficient vaccination in Italy has only led to an increase in measles and rubella susceptible adults, and in the case of mumps, vaccination has not worked at all.

14. Humoral immunity in congenital rubella. (Hayes, 1967, Clin Exp Immunol)

There is no clear relationship between the amount of antibodies and the elimination of the virus in patients with congenital rubella syndrome.

15. Congenital rubella infection after previous immunity of the mother. (Saule, 1988, Eur J Pediatr)

Vaccination of the mother does not always provide protection against congenital rubella syndrome for the baby. Here is the case of a mother who was vaccinated 7 years before pregnancy and had sufficient antibody levels 3 years before pregnancy, but nevertheless contracted rubella during pregnancy.

Here are some more similar cases:

16. Vaccines for measles, mumps and rubella in children. (Demicheli, 2012, Cochrane Database Syst Rev)

In a systematic review by Cochrane, the authors conclude that there is no study that demonstrates the clinical efficacy of rubella vaccination.

MMR safety was discussed in the parts about measles and mumps. Here are some more studies related to rubella:

17. Anaphylaxis following single component measles and rubella immunization. (Erlewyn-Lajeunesse, 2008, Arch Dis Child)

The risk of anaphylactic shock due to vaccination is 1.89 in 10,000 for measles vaccine and 2.24 in 10,000 for rubella vaccine. The authors believe that these figures are very underestimated, since the exact number of injected vaccines is unknown, and the actual figures may be 3-5 times higher.

The risk of anaphylactic shock due to MMR was estimated at 1.4 per 100,000 in 2004. However, in 2003, the risk of anaphylactic shock from all vaccines was estimated at 0.65 per million.

18. Is RA27 / 3 rubella immunization a cause of chronic fatigue? (Allen, 1988, Med Hypotheses)

In 1979, they began to vaccinate against rubella with the RA27 / 3 strain. Within three years, a new disease appeared in the medical literature - chronic fatigue syndrome, which was initially attributed to the Epstein-Barr virus.

Most of those with chronic fatigue syndrome are adult women who develop symptoms after rubella vaccination.

Patients with this syndrome have an increased level of antibodies from many viruses.

The more rubella antibodies were found, the more severe the symptoms of chronic fatigue were.

19. Chronic arthritis after rubella vaccination. (Howson, 1992, Clin Infect Dis)

A report from a special committee of the Institute of Medicine, which met for 20 months and concluded that the RA27 / 3 strain leads to chronic arthritis in women.

Here's another report that links rubella vaccine to acute arthritis.

20. A one year followup of chronic arthritis following rubella and hepatitis B vaccination based upon analysis of the Vaccine Adverse Events Reporting System (VAERS) database. (Geier, 2002, Clin Exp Rheumatol)

VAERS analysis. The rubella vaccine increases the risk of chronic arthritis 32-59 times, and the hepatitis B vaccine increases the risk of chronic arthritis 5.1-9 times.

21. Effect of measles-mumps-rubella vaccination on polymorphonuclear neutrophil functions in children. (Toraldo, 1992, Acta Paediatr)

MMR significantly reduces the function of neutrophilic leukocytes (i.e. increases susceptibility to infections). This is most likely because vaccine strains do not proliferate in lymphatic tissues like wild strains.

22. Since MMR is contraindicated in pregnant women (as well as 1-3 months before conception), the CDC recommends that pregnant women who do not have rubella antibodies get vaccinated immediately after delivery.

However, the CDC does not recommend a pregnancy test before rubella vaccination.

23. Effect of immunization against rubella on lactation products. I. Development and characterization of specific immunologic reactivity in peast milk. (Losonsky, 1982, J Infect Dis)

In 69% of women vaccinated against rubella after childbirth, the virus was excreted in breast milk. Among those who received the RA27 / 3 strain, 87.5% isolated the virus.

24. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. (Losonsky, 1982, J Infect Dis)

56% of breastmilked babies whose mothers were vaccinated against rubella contracted rubella after giving birth.

25. Postpartum rubella immunization: association with development of prolonged arthritis, neurological sequelae, and chronic rubella viremia. (Tingle, 1985, J Infect Dis)

Six women were vaccinated against rubella after giving birth. All of them developed acute arthritis, and then chronic arthritis, which lasted 2-7 years after vaccination. Three had neurological sequelae (carpal tunnel syndrome, paresthesia, blurred vision, etc.). In five of them, the virus was detected in the blood up to 6 years after vaccination. In one of them, the virus was found in breast milk 9 months after vaccination. Rubella virus has been found in the blood of two out of four babies fed on breast milk.

26. Postpartum live virus vaccination: lessons from veterinary medicine. (Yazbak, 2002, Med Hypotheses)

Among 62 mothers who were vaccinated against rubella or MMR after childbirth, 47 had at least one autistic child, and another 10 had children with suspected autism or developmental delays.

The rubella virus is known to be excreted in breast milk after vaccination, but it is not known whether measles and mumps viruses are also excreted.

In veterinary medicine, many vaccinations are not recommended after childbirth and during lactation, among them vaccination against canine distemper.

Dog distemper is often fatal, and when not fatal, it has neurological consequences. The canine distemper virus is similar to the measles virus. The measles vaccine protects dogs and distemper, and usually the two viruses are combined in one vaccine.

There is a reported case of a 5 year old Labrador bitch who was vaccinated 3 days after giving birth to 10 puppies. After 19 days, the puppies were diagnosed with distemper, and five of them had to be euthanized. Dog distemper has not previously been observed in this region, and most likely they were infected by maternal vaccination, from which it can be concluded that measles viruses are excreted in breast milk.

27. Fulminant encephalitis associated with a vaccine strain of rubella virus. (Gualberto, 2013, J Clin Virol)

A healthy 31-year-old man was vaccinated against measles and rubella. After 10 days, he was hospitalized with a diagnosis of viral encephalitis, and after another 3 days he died. He had the rubella vaccine strain RA27 / 3 in his brain and cerebrospinal fluid.

Two more similar cases are described here.

28. Illness after measles-mumps-rubella vaccination. (Freeman, 1993, CMAJ)

23.8% of infants after MMR had lymphadenopathy, 3.3% had otitis media, 4.6% had a rash, and 3.3% had conjunctivitis.

29. An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines. (Dos Santos, 2002, Rev Panam Salud Publica)

Comparison of three different MMR vaccines. Vaccinations increased the risk of lymphadenopathy by 3.11 / 2.22 / 1.4 times, and the risk of mumps by 5.72 / 2.33 / 2.46 times.

30. Rubella persistence in epidermal keratinocytes and granuloma M2 macrophages in patients with primary immunodeficiencies. (Perelygina, 2016, J Allergy Clin Immun)

The rubella vaccine strain RA27 / 3 was recently detected in skin granulomas in three immune patients.

31. One of the components of MMR and MMRV, as well as some other vaccines, is gelatin. Vaccine gelatin is made from the bones of pigs.

This, of course, is a bit of a problem for Jews and Muslims.

The Jews have a very simple solution to this issue. Pork is prohibited for oral ingestion, and the Torah does not say anything about intramuscular ingestion of pork. The sages of the Talmud also did not write anything against the intramuscular or subcutaneous intake of pork, but what is not prohibited is allowed.

Muslims took this issue more seriously, and held in 1995 in Kuwait a special seminar on this issue, with the participation of the Middle East branch of the WHO. They concluded that in the process of processing, gelatin undergoes transformation from an impure substance (haram) into a pure substance (halal), and in the process of making gelatin, the bones, tendons and skin of an unclean animal turn into pure gelatin, which can even be eaten. However, not everyone agrees with this conclusion.

Well, I don't know how safe it is to play such games with Allah. There are still 72 black-eyed houris at stake.

32. Prevalence of anti-gelatin IgE antibodies in people with anaphylaxis after measles-mumps rubella vaccine in the United States. (Pool, 2002, Pediatrics)

Although MMR contains egg white, this vaccine is not contraindicated for egg allergies, as the component that leads to anaphylactic shock from MMR is believed to be gelatin.

More about this: [1], [2], [3].

33. Christians are not embarrassed by pork vaccines, but aborted cells do. The Vatican condemns the use of aborted cells and viruses from aborted fetuses, and calls on Catholics to lobby for the development of alternative vaccines, and to resist in every possible way vaccines with aborted cells. For lack of alternatives, the Vatican allows the use of these vaccines, however, it insists that it is the duty of every Catholic to fight to change the status quo. The Vatican allows the refusal of vaccinations if this does not lead to significant risks.

34. Vaccines originating in abortion. (Furton, 1999, Ethics Medics)

While a medical career may be hurt by refusing vaccinations, refusing vaccinations with aborted materials is a heroic act for a Catholic.

35. Cinnamon as a prophylactic in measles and German measles (Drummond, 1917, BMJ)

Cinnamon essential oil is one of the most effective remedies for rhinitis. It is much more effective and much more pleasant to use than the more popular cure for the common cold, ammoniated quinine tincture.

A few years ago, the BMJ published an article claiming that he had used cinnamon successfully to prevent measles. When someone in the family got measles, they would prescribe a course of cinnamon to other children in the family, and they either did not get sick or they were sick with very mild symptoms. I also had a similar experience.

Recently, however, I have used cinnamon to prevent rubella. One of our nurses, who had contact with many children, contracted rubella. I instructed all the children who came in contact with her (20 people) to eat cinnamon in the morning and evening for three weeks (in the amount that fits on a sixpence coin). The cinnamon was added to the food and the kids loved the new flavor. None of them got sick.

Rubella, of course, is not a serious illness, and I am writing this to suggest using cinnamon not so much for rubella as for preventing measles.

(By the way, the word "coryza" is one of the names for a cold.)

36. Prior to vaccination, there were 22-67 cases of congenital rubella syndrome per year in the United States (1 in 5 million). That is, in order to prevent several dozen cases, eight million children are vaccinated every year. This, in turn, gives about 400 children a year with encephalopathy, and another 400 with anaphylactic shock (1 in 20 thousand). And this is without mentioning yet the neurological consequences of MMR, which we will talk about in another part.

VAERS has recorded 916 deaths or disabilities following MMR and MMRV since 2000 (i.e. an average of 50 per year). Given that VAERS reports 1-10% of all cases, instead of 50 cases of congenital rubella syndrome, we get 500 to 5,000 deaths or disabilities per year.