Tag: congenital rubella syndrome

Japan’s Rubella Outbreak Should Be a Warning About What Could Happen Here

Do you remember when we used to have rubella outbreaks in the United States?

There is a level 2 travel alert for Japan because of outbreaks of rubella.

Yeah, me neither, but in the rubella epidemics of the 1960s, rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome.

Japan’s Rubella Outbreak

Thanks to the rubella vaccine, the ‘R’ in the MMR, we rarely hear about rubella anymore.

Tragically, like measles and other vaccine-preventable diseases, rubella is coming back.

RubellaCongenital Rubella Syndrome
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There are still relatively few cases, but most of us would like to keep it that way.

The US had a big spike in rubella cases in the last 1980s.

We remember that with the return of measles in the late 1980s, rubella came back right along with it, causing 13 deaths and 77 cases of congenital rubella syndrome!

And that’s what is happening in many countries right now.

In Japan, for example, in addition to a rise in measles cases this year, they are seeing big outbreaks of rubella, with weekly totals exceeding 100 cases! These are numbers that are close to what they saw during outbreaks in 2013, a year that ended with 14,344 cases of rubella and 32 cases of congenital rubella syndrome.

Japan is on track to have a big rubella year.
Japan is on track to have a big rubella year.

And they are already reporting at least one case of congenital rubella syndrome, a 4 week old, which is not surprising, considering that they had nearly 3,000 cases of rubella last year.

A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.
A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.

Is that what we want to happen here too? Are folks looking forward to having to worry about babies being born with congenital rubella syndrome, a vaccine-preventable disease?

A vaccine-preventable disease that was declared eliminated in the United States in 2004.

More on Japan’s Rubella Outbreak

Why Is RFK, Jr Pimping out the Kennedy Compound to Anti-Vaxxers?

Folks who know the history of the Kennedy family and vaccines are likely surprised that RFK, Jr is holding a contest for his own organization using a visit to the Kennedy compound as a prize.

The Children’s Health Defense is ironically named, as all it seems to do is scare folks away from vaccinating and protecting their kids, something the Kennedy family once championed.

Can someone ask his mom?

Does she plan to go and does she support his work?

Do other members of the Kennedy family?

Why Is RFK, Jr Pimping out the Kennedy Compound to Anti-Vaxxers?

Before we look at the work of Robert F. Kennedy, Jr, let’s review what the Kennedy family has done to help get vaccine-preventable diseases under control.

“Today is the sixteenth anniversary of the death of President Franklin D. Roosevelt. It is also the anniversary of the announcement that a vaccine has been discovered to prevent paralytic polio. Today over 90 million Americans have been vaccinated with the Salk vaccine. Over 80 million remain unvaccinated. Almost 4,800,000 children have not been vaccinated, and the majority of these are under five years of age. I hope that the renewed drive this spring and summer to provide vaccination for all Americans, and particularly those who are young, will have the wholehearted support of every parent in America. I hope that they, knowing some of the long range suffering which comes from an attack of polio — with this miraculous drug I hope that everyone takes advantage of it.”

President John F. Kennedy News Conference 9, April 12, 1961

In 1962, John F. Kennedy signed the Vaccination Assistance Act (Section 317 of the Public Health Service Act). It started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, and has been continuously reauthorized ever since.

What else do we know about the Kennedy family and vaccines?

“Rose and maternal health and the health of her children were paramount for her as those children were growing up. She took great pride in getting them out into the countryside, getting them outside and walking through Brookline when they lived there, and getting them fresh air and getting them whatever medical needs they had. But she would say how fearful she was in the days before vaccines of how a child could pass away so quickly.”

Barbara Perry on The Life of Rose Kennedy

Why was she afraid if measles was so mild, as some folks still claim?

“Or take German Measles. We know German Measles during the first three months of pregnancy almost surely will deform the unborn child. Within the last few weeks, a new vaccine has been tested and preliminary results show it is 100% effective. It should be available within a year. Within our proposed clinics this new vaccine can be administered to children, immunizing them forever against a disease which can cause retardation in future generations. “

Eunice Kennedy Shriver speech before the Citizen’s Committee on Mental Retardation

Concerns about congenital rubella syndrome and German Measles (rubella) led many people to get vaccinated as soon as a vaccine was available.

Remember the rubella epidemic of 1964-65, when there were 12.5 million rubella virus infections, which “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome?”

“It is most encouraging to learn that 28 million children have been vaccinated. This is a wonderful record. But in the great enthusiasm over the rubella program, attention has been removed from the effort to eradicate the common measles. As a result, the 22,231 reported common measles cases in 1968 have risen to 72,000 reported cases for 1971. All children between the ages of 1 and 12 should be immunized. You can help. Keep interest alive in both the common measles and German measles program.”

Speech by Rose Fitzgerald Kennedy March 1972

Maybe we simply need more folks like this advocating for vaccines today.

“Many of you perhaps may or may not know that old-fashioned measles can cause brain damage in children. Here in California as well as in other states, there are thousands of children who have not been vaccinated against this common childhood disease.”

Speech by Rose Fitzgerald Kennedy March 1972

How many people have Sargent Shriver’s Peace Corp volunteers help get vaccinated and protected around the world?

“We already have the ability to eradicate red measles, responsible for brain inflammation and mental retardation in one in a thousand cases affected by the disease. The measles vaccine and other vaccines are being administered in increasing numbers today, but we are still far from the kind of universal vaccination program that is necessary. Measles vaccines ought to be administered to every infant from nine months of age on.”

Sargent Shriver at the Special Convocation of George Peabody College (1965)

How many people are vaccinated and protected because of the work of the Kennedy family?

Senator Edward Kennedy’s bill would have helped get more adults vaccinated and protected if it had passed.

How many kids aren’t getting vaccinated because Robert F Kennedy, Jr is scaring their parents?

“The purpose of life is to contribute in some way to making things better.”

Robert F. Kennedy

An environmental lawyer, you really have to wonder why he hasn’t championed climate change, instead of going after vaccines, which have been found to be safe, with few risks, and necessary.

More on Why Is RFK, Jr Pimping out the Kennedy Compound to Anti-Vaxxers?

About those Stanley Plotkin Videos…

Stanley Plotkin is typically described as “a prominent figure in the history of vaccinology, whose work on vaccine development has led to a significant reduction in morbidity and mortality from infectious diseases in the second part of 20th century. “

Why?

For one thing, he developed the rubella vaccine that we still use today.

He also worked on vaccines against CMV, polio, chicken pox, rabies, and rotavirus.

What Did Stanley Plotkin Say While He Was Under Oath?

That’s not why anti-vaccine folks are talking about him these days, or maybe it is…

Mostly, they are misinterpreting comments he made during a videotaped deposition.

“Lori Matheson is fighting her ex-husband, Michael Schmitt, for the right to decide if their two-year-old daughter should be vaccinated.”

Michigan anti-vaccination case to goes to court

A videotaped deposition in a case involving parents who disagreed about vaccinating their daughter…

Even though it isn't his exact quote and anti-vaccine folks don't give you the full context of what he was talking about, it is clear that Dr. Plotkin simply meant that you can't prove a negative.
Even though it isn’t his exact quote and anti-vaccine folks don’t give you the full context of what he was talking about, it is clear that Dr. Plotkin simply meant that you can’t prove a negative.

What do anti-vaccine folks think he said?

“I would say it is logically true that you cannot say, you cannot point to proof that it doesn’t cause autism. ”

Stanley Plotkin, M.D.

No, he isn’t saying that vaccines are associated with autism.

“I could not say that as a, as a scientist or a logician. But I can say as a physician that, no, they do not cause autism, because as a physician, I have to take the whole body of scientific information into consideration when I make a recommendation for a child.”

Stanley Plotkin, M.D.

All he is saying is that you can’t definitively prove a negative.

One of the different things in communicating the fact that there is no link is that science and English are not really the same language. So when a scientist says, “We have no evidence that there’s a link between vaccines and autism,” what they’re really saying is, “We are as positive as someone can humanly be that there’s no link.”
Seth Mnookin explain it well – One of the different things in communicating the fact that there is no link is that science and English are not really the same language. So when a scientist says, “We have no evidence that there’s a link between vaccines and autism,” what they’re really saying is, “We are as positive as someone can humanly be that there’s no link.”

For example, just because I have never seen a black swan, I can’t use that as proof that black swans don’t exist somewhere. After all, I haven’t been everywhere.

“…scientists can be at a real disadvantage in this debate because they, by their nature, are careful in how they present their conclusions.”

Vaccines: Last Week Tonight with John Oliver (HBO)

What else do anti-vaccine folks have a problem with?

Remember the rubella vaccine he developed?

“After a detour to obtain credentials as a pediatrician, I returned to Wistarto work on rubella. Those years were fraught with advances and reverses, controversy and eventually vindication. The pandemic of CRS babies in 1964-65 was an important stimulus to research on the vaccine. “

Stanley Plotkin’s On the Occasion of the Presentation Of The 2002 Albert B. Sabin Gold Medal

During the rubella epidemic of 1964-65, there were 12.5 million rubella virus infections, which “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome.”

And that’s just in the United States.

The controversy?

“There were only two fetuses involved in making vaccines. When fetal strains of, fibroblast strains were first developed, I was involved in that work trying to characterize those cells; but they were not used to make vaccines.”

Stanley Plotkin, M.D.

It is well known (this isn’t some shocking truth as some are trying to push) that some vaccines are made with fetal embryo fibroblast cells (the WI-38 and MRC-5 cells) from cell lines that are derived (they can replicate infinitely) from two electively terminated pregnancies (abortions) in the 1960s.

Those two fetuses weren’t the only two fetuses ever used in research though, they were just the only ones used to actually make vaccines.

“Human diploid cell strains (HDCSs) are batches of cells that are currently used for different purposes, including culturing viruses for the manufacturing of vaccines”

A brief history of human diploid cell strains.

They had to get to the point where they knew how to make vaccines in human cell lines though and that’s what he is talking about in the deposition.

“Q. In any event, so we have 76 in this study. Would you approximate it’s been a few hundred fetuses?


A. Oh, no, I don’t think it was that many. Probably not many more than in this paper. And I should stipulate that we had nothing to do with the cause of the abortion.”

It took some experimentation to find the right kind of cells and the right methods, but ultimately, they found that fetal embryo fibroblast cells were the best to use to grow many viruses.

Copies of those same cells are still used today.

What about the other “issues” brought up in the deposition?

Did he experiment on orphans, people who were mentally handicapped, or those who lived in third world countries?

“I don’t remember specifically, but it’s possible. And, again, I repeat that in the 1960s, that was more or less common practice. I’ve since changed my mind. But those were, that was a long time ago.”

Stanley Plotkin, M.D.

Those were different times, but Dr. Plotkin’s vaccine studies weren’t unethical and weren’t like what was done at Willowbrook, in which children were purposely exposed to hepatitis, with the justification that most of them ended up getting it anyway.

Surprisingly, in the early 1970s, there was still some debate about the ethics of doing experiments on children, and as you can see, using ableist language to describe children with a disability.
Surprisingly, in the early 1970s, there was still some debate about the ethics of doing experiments on children, and as you can see, using ableist language to describe children with a disability.

And from those times, experts developed the rules for how things are now done.

Ironically, anti-vaccine folks are pushing this stuff about Plotkin, but don’t understand why leaving kids completely unvaccinated and unprotected in a study is unethical.

“One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

National Catholic Bioethics Center FAQ on the Use of Vaccines

Or why it’s immoral to push anti-vaccine propaganda or put others at risk to get a vaccine-preventable disease.

“Results indicate that the total number of cases of poliomyelitis, measles, mumps, rubella, varicella, adenovirus, rabies and hepatitis A averted or treated with WI-38 related vaccines was 198 million in the U.S. and 4.5 billion globally (720 million in Africa; 387 million in Latin America and the Caribbean; 2.7 billion in Asia; and 455 million in Europe). The total number of deaths averted from these same diseases was approximately 450,000 in the U.S., and 10.3 million globally (1.6 million in Africa; 886 thousand in Latin America and the Caribbean; 6.2 million in Asia; and 1.0 million in Europe).”

Olshansky et al on The Role of the WI-38 Cell Strain in Saving Lives and Reducing Morbidity

Dr. Plotkin’s work has helped save millions of lives.

“His achievements in vaccinology are on a scale that truly can be measured in lives saved and lives restored.”

On the Occasion of the Presentation Of The 2002 Albert B. Sabin Gold Medal

And that’s why anti-vaccine folks are attacking him.

More on Stanley Plotkin

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