Rubella vaccine

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Rubella vaccine
MMR vaccine.jpg
MMR vaccine contains rubella vaccine
Vaccine description
Target Rubella
Vaccine type Attenuated
Clinical data
Trade names Meruvax, other
MedlinePlus a601176
ATC code
Identifiers
CAS Number
ChemSpider
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Rubella vaccine is a vaccine used to prevent rubella. [1] Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated. [1] By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020. [2]

Contents

The World Health Organization (WHO) recommends that the rubella vaccine be included in routine vaccinations. If not all people are immunized then at least women of childbearing age should be immunized. It should not be given to those who are pregnant or those with very poor immune function. While one dose is often all that is required for lifelong protection, often two doses are given. [1]

Side effects are generally mild. They may include fever, rash, and pain and redness at the site of injection. Joint pain may be reported at between one and three weeks following vaccination in women.Severe allergies are rare. The rubella vaccine is a live attenuated vaccine. It is available either by itself or in combination with other vaccines. Combinations include with measles (MR vaccine), measles and mumps vaccine (MMR vaccine) and measles, mumps and varicella vaccine (MMRV vaccine). [1]

A rubella vaccine was first licensed in 1969. [3] It is on the World Health Organization's List of Essential Medicines. [4] As of 2019, more than 173 countries included it in their routine vaccinations. [1]

Medical uses

Rubella vaccine is used to provide protection against infection by the rubella virus. [1]

Rubella vaccine is on the World Health Organization's List of Essential Medicines. [4]

Schedule

There are two main ways to deliver the rubella vaccine. The first is initially efforts to immunize all people less than forty years old followed by providing a first dose of vaccine between 9 and 12 months of age. Otherwise simply women of childbearing age can be vaccinated. [1]

While only one dose is necessary two doses are often given as it usually comes mixed with the measles vaccine. [1]

Pregnancy

Women who are planning to become pregnant are recommended to have rubella immunity beforehand, as the virus has a potential to cause miscarriage or serious birth defects. [5] Immunity may be verified by pre-pregnancy blood test, and it is recommended that those with negative results should refrain from getting pregnant for at least a month after receiving the vaccine. [5]

The vaccine theoretically should not be given during pregnancy. However, more than a thousand women have been given the vaccine when they did not realize that they were pregnant and no negative outcomes occurred. Testing for pregnancy before giving the vaccine is not needed. [1]

If a low titre is found during pregnancy, the vaccine should be given after delivery. It is also advisable to avoid becoming pregnant for the four weeks following the administration of the vaccine. [6]

History

Laboratory monkey inspected by Drs. Harry M. Meyer Jr. (left) and Paul D. Parkman (right), assisted by Rudyard Wallace, technician (center). Nlm nlmuid-101679498-img.tif
Laboratory monkey inspected by Drs. Harry M. Meyer Jr. (left) and Paul D. Parkman (right), assisted by Rudyard Wallace, technician (center).

Since the 1962–1965 rubella epidemic that swept Europe in 1962-1963 and the US in 1964–1965, several efforts were made to develop effective vaccines using attenuated viral strains, both in US and abroad. [7]

HPV-77

The first successful strain to be used was the HPV-77, prepared by passing the virus through the cells of an African green monkey kidney 77 times. The efforts to develop the vaccine were conducted by a team of researchers at the National Institutes of Health's Division of Biologics Standards. Led by Harry M. Meyer and Paul D. Parkman, the team included Hope E. Hopps, [8] Ruth L. Kirschstein, and Rudyard Wallace among others, the team began serious work on the vaccine with the arrival of a major rubella epidemic in the United States in 1964. Prior to arriving at the National Institutes of Health (NIH), Parkman had been working on isolating the rubella virus for the Army. He joined the laboratory of Harry Meyer. [9]

Parkman, Meyer, and the team from the NIH tested the vaccine at the Children's Colony in Conway, Arkansas in 1965 while a rubella epidemic still raged across the United States. [10] This residential home provided care for children with cognitive disabilities and children who were ill. The ability to isolate children in their cabins and control access to the children made it an ideal location for testing a vaccine without starting an epidemic of rubella. Each of the children's parents provided consent for the participation in the trial. [9]

In June 1969, the NIH issued the first license for commercial production of the rubella vaccine to the pharmaceutical company Merck Sharp & Dohme. [11] This vaccine made use of the HPV77 rubella strain and was produced in duck embryo cells. This version of the rubella vaccine was in use for only a few years before the introduction of the combined measles, mumps, and rubella (MMR) vaccine in 1971. [12]

RA 27/3

Most of the modern Rubella vaccines (including the combination vaccine MMR) contain the RA 27/3 strain, [13] which was developed by Stanley Plotkin and Leonard Hayflick at the Wistar Institute in Philadelphia. The vaccine was attenuated and prepared in the WI-38 normal human diploid cell strain which was developed by Hayflick [14] [15] and gifted to Plotkin by him.

In order to isolate the virus, instead of taking swab samples from the throats of infected patients, which could have been contaminated with other resident viruses, Plotkin decided to utilize aborted fetuses provided by the department of Obstetrics and Gynecology of the Hospital of the University of Pennsylvania. At the time, abortion was illegal in most of the United States (including Pennsylvania), but doctors were allowed to perform "therapeutic abortions" when the life of the woman was in danger. Some started to perform them also on women infected with rubella. [16] Several dozens of aborted fetuses were collected and studied by Plotkin. The kidney tissue from fetus 27 produced the strain that was used to develop the attenuated rubella vaccine. The name RA 27/3 refers to "Rubella Abortus", 27th fetus, 3rd organ to be harvested (the kidney). [17]

The vaccine was first approved by the UK in 1970. The strain became the preferred vaccine used by pharmaceutical companies over the HPV-77, due to several considerations, including its higher immunogenicity; Merck made it its mainstay rubella vaccine in 1979. [7]

Parkman and his team did not monetize their patents, wanting the vaccine to be freely available. [18]

Types

Measles, mumps and rubella combined vaccine (MMR vaccine) Priorix.jpg
Measles, mumps and rubella combined vaccine (MMR vaccine)

Rubella is seldom given as an individual vaccine and is often given in combination with measles, mumps, or varicella (chickenpox) vaccines. [19] [20] Below is the list of measles-containing vaccines:

Related Research Articles

<span class="mw-page-title-main">Vaccine</span> Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">Mumps</span> Human disease caused by paramyxovirus

Mumps is a highly contagious viral disease caused by the mumps virus. Initial symptoms of mumps are non-specific and include fever, headache, malaise, muscle pain, and loss of appetite. These symptoms are usually followed by painful swelling around the side of the face, which is the most common symptom of a mumps infection. Symptoms typically occur 16 to 18 days after exposure to the virus. About one third of people with a mumps infection do not have any symptoms (asymptomatic).

<span class="mw-page-title-main">MMR vaccine</span> Combined vaccine against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

<span class="mw-page-title-main">Immunization</span> Process by which an individuals immune system becomes fortified against an infectious agent

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent.

<span class="mw-page-title-main">Wistar Institute</span> American biomedical research institute

The Wistar Institute is an independent, nonprofit research institution in biomedical science with special focuses in oncology, immunology, infectious disease, and vaccine research. Located on Spruce Street in the University City section of Philadelphia, Wistar was founded in 1892 as a nonprofit institution to focus on biomedical research and training.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Childhood immunizations in the United States</span>

The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.

The MMRV vaccine is a combination vaccine which combines the attenuated virus measles, mumps, rubella, and varicella (chickenpox). The MMRV vaccine has similar immunogenicity and overall safety profiles to the MMR vaccine administered with or without the varicella vaccine. The MMRV vaccine is typically given to children between one and two years of age.

<span class="mw-page-title-main">Mumps vaccine</span> Vaccine which prevents mumps

Mumps vaccines are vaccines which prevent mumps. When given to a majority of the population they decrease complications at the population level. Effectiveness when 90% of a population is vaccinated is estimated at 85%. Two doses are required for long term prevention. The initial dose is recommended between 12 and 18 months of age. The second dose is then typically given between two years and six years of age. Usage after exposure in those not already immune may be useful.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

Immunization during pregnancy is the administration of a vaccine to a pregnant individual. This may be done either to protect the individual from disease or to induce an antibody response, such that the antibodies cross the placenta and provide passive immunity to the infant after birth. In many countries, including the US, Canada, UK, Australia and New Zealand, vaccination against influenza, COVID-19 and whooping cough is routinely offered during pregnancy.

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. These vaccines contrast to those produced by "killing" the pathogen.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper, authored by discredited former doctor Andrew Wakefield and published in The Lancet, falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaccine activists.

<span class="mw-page-title-main">Rabies vaccine</span> Vaccines to prevent rabies in humans and animals

The rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the latent period after exposure to prevent the disease. Transmission of rabies virus to humans typically occurs through a bite or scratch from an infectious animal, but exposure can occur through indirect contact with the saliva from an infectious individual.

<span class="mw-page-title-main">Chickenpox</span> Human viral disease

Chickenpox, also known as varicella, is a highly contagious, vaccine-preventable disease caused by the initial infection with varicella zoster virus (VZV), a member of the herpesvirus family. The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face. It then spreads to the rest of the body. The rash and other symptoms, such as fever, tiredness, and headaches, usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is usually more severe in adults than in children.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

<span class="mw-page-title-main">WI-38</span> Human cell line composed of fibroblasts

WI-38 is a diploid human cell line composed of fibroblasts derived from lung tissue of a 3-month-gestation female fetus. The fetus came from the elective abortion of a Swedish woman in 1963. The cell line was isolated by Leonard Hayflick the same year, and has been used extensively in scientific research, with applications ranging from developing important theories in molecular biology and aging to the production of most human virus vaccines. The uses of this cell line in human virus vaccine production is estimated to have saved the lives of millions of people.

References

  1. 1 2 3 4 5 6 7 8 9 World Health Organization (July 2020). "Rubella vaccines : WHO position paper". Weekly Epidemiological Record. 95 (27): 306–24. hdl:10665/332952.
  2. ↑ Suryadevara M (2020). "27. Rubella". In Domachowske J, Suryadevara M (eds.). Vaccines: A Clinical Overview and Practical Guide. Switzerland: Springer. pp. 323–332. ISBN   978-3-030-58413-9. Archived from the original on 11 July 2022. Retrieved 11 July 2022.
  3. ↑ Lanzieri T, Haber P, Icenogle JP, Patel M (2021). "Rubella". In Wodi AP, Hamborsky J, Morelli V, Schillie S (eds.). Epidemiology and Prevention of Vaccine-Preventable Diseases (14th ed.). Washington, D.C.: Centers for Disease Control and Prevention. Archived from the original on 1 May 2017. Retrieved 8 September 2017.
  4. 1 2 World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl: 10665/371090 . WHO/MHP/HPS/EML/2023.02.
  5. 1 2 "Pregnancy and Vaccination". Centers for Disease Control and Prevention (CDC). 21 August 2019. Archived from the original on 2 October 2019. Retrieved 3 October 2019.
  6. ↑ Marin M, Güris D, Chaves SS, Schmid S, Seward JF, Advisory Committee on Immunization Practices, et al. (June 2007). "Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF). MMWR Recomm Rep. 56 (RR-4): 1–40. PMID   17585291. Archived (PDF) from the original on 9 February 2020.
  7. 1 2 Parkman PD (June 1999). "Making vaccination policy: the experience with rubella". Clinical Infectious Diseases. 28 (Suppl 2): S140-6. doi:10.1086/515062. JSTOR   4481910. PMID   10447033.
  8. ↑ Bowen A (6 September 2018). "Finding Hope: A Woman's Place is in the Lab". Circulating Now from NLM. Archived from the original on 18 February 2021. Retrieved 20 January 2021.
  9. 1 2 Parkman PD. "Dr. Paul Parkman Oral History" (PDF). Office of NIH History. National Institutes of Health. Archived from the original (PDF) on 13 December 2019. Retrieved 13 October 2018.
  10. ↑ Milford L. "Arkansas Children's Colony aka: Conway Human Development Center". Encyclopedia of Arkansas History and Culture. Archived from the original on 14 October 2018. Retrieved 13 October 2018.
  11. ↑ Wendt D (30 September 2015). "Combating infectious disease and slaying the rubella dragon, 1969-1972". O Say Can You See?. National Museum of American History. Archived from the original on 14 October 2018. Retrieved 13 October 2018.
  12. ↑ "Rubella". historyofvaccine.org. 7 February 2019. Archived from the original on 1 May 2021. Retrieved 29 January 2020.
  13. ↑ "Information Sheet Observed Rate of Vaccine Reactions Measles, Mumps and Rubella Vaccines" (PDF). WHO. May 2014. Archived (PDF) from the original on 17 December 2019. Retrieved 25 October 2021.
  14. ↑ Hayflick L, Moorhead PS (December 1961). "The serial cultivation of human diploid cell strains". Experimental Cell Research. 25 (3): 585–621. doi:10.1016/0014-4827(61)90192-6. PMID   13905658.
  15. ↑ Hayflick L (March 1965). "The limited in vitro lifetime of human diploid cell strains". Experimental Cell Research. 37 (3): 614–636. doi:10.1016/0014-4827(65)90211-9. PMID   14315085.
  16. ↑ Little B (5 February 2016). "Way Before Zika, Rubella Changed Minds on Abortion". National Geographic. Archived from the original on 7 August 2020.
  17. ↑ Wadman M (7 February 2017). The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease. Penguin. ISBN   978-0-698-17778-9.
  18. ↑ Roberts S (21 May 2024). "Dr. Paul Parkman, Who Helped to Eliminate Rubella, Dies at 91". The New York Times. ISSN   0362-4331. Archived from the original on 21 May 2024. Retrieved 6 July 2024.
  19. 1 2 World Health Organization (April 2017). "Measles vaccines: WHO position paper – April 2017". Weekly Epidemiological Record. 92 (17): 205–27. hdl:10665/255377. PMID   28459148.
  20. ↑ "Summary of the WHO position on Measles Vaccine- April 2017" (PDF). who.int. 13 September 2020. Archived from the original (PDF) on 7 March 2022.
  21. ↑ "M-M-R II- measles, mumps, and rubella virus vaccine live injection, powder, lyophilized, for suspension". DailyMed. 24 September 2019. Archived from the original on 6 April 2020. Retrieved 29 January 2020.
  22. ↑ "M-M-RVaxPro EPAR". European Medicines Agency (EMA). 17 September 2018. Archived from the original on 6 April 2020. Retrieved 29 January 2020.
  23. ↑ "Priorix - Summary of Product Characteristics (SmPC)". (emc). 14 January 2020. Archived from the original on 6 April 2020. Retrieved 29 January 2020.
  24. ↑ "ProQuad- measles, mumps, rubella and varicella virus vaccine live injection, powder, lyophilized, for suspension". DailyMed. 26 September 2019. Archived from the original on 6 April 2020. Retrieved 29 January 2020.

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