Rubella vaccine

Rubella vaccination is the main and only way to avoid infection. The causative agent of the disease – rubella virus – practically does not pose a threat to children, but is very dangerous for adults, especially pregnant women. Infection in the early stages causes congenital pathologies, intrauterine fetal death or stillbirth. In this regard, WHO, within the framework of the Global Immunization Action Plan, calls on all states to take measures to control and eliminate rubella.

Rubella prevention

Rubella is a viral disease with a rapid and mild course. It affects in most cases the children’s and young organism. Rubella virus – a carrier of the disease, is transmitted from a patient to a healthy person by airborne droplets: when talking, sneezing, coughing. Viruses are able to survive in the external environment for a short time, so you can get infected from objects, through dirty hands, other people’s things for several hours after the virus hits them. A pregnant woman can transmit the virus to her fetus through the placenta. In addition to the common name, synonyms are used for rubella: the third disease, German measles, measles rubella. A detailed description of the disease, the ways of infection, its consequences for children and adults, we considered in the article – “Rubella”.

This infection is characterized by epidemic outbreaks. This is due to the rapid transmission of the infectious agent in closed communities: schools, kindergartens, nurseries, hospitals, etc. In a temperate climate, such quarantines occur about once every 5 years, in spring and autumn. Children endure the entire set of symptoms within one week without severe consequences. The body of an adult reacts to infection brighter, the symptoms are more pronounced and last longer, with possible complications. Children whose mothers were ill in the first trimester of pregnancy are born with pathologies of internal organs, deafness, visual impairment, and lag behind in development. In some cases, intrauterine death of the fetus is recorded.

Rubella prevention is an important anti-epidemic measure that the state provides and controls. Immunization of the population, that is, vaccination, remains the main factor in preventing the disease. This also includes isolation of patients, unvaccinated (susceptible) men and women, adolescents should avoid contact with the sick. Infected people are able to infect susceptible people a week before the first signs appear and at least another week after them. Infants with congenital rubella are sources of the disease for up to a year after birth, sometimes longer.

Rubella virus is covered with a shell that keeps it active in the external environment. However, this shell is easily destroyed by disinfectants. Preventive measures include the treatment of premises, furniture and household items. To prevent epidemics, it is recommended to use solutions of ethyl alcohol, chlorine, formaldehyde. Personal hygiene is a preventive measure against many infectious diseases, including German measles. To reduce the incidence of congenital rubella syndrome (CRS) in children, it is recommended that women of reproductive age donate blood for rubella antibodies. This should be done at least three months before the expected pregnancy. All girls who are not immune to rubella virus should be vaccinated.

Rubella vaccination

German measles, known for centuries, suddenly came into the spotlight in the middle of the last century. In 1965, the epidemic broke out throughout Europe, by 1964 it had reached the United States. Millions of people have been ill, including adults with subsequent complications. The consequences of this pandemic have drawn the attention of scientists to the problem of rubella infection. In America alone, in two years, 20 babies were born with congenital deformities caused by their mothers’ illness. By 1965, it was clear that rubella vaccination was the top priority for scientists.

In the same year, laboratory doctors managed to obtain several weakened strains of rubella virus. The clinical trial lasted almost three years, and by 1970 the vaccine had finally entered commercial use. In 1971, a vaccine based on a strain isolated from human cells was licensed in Europe. It is designated – RA 27/3 and is still used. Over time, it was licensed in the United States and some other countries. The mass population immunization scheme in Europe, the UK and the States has shown a gradual decline in CRS cases and the disease in general. In 2015, the Region of the Americas was declared completely free from endemic rubella.

Today, out of 194 countries, 152 countries have adopted the rubella vaccination plan. However, within each country, the percentage of diseases is different, as well as cases of CRS. The WHO Strategic Advisory Group notes that it is not possible to completely eliminate the burden of rubella due to insufficient distribution of the vaccine and individual refusals of injections. In Russia in 2017, only 3 cases of rubella were registered from January to June (according to Rospotrebnadzor “Information on infectious and parasitic diseases”).

Is it worth it to get vaccinated against rubella?

During illness, the body produces antibodies that eliminate the virus when it encounters it. These antibodies persist after infection for life, only in isolated cases throughout the planet re-infection is recorded. After developing immunity, a person becomes immune to the virus, and if he encounters it again, then he is no longer threatened with rubella. As part of the vaccines, weakened viruses are used, the immunity that the body develops during vaccination will last for a period of 10 to 21 years, after which the person becomes susceptible again and revaccination is carried out.

A mild illness in children can be extremely dangerous for unprotected adults. Thus, women without vaccination and a previous infection can be infected during pregnancy. This leads to miscarriages, stillbirths, congenital deformities and pathologies of internal organs. In adolescents and adults, in about one case out of 7 thousand, after infection, a complication occurs in the form of encephalitis – brain damage, which in some cases can lead to death.

Due to the dangerous impact of the virus on the adult population and unborn children, mandatory vaccination was introduced. Today, every person can be vaccinated if he does not have immunity, but may not be vaccinated due to personal circumstances. Also, each parent can write a refusal to be vaccinated for their child, bearing responsibility for the possibility of the disease and its complications. The medical community is worried about the trend of vaccine rejection, as this may further lead to a new susceptible generation that will produce offspring with pathologies and congenital anomalies.

International experience in the use of rubella vaccinations has shown that effective protection against epidemics and severe consequences is provided by mass vaccination of children at the age of one, revaccination at 6-7 years of age and vaccination of adolescent girls. Adolescent boys and men need to be immunized because they can transmit the virus to susceptible women of childbearing age.

Despite the fact that in most cases children tolerate rubella very easily, even among them there may be side effects after the illness. These include:

• encephalitis;
• thrombocytopenic purpura (decreased blood clotting);
• damage to the cardiovascular system.

Rubella is more difficult for children who have any underlying disease, such as diabetes mellitus or bronchial asthma, than healthy children. Therefore, sick babies especially need protection, this applies to absolutely all infectious diseases.

Unfortunately, many parents perceive the need for vaccination in their own way, as a favor to their pediatrician, clinic or state, without weighing their own ambitions and the future of the child and his offspring. To be vaccinated is the right of every person to protection against infections, and not at all an obligation to someone. The sad experience of the lack of vaccination and the terrible consequences of the epidemic suggests that the vaccine was invented and made mandatory for a reason. It is definitely worth doing for both children and adults. The main thing is to take precautions: a pediatrician’s examination for children and adolescents, and a therapist for adults is first necessary in order to exclude acute diseases for the current period. If any are determined, then rubella vaccination is postponed for two weeks after recovery.

rubella vaccination schedule

All countries that have adopted a measles and rubella program have a single immunization schedule. The first vaccination for children is carried out at the age of 12 months. Then revaccination is carried out at 6-7 years. Since the immunity obtained in this way does not last for life, adolescents are additionally vaccinated at the age of 12-14 years. In addition, every woman of reproductive age from 18 to 40 years old can be vaccinated when planning a pregnancy. Adult males can also be vaccinated to eliminate the risk of disease if the patient is not immune.

The vaccination calendar includes only mandatory vaccinations at 1 year, 6-7 years and in adolescence.

Revaccination

The vaccine contains weak infectious agents; over time, it simply loses its resistance to the virus. To strengthen immunity to rubella virus and extend the duration of the drug, a second procedure is done after a few years. If revaccination is not done in time, then the body becomes again susceptible to infection with the rubella virus. The developed antibodies are lost over time and the person will get sick at a more mature age, which is much worse.

Vaccination procedure

On the day of vaccination, you need to make sure that the child or adult does not have an acute course of any disease. To do this, the pediatrician must examine the babies in order to exclude the possibility of contraindications. Against the background of exacerbations, such a procedure is not carried out. Adults are advised to donate blood for the presence of antibodies, which will show whether a rubella vaccine is needed. Allergic persons are advised to take an antihistamine before vaccination.

Immunization is carried out taking into account the following rules:

• the patient must be healthy, without exacerbations of any disease;
• the procedure is carried out exclusively by a health worker in the office of the clinic;
• the syringe must be disposable and opened in front of the patient;
• the ampoule is treated with an antiseptic before opening and opened before immunization;
• the injection site is treated with an antiseptic;
• after the introduction of the drug, the injection site is again treated with an antiseptic.

One-year-old children are vaccinated in the thigh area, while it is never placed in the gluteal muscle. Older children, adolescents and adults are given an injection in the area under the shoulder blade or in the shoulder. Such a vaccine works individually, side effects are extremely rare, there are no data on severe consequences.

During the first day after vaccination, it is advised not to wet the injection site, as this may affect the occurrence of a local skin reaction. It is also better to avoid large crowds of people so as not to get sick with another infection. During the first hour after the procedure, you need to monitor the reaction of the body, if extraneous symptoms appear, consult a doctor. For the same reason, patients are advised to spend the first hour after the injection in or near the clinic. These recommendations are common to all vaccinations.

The duration of post-vaccination immunity is usually 10-20 years, after which the immune response decreases. You should also take into account the individual characteristics of immunity, a vaccinated person can become susceptible to the virus after 5 years, and sometimes antibodies persist for 40 years. Therefore, the recommendations of WHO experts call on the adult population to be vaccinated every decade.

Rubella vaccine and pregnancy

Long-term observations of the epidemiology of rubella have led to the conclusion that the probability of fetal damage during the mother’s illness is up to 90%. Given the severe consequences of rubella infection during pregnancy, the presence of immunity for women is extremely important. Girls of reproductive age are recommended to be tested for the presence of antibodies. In the event that there is no immunity, the patient is vaccinated. Immunization is possible at least three months before the onset of gestation. During the gestation period, vaccination is not carried out. However, it is possible that after vaccination it is found that the woman became pregnant.

The WHO guidelines for diagnosing rubella and measles present the results of studies in this regard. Observations of 1000 pregnant women who were unintentionally vaccinated showed that all of them gave birth to healthy children. That is, there is no confirmed evidence that the injected virus can lead to CRS. However, pregnant women are not deliberately vaccinated due to fear of mishaps. Every girl planning offspring can be tested for immunoglobulins (antibodies) and get vaccinated.

Also, in families with pregnant women susceptible to the virus, it is recommended that all family members be tested and immunized. This applies to both children and adults. Especially vigilant should be those families where there is an older child who was not sick, was vaccinated once or not vaccinated at all.

Types of rubella vaccines

Almost 50 years have passed since the first attenuated (weakened) strains of rubella virus were obtained. Nevertheless, the mandatory vaccine began to be considered only by the year 2000. Today, medicine uses two injection options: combined and monovalent. The production of combined vaccines is considered to be the greatest achievement of modern vaccine prevention. They protect against several possible ailments at once, but there are suspicions that monovalent formulations have a lower risk of adverse reactions.

Rubella monovaccines

These drugs are based on rubella viruses only. Infectious agents in it are weakened; when introduced into the body, they cause the same immune response as in normal infection. These vaccines rarely cause reactions and are therefore considered to be of little reactogenicity. Also, the introduced virus cannot be transmitted to other people, unlike the true one.

To date, the following monovaccines against the “third disease” are used:

1. “Ervevaks” made in Belgium. It is used for children, girls of prepubertal age, adult women. Like all other rubella formulations, it is based on live strains. Developed immunity lasts at least 15 years. It is most often used for vaccinating older patients, since children are most often given multicomponent vaccines. It can be used on the same day as DTP, measles, and mumps vaccines.
2. “Cultural attenuated rubella vaccine”, which is produced by Croatia, is registered in Russia. Used for prophylaxis in all population groups, prepared on the basis of strain RA 27/3. It is often used for vaccination in polyclinics in the CIS countries, and it can also be bought as prescribed by a doctor for unscheduled immunization.
3. “Rudivax” – a vaccine made in France. It is also monovalent and provides immunity for 10 to 20 years, sometimes more. Can be applied to all age groups. Among imported vaccines, it is considered very popular, as it has high efficiency and a very low threshold for side effects.
4. The Russian Rubella Live Vaccine is based on the same strain, RA 27/3. Unlike imported ones, it is prepared on the basis of quail egg protein, therefore it can be used for allergy sufferers. Acts as the main source of vaccination in most CIS countries, applicable to children 12 months old, 6-7 years old, adolescents and adults. Side effects are minimal and rare.

All these compounds allow for the prevention of rubella, have minimal consequences, and are easily tolerated by patients. However, for routine vaccination, such highly targeted formulations are inconvenient. Therefore, when immunizing children, combined multicomponent vaccines are more often used.

Three-component vaccines

The obvious advantage of such vaccines is that they contain weakened viruses of three types at once. Accordingly, one shot provides protection against several diseases at the same time. Such compositions are interchangeable, that is, they can be replaced by three separate injections.

However, it is much easier to carry out one procedure, primarily for the patient himself. Such three-component formulations develop immunity from measles, rubella and mumps (mumps). There is no such vaccine domestically, so only imported ones are used. To date, the following three-component vaccines are used in Russia and the CIS countries:

1. The American MMR-II is considered the most popular multi-component vaccine. It ensures the production of antibodies to the three most common childhood diseases: measles-rubella-mumps. It can be given on the same day as DPT, varicella vaccine, polio vaccine. They are taken to separate parts of the body with sterile syringes. Prepared on the basis of chicken egg protein.
2. The Belgian “Priorix” is the second most popular among multivalent drugs. Like MMR-II, it protects against three types of virus. Formulated with chicken egg protein and neomycin. The intensity of side effects and their frequency is no different from other formulations, therefore it is recommended by doctors for vaccinating children and adults.

Also, the Russian live attenuated bicomponent vaccine against mumps and rubella is used to protect against rubella.

It requires another injection of measles vaccine, which is not very convenient.

Domestic

The advantages of domestic vaccines are that they are more accessible. If we are talking about monovalent formulations, they are given to children and adolescents free of charge as part of the state vaccination calendar. A bicomponent vaccine will have to be bought, but compared to imported ones, it will cost much less. In addition, Russian vaccines have a very significant plus – they are prepared on the basis of hypoallergenic quail egg protein. All imported vaccines are not suitable for people with an allergy to anaphylactic chicken egg protein, in this case there are no analogues to Russian drugs.

Disadvantage: there are no three-component vaccines among domestic ones, so the injection has to be done twice if bicomponent and monovalent measles are combined. Sometimes you have to visit the clinic three times if immunization occurs with separate vaccines.

Imported

Advantage: imported preparations are convenient to use, as they are three-component. This allows you to prevent several diseases at once with one injection. However, there is no direct evidence of cases of increased side effects. Immunity to each individual virus is developed and maintained as effectively as with the introduction of monovalent vaccines.

The disadvantages include the price of these vaccines, as they are not supplied to polyclinics for mass immunization. They are purchased independently. The Belgian “Priorix” will cost about 30-40 dollars, the American MMR-II – 20-35 dollars. Prices may vary in different regions and medical institutions.

Complications, consequences and side effects after rubella vaccination

Because the vaccine uses a live attenuated virus, it can cause side effects. The fact of using live strains determines both the effectiveness of vaccination and its possible complications, which are extremely rare. In response to the introduction of an infectious agent, the body produces antibodies that persist for a long time, which protects a person from infection for 10-20 years. At the time of the production of antibodies, the body reacts to the presence of the virus, which is why side effects appear. As a rule, these include erased symptoms of rubella.

Reactions to vaccination at the injection site

At the injection site, redness sometimes appears, slight pain and itching may occur. In rare cases, lymph nodes located closer to the injection site (in the armpits, on the neck) may increase.

Common Reactions to Vaccination

Also distinguish the general response of the body. After the administration of the drug, the temperature may slightly rise, weakness, cold symptoms may occur. It is not necessary to treat them with additional medicines, they will pass within one or two days. In rare cases, the pediatrician may prescribe adjuvant therapy. It is not recommended to take medicines on your own and give them to a child.

In addition, reactions on the skin in the form of bright pink, purple spots are possible. As a rule, it disappears in a few days, but if such a rash appears, it is better to see a doctor in order to exclude possible risks. In rare cases, there is pain in the joints, signs of arthritis. In children, this side effect practically does not occur, most often the symptoms are reported in adolescents and adult women. However, they pass within a week.

If the patient is not sufficiently examined, then against the background of immunosuppression, after the introduction of the vaccine, classical rubella develops. Immediately after the injection, be sure to wait at least half an hour in the clinic. This precaution is necessary in order to completely eliminate the risk of developing serious side effects and first aid, if necessary.

How to reduce the risk of complications

All vaccines have a low reactogenicity, that is, the chance of developing side effects is very low. However, they are possible, so patients would like to further reduce the possible risks. Often these consequences depend on the patients themselves. To reduce the possibility of complications, it is recommended:

1. Before vaccination, undergo an examination and prepare. This is a very important part of the whole process that is often neglected. Vaccinations have their own contraindications and it is very important to identify them even before the process itself. It is necessary to be examined to find out if there is an allergy to one of the components of the vaccine or to the excipients that make up the composition, the presence of a disease incompatible with the vaccine.
2. Consult with your doctor about which vaccine is planned to be administered, what its possible consequences are, what to do with them, how long the injection will last. In a word, good preparation will reduce the number of unnecessary experiences.
3. 2-3 days before vaccination, crowded places should be avoided to prevent infection with influenza, acute respiratory infections or acute respiratory viral infections. Also, within 3 days after the procedure, contact with a large number of others should be avoided.

You can wash and walk after the vaccine. It is recommended to take a shower, not a bath, to walk in places that are not crowded. Before the injection and for the first time after the injection, it is also important not to get another infection. It is advisable for adults not to drink alcohol before testing and vaccination.

Rubella vaccination contraindications

Since the composition of the drugs is based on live strains, they can give an undesirable effect if contraindications are not taken into account. Not all children and adults can be vaccinated, you can find out whether it is possible to get vaccinated or it is better to refuse it after a detailed examination. The vaccine should not be administered in the following cases:

1. With exacerbation of chronic diseases, acute infections. Such restrictions are temporary and after recovery a person can be vaccinated.
2. In the presence of a severe allergy to one of the components of the drug. This takes into account only anaphylactic reactions, mild manifestations (redness of the cheeks, small rash, etc.) are not a contraindication to vaccination.
3. If you are allergic to aminoglycosides;
4. With immunodeficiency: AIDS, HIV, malignant tumors, blood diseases.
5. Complications and adverse reactions from previous administration of this vaccine.

Also, no live vaccines are given during pregnancy, including rubella vaccines. Against the background of immunodeficiency, the patient should be constantly monitored, in the absence of clinical manifestations, immunization can be carried out, and given the weakness of the immune system, it is even very desirable. If, after vaccination, a child or an adult has a severe fever, shortness of breath, other symptoms are disturbing, you should definitely consult a doctor.

Anti-epidemic measures for rubella

Avoiding new epidemics of rubella is an important task, as the disease is more complex than is commonly believed. The only effective way to prevent a pandemic is still the same vaccination. At the same time, it is important to carry out revaccination among the adult population, since complications from infection of adult men and women are much more severe. Additional preventive measures, such as disinfection of premises and isolation of patients, are ineffective. The long incubation period is asymptomatic, so the viruses are airborne and infect anyone susceptible.

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