Congenital rubella syndrome after rubella vaccination in 1-4 weeks periconceptional period.

OBJECTIVE: To examine weather exposure to rubella vaccine during 1-4 wk periconceptional period can cause congenital rubella syndrome (CRS). METHODS: This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wk pre or post conception. Time of conception was determined by last menstrual period (LMP) and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody titers in cord blood samples. RESULTS: A total of 60 pregnant women with the median gestational age of 38 weeks were studied. The mean maternal age was 22 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects (fever, lymphadenopathy, arthritis, arthralgia). None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3100grs and 6.7% of them were premature. No signs of CRS were found in the neonates based on systemic physical exam at birth and one month later. Mean value of cord blood anti rubella IgG titere was 148/28+/-67/26 lu/ml. cord blood anti rubella IgM was negative in all of the neonates. CONCLUSION: In this study inadvertent rubella vaccination 1-4 wk before and after conception did not cause CRS in neonates and according to all reasearches pregnancy termination is not indicated in these cases.

Early onset optic neuritis following measles-rubella vaccination

To report two cases of optic neuritis with onset less than 24 hours following measles-rubella [MR] vaccination. Two teenage patients developed acute optic neuritis 6 to 7 hours after MR booster vaccination. The first patient demonstrated bilateral papillitis and severe visual loss but improved significantly with pulse intravenous steroid therapy with methylprednisolone 500 mg/day. The second patient had unilateral retrobulbar optic neuritis and demonstrated excellent visual recovery without intervention. Acute optic neuritis is a rare complication of MR vaccination and may occur early after immunization

Desarrollo de anticuerpos y frecuencia de eventos temporalmente asociados a las vacunas contra el sarampión y rubéola en personal de salud universitario de Jalisco / Antibody development and frequency of events temporarily with measles and rubella vaccines among university health personnel in Jalisco

Objetivo: Evaluar el estado inmune y la seroconversión o respuesta anamnésica posterior a inmunización con vacuna de sarampión-rubéola (SR) y eventos temporalmente asociados, en personal de salud universitario. Materiales y métodos: Estudio prospectivo, longitudinal y comparativo de mayo a junio de 2000 en 120 adultos sanos de un Hospital de la Universidad Autónoma de Guadalajara. Previo consentimiento informado se aplicó la vacuna SR de sarampión (Schwarz) y rubéola (RA 27/3). Se realizó seguimiento telefónico semanal para identificar eventos locales y sistémicos temporalmente asociados a la vacunación (30 días posteriores a su aplicación, no atribuibles a otro proceso mórbido). Se tomó suero antes y seis semanas después de la vacunación. Los anticuerpos (IgG) contra sarampión y rubéola fueron cuantificados por análisis inmunoenzimático (Enzygnost®, Dade Behring) con puntos de corte de > 300mUI/mL y > 8UI/mL, respectivamente. Análisis: media, desviación estándar (DS), Prueba t de Student pareada (significancia de P < 0.05). Resultados: Se logró seguimiento en 105/120 (87.5%) durante seis semanas. El 87.4% fue personal de salud y 44.6% varones. Rango de edad 17-71 años (mediana = 21). En la historia clínica hubo antecedente de posible sarampión en 57.1%. Se obtuvo suero pareado en 75 casos. La proporción de voluntarios con anticuerpos para sarampión y rubéola antes (90.7 y 94.7%) y después (100 y 100%) de la vacuna se incrementó de manera significativa (P < 0.001). Dolor, calor, rubor e induración en el sitio de inyección se presentó en 4/105 (~4%). Fiebre, exantema, artralgias y artritis en 9/105 (~9%). Conclusiones: La proporción de susceptibles a sarampión fue alta si tomamos en consideración la potencialidad de transmisión del virus de sarampión a la población que atenderían durante el período de contagiosidad (3-5 días). La respuesta de inmunidad postvacunal fue óptima. La vacunación en personal de salud debe ser prioritaria.

Objective: To evaluate the seroprevalence, seroconversion, anamnesic response and events temporally associated with immune status pre and post immunization with measles and rubella vaccine in health personnel from a public University in Guadalajara, Mexico. Material and methods: We carried out a prospective, longitudinal and comparative study from May to June 2000 among 120 healthy volunteers. Informed consent was obtained from all participants. We administered measles (Schwarz) and rubella (RA 27/3) vaccines. Weekly phone calls during six weeks were recorded from each volunteer to assess local and systemic events temporally associated with immunization non attributable to any other disease. Serum samples were obtained before and after vaccination in 75 volunteers. Antibodies against measles and rubella were measured by an enzyme immunoassay kit (Behring) with cut-off points of ³300mUI/mL and ³8UI/mL respectively. Statistical analysis included mean, standard deviation and paired Student's t-test (P < 0.05). Results: 105/120 participants (87.5%) were followed during 6 weeks. 87.4% were health personnel and 44.6% were males. The age range was 17-71 years (median = 21). We found a prior history of measles in 57.1%. Local events included pain, heat, redness and induration and were reported by 4/105. Systemic events such as fever, exanthema, pain in joints and arthritis was reported by 9/105. The proportion of study subjects with protective antibodies against measles and rubella prior to vaccination was 90.7 and 94.7% respectively. Both groups reached 100% after vaccination. Conclusions: The proportion of non-immune health personnel was low and similar to other reports. However, the potential spread of measles and rubella virus from a non-immunized infected health care provider could be amplified by the number of patients seen daily during the peak period of 3-5 days. The vaccination of health personnel should be encouraged.

Estudo dos efeitos da vacina contra rubéola sobre o produto da gestação de mulheres vacinadas durante campanha realizada no estado de São Paulo, 2001 / Rubella vaccine effects in pregnant women and their concepts during vaccination compaign in São Paulo, 2001

O objetivo deste estudo é estimar o risco de infecção congênita pelo vírus da vacina contra rubéola e estimar o risco de ocorrência de aborto, baixo peso e prematuridade nas gestantes suscetíveis e imunes para rubéola identificando os fatores de risco associados a estes eventos. Embora não tenham havido manifestações clínicas compatíveis com SRC, observou-se uma ocorrência aumentada de baixo peso ao nascer e prematuridade entre os RN infectados quando comparados com as crianças não infectadas também nascidas de mães susceptíveis. No modelo final das análises utilizando a regressão logística multivariada, entretanto, a suscetibilidade para rubéola não esteve associada com a ocorrência de baixo peso e nem com prematuridade. Estes resultados sugerem que a recomendações de não vacinar gestantes para rubéola ainda deve ser mantida / The objective of this study is to evaluate the risk of congenital infection due to rubella vaccine virus and the occurrence of premature labor, miscarriage, and low birth weight in susceptible and immune pregnant women vaccinated during pregnancy, identifying the risk factors associated. We observe a high incidence of low birth weight and prematurity in the infected newborns, when compared with the children not infected, also born of susceptible mothers. In the final model of the logistic regression we didn’t find association with rubella susceptibility and the predictors miscarriage, low birth weight and premature labor. These results suggest that the recommendations to not vaccinate pregnant women against rubella must be sustained...

Identification of seronegative pregnant women eligible for immunization against rubella

To estimate the frequency of Rubella seropositivity among pregnant women and thereby getting an estimate of seronegative women who should eventually be immunized against Rubella. A blood sample of 100 consecutive pregnant women coming for their first antenatal check-up at Shifa International Hospital, Islamabad, was collected in the year 2002. Enzyme-Linked immunosorbent assay [ELISA] technique was used to detect IgG antibodies against Rubella. Out of 100 pregnant women 61[61%] were positive for rubella [IgG antibodies] in the first trimester of pregnancy. Mean age of the study participants was 27 ' 3.27 years. Twenty-five [25%] women were primigravida, while 75 [75%] were multigravida. Majority of the women were housewives belonging to middle and lower middle socioeconomic class. We found 61% women had positive Rubella antibodies during first antenatal visit. Nearly 40% who were negative should be immunized against rubella, preferably before conception

[Bilatral optic neuritis following measles/rubella [MR] vaccination [a case report]]

A thirteen years old female caucasition admitted in 5 Azar General hospital with a 3-day history of deteriorating vision. Two weeks prior to admission she had received a measles-rubella vaccination at school [as a mass campain of MR vaccination in IRAN]. General and neurological examination except lung wheezing and occular findings were normal. In visual exam she had questionable light perception in right eye and hand motion sensation in left eye. Funduscopy revealed moderate bilateral opitc disc hypermia. Investigations revealed normal full cell blood count, biochemistry profile, clotting studies and sputum. Brain CT scan and MRI were normal except pansinusitis. CSF examination revealed normal constituents. The patient treated with methyl prednisolon [1 gr/daily] for 7 days and patient had dramatic response to therapy. After 6 weeks of starting medical treatment ophthalmologic exam revealed 2 meters finger count vision in Rt eye and 6/10 visual aquity in Lt side. This patient is a rare case of bilateral optic neuritis after MR vaccination

Tipos de vacunas pediátricas / Types of pediatric vaccines

La autora describe las vacunas pediátricas de uso obligatorio en nuestro país en la actualidad. Se menciona su acción, vía de administración, efectos adversos y contraindicaciones

Reaçöes adversas a vacina MMR em pacientes alergicos a ovo: revisao da literatura / Adverse reactions to MMR vaccine in patients with egg allergy: review

Reacoes adversas agudas apos a administracao da vacina MMR podem ocorrer em pacientes com hipersensibilidade a ovo. Essas reacoes podem decorrer da presenca de proteinas originadas do tecido embrionario da galinha, incluindo substancias antigenicamente similares ao ovo. Os autores deste relato discutem o risco da administracao da vacina MMR em criancas alergicas a ovo, concluindo que se trata de...

Study of young women vaccinated against rubella virus for 10 years in Taiwan.

Since the licensing of the rubella virus vaccine (RA 27/3 strain) in 1979, clinical studies on the RA 27/3 strain vaccine, which gives rise to high titer antibody, have been reported. In the present study, this vaccine was used to examine the immune response in young women. Volunteers without the previous immunity to rubella virus screened by hemagglutination inhibition (HAI), latex agglutination (LA), fluorescence immunoassay (FIA) and solid-phase immunoassay (SPIA) tests were injected with Rudivax vaccine or Meruvax II vaccine. Adverse reactions occurred between 10 and 20 days after vaccination in 30% of the volunteers. After 28-35 days, vaccinees developed antibodies against rubella virus. The titer of rubella antibody reached it's peak from the 40th day through the 100th day. One year after vaccination, the geometric mean titer (GMT) of rubella virus antibody still remained over 1 : 64 (HAI) and 1 : 38.2 (FIA), and SPIA IgG RI mean was 2.80. Two years later, the antibody titers were 1 : 52 by HAI and 1 : 32.1 by FIA, and SPIA IgG RI mean was 2.75. After 5 years, the antibody titers were 1 : 48.6 (HAI) and 1 : 28.2 (FIA), and SPIA IgG RI mean was 2.74. After 10 years, the anti-rubella virus antibody titers were 1 : 38.9 (HAI) and 1 : 25.1 (FIA), and SPIA IgG RI mean was 2.42. LA antibody still remained seropositive. In conclusion, the rubella vaccine RA 27/3 is safe and efficient, and it is applicable for the control of the rubella in Taiwan.