Tag: congenital rubella syndrome

First Day Deaths and the Hepatitis B Vaccine

Worldwide, one million babies die within 24 hours of their birth?

Why?

“The initial 24 hours of a child’s life are the most dangerous with over one million newborns around the world dying each year on their first and only day of life, according to Ending Newborn Deaths, a new report by Save the Children. The research reveals of another 1.2 million tragic losses: stillbirths where the heart stopped beating during labour. In total, 2.9 million babies die in their first month. Most of these deaths occur because of premature birth and complications during birth – such as, prolonged labour, pre-eclampsia, and infection.”

WHO on One Million Babies Die Within 24 Hours Of Birth

It ain’t vaccines…

First Day Deaths and the Hepatitis B Vaccine

Of course, that doesn’t keep anti-vaccine folks from trying to correlate the two things, especially with the hepatitis B vaccine.

The neonatal mortality rate is actually similar among developed countries…

Korea for example, gives a birth dose of hepatitis B vaccine.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines. The birth dose of hepatitis B was added to their schedule in 1991.

In general, Korea’s immunization schedule looks a lot like the one used in the United States. And Korea has both a lower infant and neonatal mortality rate than the United States and most European countries.

What about the idea that the United States has 50% more first day deaths than all other developed countries combined?

That’s likely true.

But not because of vaccines.

In addition to our higher population, this reflects “significant gaps between babies born to wealthy, well-educated urban mothers and those born to poor, less-educated mothers,” among other factors.

“In the United States, many suspect increases are due to more high-risk pregnancies caused by the rising prevalence of obesity, diabetes, hypertension and cardiovascular disease, more older women having children, advancements in fertility treatments that result in multiple births, and the high rate of cesarean sections – all of which increase the risk a mother faces during pregnancy and childbirth. Recent studies in the U.S. also suggest that poor quality care and better counting of maternal deaths may play a role.”

State of the World’s Mothers 2014

First day deaths are a serious issue.

It shouldn’t become yet another talking point anti-vaccine folks use to scare parents away from vaccinating and protecting their kids.

More on Myths About Newborn Deaths

Myths About Warnings and Adverse Reactions in the MMR Package Inserts

Have you heard that the MMR package insert “contains 42 paragraphs of warning and adverse reactions?”

And some of those warnings include “seizures, encephalitis, pneumonia, deafness, death and MEASLES?”

Measles? From the measles vaccine?

Myths About Warnings and Adverse Reactions in the MMR Package Inserts

Is that really in the MMR package insert?

Package inserts aren't so scary once you learn what's really in them.
Package inserts aren’t so scary once you learn what’s really in them.

Let’s see, 42 paragraphs of warning and adverse reactions???

Nope.

Anti-vaccine propaganda is not informed consent.
Anti-vaccine propaganda is not informed consent.

The Warning Section, which lists all adverse reactions and safety hazards that may occur after getting a vaccine and what you should do if they occur, actually only contains five paragraphs!

There are 23 more paragraphs in the Adverse Reactions section, but as most folks understand, this section includes clinical trials experience, postmarketing experience, and voluntary reports, so it is not always possible to establish a causal relationship to vaccination for the adverse effects listed here.

What does the MMR package insert say about seizures, encephalitis, hearing loss, and death?

“Measles is also known as rubeola. It is a serious illness. Measles virus can be passed to others if you have it. Measles can give you a high fever, cough, and a rash. The illness can last for 1 to 2 weeks. In rare cases, it can also cause an infection of the brain. This could lead to seizures, hearing loss, mental retardation, and even death.

Mumps can also be passed to others. This virus can cause fever and headache. It also makes the glands under your jaw swell and be painful. The illness often lasts for several days. Sometimes, mumps can make the testicles swell and be painful. In some cases, it can cause meningitis, which is a mild swelling of the coverings of the brain and spinal cord.

Rubella is also known as German measles. It is often a mild illness. Rubella virus can cause a mild fever swollen glands in the neck, pain and swelling in the joints, and a rash that lasts for a short time. It can be very dangerous if a pregnant woman catches it. Women who catch German measles when they are pregnant can have babies who are stillborn. Also, the babies may be blind or deaf, or have heart disease or mental retardation.”

So the package insert is telling folks to get vaccinated and protected to avoid seizures, encephalitis, and death. Why don’t anti-vaccine folks ever mention that part of the package insert?

Don’t listen to anti-vaccine propaganda about vaccine package inserts.

Learn the risk of misinformed consent and following bad advice – leaving your kids unvaccinated and unprotected.

More on Myths About Warnings and Adverse Reactions in the MMR Package Inserts

Complications of Vaccine-Preventable Diseases

We know that vaccine-preventable diseases can be life-threatening.

In the pre-vaccine era, when these diseases were much more common, way too many people died, but still, most people did recover.

They didn’t always survive without complications though.

Tragically, we are starting to see more of these complications as more kids are now getting some of these vaccine-preventable diseases again.

Complications of Vaccine-Preventable Diseases

That we can prevent these serious complications is another benefit of getting vaccinated!

How serious?

Have you ever seen someone who has survived a meningococcal infection?

Do they always have all of their arms and legs?

How about their fingers and toes?

"Baby" Charlotte survived her battle with meningococcemia and continues to take on new challenges!
“Baby” Charlotte survived her battle with meningococcemia and continues to take on new challenges!

There is a reason that we say that you have to earn your natural immunity. You have to survive these diseases to get it. And you want to survive without any long-term complications, which can include:

  1. chicken pox – shingles, secondary bacterial infections, pneumonia, meningitis, encephalitis, seizures, transverse myelitis, Reye syndrome, neonatal varicella, congenital varicella syndrome
  2. congenital rubella syndrome – neonatal death, heart problems, deafness, cataracts, intellectual disability, liver and spleen damage, glaucoma, thyroid problems
  3. diphtheria – myocarditis, heart failure, nerve damage, muscle paralysis
  4. Haemophilus influenzae type b – meningitis, epiglottitis, pneumonia, osteomyelitis, cellulitis, hearing loss, brain damage, loss of limbs
  5. hepatitis A – can rarely lead to liver failure
  6. hepatitis B – chronic hepatitis B, cirrhosis, liver failure, liver cancer
  7. HPV – genital warts, cancer
  8. influenza – parotitis, pneumonia, myocarditis, encephalitis, myositis, rhabdomyolysis, multi-organ failure
  9. measles –pneumonia, seizures, encephalitis, SSPE
  10. mumps – orchitis (inflammation of the testicles), oophoritis (inflammation of the ovaries), pancreatitis, meningitis, encephalitis
  11. pneumococcal disease – pneumonia, mastoiditis, meningitis, bacteremia, sepsis, empyema, pericarditis, hearing loss, brain damage
  12. pertussis – pneumonia, seizures, apnea, encephalopathy, rib fractures
  13. polio – meningitis, paralysis, post-polio syndrome
  14. rabies – it is very rare to survive a rabies infection without treatment
  15. rotavirus – dehydration, intussusception
  16. rubella – arthritis, congenital rubella syndrome
  17. shingles – postherpetic neuralgia, pneumonia, hearing problems, blindness, encephalitis
  18. tetanus – seizures, laryngospasm, fractures, pulmonary embolism, aspiration pneumonia
  19. typhoid fever – intestinal perforation, internal bleeding, peritonitis, hepatitis, osteomyelitis, arthritis, meningitis, myocarditis,
  20. yellow fever – pneumonia, parotitis, sepsis

Anti-vaccine folks rarely talk about the complications of vaccine-preventable diseases. For that matter, they also often push the idea that vaccines don’t even work and that these diseases aren’t even vaccine preventable, don’t they?

Don’t believe them. Vaccines work and they are safe and necessary, especially if you want to avoid these diseases.

More on Complications of Vaccine-Preventable Diseases

Did Your Rubella Titer Come Back Negative?

Two doses of the MMR vaccines give the great majority of people long lasting immunity to measles, mumps, and rubella. Well, measles and rubella anyway. Unfortunately, the mumps part of the vaccine has some issues with waning immunity.

Do you need to get your titers checked to make sure you are immune?

Usually not. Simply being fully vaccinated with the MMR vaccine is  good enough evidence that you are immune in most, but not all circumstances

Getting or being pregnant is one of those circumstances in which it is important to know for sure. It is really one of the only circumstances. Health care works are no longer routinely tested after they are vaccinated, as proof of vaccination is good evidence of immunity for the MMR vaccine.

The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.
The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.

That screening test is a rubella serum IgG levels or as it is more commonly known as, a titer level.

Non-Immune Rubella Titers

Why check it?

Because of the devastating effects of congenital rubella syndrome, all pregnant women are screened early in their pregnancy.

Babies with congenital rubella syndrome may have cataracts and many other birth defects.
Babies with congenital rubella syndrome may have cataracts and many other birth defects. Photo courtesy PHIL

Having a positive rubella titer, typically defined as a IgG level of ≥10 IU/mL, means that you are immune and protected.

But what if your rubella titer is negative? What if your level is <10 IU/mL?

We know that levels of vaccine-induced rubella antibodies can decrease over time, but unlike mumps and pertussis, this does not seem lead to waning immunity with rubella.

Still, the current recommendations from the Advisory Committee on Immunization Practices (ACIP) are that:

  1. Vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses.
  2. After this additional dose, they do not need to be retested for serologic evidence of rubella immunity.
  3. Since MMR is a live vaccine, the additional dose should not be given during pregnancy or within a month of when you plan to get pregnant. You can get it while you are breastfeeding though.

How much should you be concerned about a negative rubella titer?

Although congenital rubella syndrome is not uncommon in other countries that don’t routinely vaccinate for rubella, there has not been a case of congenital rubella syndrome in the United States since – 2017.

That’s right, we have actually had two cases of congenital rubella syndrome in the US this year! In past years, these cases have all been linked to pregnant women becoming infected outside the US though, as there are thought to be very few rubella infections locally.

And two cases is a far cry from when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome during an epidemic in the mid-1960s, before the first rubella vaccine was available.

That’s because vaccines work.

Wait, then why do some of these folks have a negative titer when they are tested?

While the easy answer is to say that they aren’t immune, it is more complicated than that. For example, some of the negative results could be false negatives (a negative test result that really should be positive). Others could possibly have low antibody levels, but they are still immune. Still, since one dose of a rubella containing vaccine is only about 97% effective, some of them could be non-responders.

Will a second or third booster dose of vaccine help increase your antibody levels? Yes, but in this situation, they will likely just rise temporarily. The second or third dose of MMR isn’t technically a booster dose, but rather a dose for those who didn’t respond to the previous doses, particularly for the measles component.

Avoiding Rubella

With a negative rubella titer, especially if you have not been previously vaccinated with one or more rubella-containing vaccines, you should likely try to avoid anyone who might have rubella.

There aren’t a lot of guidelines on how to avoid rubella though.

If you want to avoid rubella, avoid folks who aren't vaccinated against rubella.
If you want to avoid rubella, avoid folks who aren’t vaccinated against rubella. Photo courtesy of PHIL

That probably surprises you, especially with all of the information out there on how to avoid the flu, measles, mumps, and other infectious diseases, but it shouldn’t.

Symptoms of a rubella infection can include swollen lymph glands, low grade fever, a mild case of pink eye, and a red rash that can be hard to see, unless the person is overheated, like after a bath. Most importantly, people with rubella can be contagious for another few weeks, even as all of the symptoms have gone away. Also, like most viral infections, they were contagious for a few days even before they developed their first symptoms. And, believe it or not, some people with rubella might have no symptoms at all and still be contagious.

So how do you avoid someone who doesn’t even know that they are sick and are still contagious?

You basically want to try and away from anyone who might become sick and contagious…

While that sounds impossible, avoiding kids and adults who are intentionally unvaccinated, especially those who are intentionally unvaccinated and have recently traveled out of the country, can be a good start.

And like someone with a medical exemptions to getting vaccinated, if you have been vaccinated and lost your immunity to rubella, feel free to hide in the herd. This is one of the reasons everyone gets vaccinated!

What to Know About Rubella Titers

Get vaccinated and follow the latest guidelines if you are pregnant and your rubella titer is negative.

More on Rubella Titers and Immunity