Tag: rubella

When Was the Last Case of Rubella in the United States?

While we rarely hear about rubella anymore, like most other vaccine-preventable diseases, the last case of rubella in the United States was a lot more recent than you probably imagine.

Austin recently had its first case of rubella in twenty years.

Although endemic rubella and congenital rubella syndrome were declared eliminated in 2004, like measles, we still have cases each year.

When Was the Last Case of Rubella in the United States?

To be sure, rubella is far less common that it used to be.

Remember the rubella epidemics of the 1960s, when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome?

If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don't use the rubella vaccine?
If natural herd immunity really works, how do you explain congenital rubella syndrome in the pre-vaccine era and in countries that don’t use the rubella vaccine? Why doesn’t everyone get natural immunity when they are younger and rubella is milder, avoiding the chance of getting sick when they are pregnant?

How about the rubella outbreaks in the early 1990s, when rubella caused 13 deaths and 77 cases of congenital rubella syndrome?

“Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS).”

Grant et al on Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2000–2018

One of our problems today is that most people don’t remember these epidemics and outbreaks, so they don’t understand how important it is for everyone to be vaccinated and protected.

They have no idea how fortunate they are that these diseases no longer make routine headlines.

But what happens if too many people skip or delay their vaccines?

Japan is still dealing with a large outbreak of rubella, with resulting cases of congenital rubella syndrome.

We will see more rubella and congenital rubella syndrome.

There were five cases of congenital rubella syndrome in the United States in 2017, all import related.
All five cases of congenital rubella syndrome in the United States in 2017 were import related.

While we do see some congenital rubella cases now, they are all women who were exposed to rubella outside the United States when they were pregnant.

“During 2001–2004, four CRS cases were reported to CDC; the mothers of three of the children were born outside the United States.”

Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome — United States, 1969–2004

Again, since the endemic spread of rubella was declared eliminated in 2004, cases since then are import related. People who aren’t immune get exposed to rubella when they are traveling to areas of the world where rubella is more common and return. Fortunately, since rubella isn’t as contagious as measles, these cases don’t usually cause big outbreaks.

So when was the last case of rubella and congenital rubella syndrome in the United States that wasn’t imported from outside the United States?

It was just before 2004.

Let’s get everyone vaccinated and protected before we see the next case.

More on Rubella and Congenital Rubella Syndrome

Did Pediatricians Ever Encourage Parents to Have Measles Parties?

While the idea of chickenpox and measles parties now seems ridiculous to most people, in the pre-vaccine era, it might not have been so strange. Since getting these diseases was inevitable, it might make some sense to try and control when your kids got sick. Did did pediatricians actually encourage parents to have measles parties?

Did Pediatricians Ever Encourage Parents to Have Measles Parties?

Some folks think they have evidence that they did!

This is not evidence for measles parties...
This is not evidence for measles parties…

Wait, did they really have measles?

As most folks know, German measles is another name for rubella or 3-day measles.
As most folks know, German measles is another name for rubella or 3-day measles.

Not exactly…

These kids had German measles – better known as rubella. Of course, that is not the same thing as measles or rubeola.

Measles vs Rubella

Why do we worry about rubella? Unlike measles, it’s not because it can make kids very sick, but rather because if a pregnant woman gets rubella, then it can be devastating for their baby.

The idea for rubella parties started in the UK in the 1950s.
The idea for rubella parties started in the UK in the 1950s.

That’s why some folks tried to get rubella when they were kids, well before they reached the age when they could become pregnant.

How did that strategy work out?

Many articles advocating for rubella parties (German measles) appeared in the 1950s and early 1960s.

Of course, those rubella parties didn’t prevent the rubella epidemics that came in 1964-65 and caused 12.5 million rubella virus infections and “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome.”

In addition to spreading rubella to pregnant women, at these parties, younger children could get exposed to other diseases that are more serious, like measles.
In addition to spreading rubella to pregnant women, at these parties, younger children could get exposed to other diseases that are more serious, like measles.

It was the rubella vaccine that was developed in 1969 that helped control and eventually eliminate rubella and congenital rubella syndrome in the United States. And eliminated all of the risks of the measles parties that some folks used to have.

More on Measles Parties

Can Vaccines Cause Arthritis?

Many people think that vaccines can cause arthritis.

Vaccines and Arthritis

That’s not surprising, as there are many case reports associating vaccines and arthritis.

Arthritis is even listed as an adverse reaction in the package insert for the MMR vaccine.

While rubella vaccines can cause arthritis, so can a rubella infection.
While rubella vaccines can cause arthritis, so can a rubella infection.

And chronic arthritis is also listed as a table injury for vaccines containing the rubella virus.

Can Vaccines Cause Arthritis?

So that means that vaccines cause arthritis, right?

Actually, no, it doesn’t. At least not the type of arthritis that most people associate with the term arthritis.

Wait, what does that mean?

Vaccines do not cause juvenile arthritis or rheumatoid arthritis, for example.

“Rubella-containing vaccines (e.g. MMR) can cause mild, acute, transient arthralgia or arthritis, rarely in children but very commonly in certain adult women (between 10-25% of adult female vaccinees without preexisting rubella immunity), usually beginning 1-3 weeks after vaccination and then persisting up to 3 weeks. Other vaccines currently routinely recommended to the general population in the U.S. have not been shown to cause chronic arthralgia or arthritis.”

Do Vaccines Cause Arthralgia or Arthritis?

While rubella-containing vaccines can cause arthritis, it is a mild type of arthritis that is usually temporary, lasting about two days.

“Postpubertal females should be informed of the frequent occurrence of generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination.”

MMR-II Package Insert

It is also rare in children.

And it also occurs after a natural rubella infection. In fact, up to 70% of adult women with rubella develop arthralgia or arthritis.

Of course, arthritis isn’t the rubella complication that we worry about…

During the rubella epidemic in the United States just before the rubella vaccine was developed, there were 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 babies born with congenital rubella syndrome.

Vaccines for Arthritis

Except for temporary arthritis after the rubella vaccine, not only do vaccines not cause arthritis, it is recommended that people with chronic arthritis get vaccinated.

“Keeping up with your vaccinations is always a smart move, but getting immunized is especially important when you have an autoimmune disease like rheumatoid arthritis (RA). Both RA and the medicines you take to treat it can increase your risk for infections.”

RA & Vaccinations

And one day, we might even have therapeutic vaccines for arthritis!

Rheumavax completed a phase I clinical trial in Australia a few years ago. That led to the development of a new drug, DEN-181, that is now in phase 1 trials.

What to Know About Vaccines Causing Arthritis

Rubella containing vaccines can cause mild, temporary arthritis, but mostly in postpubertal females and less commonly than after a natural rubella infection.

More on Vaccines and Arthritis

What’s the Difference Between the MMR and MMR-II Vaccines?

As most folks know, the original MMR vaccine, which combined the separate measles, mumps, and rubella shots, was licensed way back in 1971.

It included the original rubella vaccine, which was made with a duck embryo derivative of HPV-77 that was attenuated by passing it 77 times in monkey kidney cells.

Wait, what?

HPV?

Before the new conspiracy theories start, no, not that HPV.

It stands for High Passage Virus.

What’s the Difference Between the MMR and MMR-II Vaccines?

And while the vaccine worked, it didn’t work as well and caused more side effects than a RA27/3 rubella vaccine that was already approved in Europe

“Over the next decade, accumulating evidence led to changes in the United States. First, the duck embryo and dog kidney vaccine strains caused significant joint reactions [24–27]. Second, reinfection on exposure to wild rubella virus was demonstrated frequently with all strains except the RA 27/3 vaccine [28–30]. Third, the good safety record of the RA 27/3 vaccine in Europe, plus the majority opinion of scientists, led the US Food and Drug Administration to license RA 27/3. Important pressure for this decision came from Dorothy Horstmann at Yale, who was convinced by her comparative studies of rubella vaccines [31], and by Maurice Hilleman at Merck, who sought a better rubella strain for measles-mumps-rubella (MMR) vaccine.”

Stanley Plotkin on The History of Rubella and Rubella Vaccination Leading to Elimination

So that’s it, they just changed out the rubella component for one that was safer and worked better.

The new and improved MMR-II vaccine was approved by the FDA in 1978.
The new and improved MMR-II vaccine was approved by the FDA in 1978.

And of course, they did the appropriate clinical trials and got FDA approval for this updated vaccine.

The control group didn't get a vaccine during the study.
The control group didn’t get a vaccine during the study.

But did they compare the vaccines against a saline placebo?

“The inclusion of a seropositive control group allowed the rates of reaction to be viewed against the background symptoms unrelated to vaccine administration.”

Polk et al on A controlled comparison of joint reactions among women receiving one of two rubella vaccines.

They actually went a little further, in a double-blind, controlled cohort study comparing it to folks who didn’t receive any vaccine at the time of the study!

Why so many joint issues with the vaccine?

The studies were in adults, who seemed to have more side effects with the vaccine. Still, the side effects, including arthritis, were transient.

What about the idea that it was studied long enough before being approved?

Both the rubella component and the MMR-II vaccine were studied both before and after being approved. In fact, the MMR-II vaccine is probably the most studied vaccine in history!

Believe it or not, they include placebo-controlled trials.

A double-blind, placebo-controlled, cross-over MMR study in twins!

What was the placebo in the Finland twin trial?

“The injections consisted of 0.5 ml of vaccine 2-5 or placebo (the same product including neomycin and phenol-red indicator but without the viral antigens) and were administered subcutaneously by the nurse to the left deltoid or gluteal region.”

Peltola et al on Frequency of true adverse reactions to measles-mumps-rubella vaccine. A double-blind placebo-controlled trial in twins.

If that doesn’t sound like a placebo to you, keep in mind that the MMR vaccine doesn’t contain that many ingredients. Remember, MMR doesn’t contain aluminum or thimerosal. And if the placebo didn’t contain the antigens, then it likely didn’t contain all of the things that went into getting those antigens in the vaccine, such as cell cultures and albumin, etc.

Still, some folks aren’t going to be satisfied unless there is a study with a saline placebo.

“The four other vaccines were commercial products of Merck Sharp & Dohme. The placebo consisted of vaccine diluent.”

Lerman et al on Clinical and Serologic Evaluation of Measles, Mumps, and Rubella (HPV-77: DE-5 and RA 27/3) Virus Vaccines, Singly and in Combination

The vaccine diluent?

What’s that?

It depends on the vaccine, but for MMR-II it’s sterile water.

“Placebo DTP consisted of sterile saline which was dispensed into sterile Tubex syringes.”

Deforest et al on Simultaneous Administration of Measles-Mumps-Rubella Vaccine With Booster Doses of Diphtheria-Tetanus-Pertussis and Poliovirus Vaccines

The MMR vaccine was even tested in placebo controlled trials with other vaccines!

And like other vaccines, the MMR vaccine has been found to be safe, with few risks, and is definitely necessary.

More on the the Difference Between the MMR and MMR-II Vaccines