Download Rubella (German measles)

Rubella (German measles)
What is rubella?
Which vaccine protects against rubella?
Rubella, also known as German measles, is an infectious disease
caused by a virus. Maternal infection during pregnancy can
cause serious abnormalities in the growing baby.
Two doses of the MMR vaccine are recommended from the
age of 12 months given at least four weeks apart. After the
first dose of MMR vaccine 90–97% of people will be protected
from rubella. More people are expected to be protected after a
second dose.
How do you catch rubella?
Rubella is spread through contact with infectious droplets from
the nose or throat of a person with rubella. A person with rubella No rubella only vaccine is available in New Zealand.
can pass the virus on from up to 7 days before they develop
How safe is the MMR vaccine?
a rash to 7 days after. It usually takes 16–18 days between
The risk of the MMR vaccine causing serious harm is extremely
catching rubella and getting sick.
rare. A table comparing the effects of rubella with vaccine
Babies exposed to rubella before they were born may be able
responses is on page two.
to pass the infection on to others for up to a year after they are
People with significant weaknesses of their immune system
born.
cannot be given MMR because it is a live vaccine. Therefore,
How common is rubella?
healthy close contacts of pregnant women or those with an
The number of known cases of rubella in New Zealand each
immune system weakness should be given the MMR vaccine to
year has decreased since the late 1990s. However, as symptoms protect them.
can be mild, short-lived, and imitate other viral infections, some
Women who are breastfeeding can be given the MMR vaccine.
rubella cases may not be diagnosed as rubella.
How serious is rubella?
Rubella is usually a mild disease in children and adults. However,
it is a very serious disease for a pregnant woman because it is
passed onto her unborn baby.
Maternal infection during the first trimester has the highest
risk of causing harm to the growing baby, and infection during
the third trimester has the lowest risk. Unborn babies infected
with rubella may develop Congenital Rubella Syndrome which
includes being born deaf, blind, with heart defects, and/or brain
damage.
Rubella in children and adults can cause brain inflammation
(encephalitis) in around one person out of 6,000 cases. Brain
inflammation can cause permanent damage.
Anyone who has not been immunisation against rubella or had
rubella disease can catch rubella.
What are the symptoms of rubella?
Some people with rubella have no symptoms. Others may have
mild or severe symptoms including a rash and/or swollen glands.
Adolescents and adults may also experience joint pain.
How do you prevent rubella?
Immunisation is the only way to prevent rubella. To reduce
the risk of rubella during pregnancy women who do not have
two documented MMR immunisations, can have these for free
before becoming pregnant. Women cannot receive MMR during
pregnancy.
A pregnant woman who may not be protected from rubella is
recommended to stay away from children and adults with a rash
or rubella. It is also important that children in the family are upto-date with their immunisations. Pregnant women who come
in contact with a suspected or confirmed rubella case should
contact her midwife or family doctor for urgently.
Children or adults with suspected rubella should stay away
from early childhood services school or work until well and at
least 7 days have passed since the rash appeared. Unimmunised
children may also be required to stay away from early childhood
education or school.
There is no evidence that the MMR vaccine causes autism.
Extensive research conducted into whether the MMR vaccine
contributes to the development of autism has not shown a link.
More detailed information is available on our website.
Who should have MMR vaccine?
• Immunisation with the MMR (measles/mumps/rubella)
vaccine is free on the National Immunisation Schedule
for children at 15 months and 4 years of age, and for
unimmunised adults.
• Parents can request that the first MMR vaccine be given to
their child any time from 12 months of age and the second
dose as soon as four weeks later.
• Occasionally, an extra dose of MMR vaccine is given to a baby
aged 6–12 months during a measles outbreak. This dose is
in addition to the two doses of MMR vaccine recommended
from the age of 12 months and is considered ‘dose 0’.
• If an adolescent or adult has no documented history of
immunisation with MMR, two doses of MMR given at least
four weeks apart are recommended and funded. There are no
safety concerns about having extra doses.
• Infants in whom a liver or kidney transplant is likely are
funded for an accelerated immunisation schedule and have
their MMR immunisations aged 7 months, 12 months, and 4
years if pre-transplant.
• Older children and adults who are scheduled for solid organ
transplantation should also receive the MMR vaccine before
their transplant if they have not been immunised or are not
immune.
• Individuals who have had a bone marrow transplant,
chemotherapy, or immunosuppressive therapy, can only
receive MMR on advice of their specialist.
Can people with an egg allergy have the MMR vaccine?
Yes. Egg allergy, including anaphylaxis, is not a contraindication
for MMR vaccine. Two studies of over 1200 children with severe
egg allergy showed that these children safely received the MMR
vaccine. Those with a severe allergic reaction (anaphylaxis) to
egg can be vaccinated in general practice following the usual
processes for safe immunisation.
Rubella (German measles)
Who should not have the vaccine?
• Anyone who has experienced a severe allergic reaction (anaphylaxis) to a previous dose of any rubella containing vaccine or any
of the vaccine components.
• Anyone who is acutely unwell. The presence of a minor infection is not a reason to delay immunisation.
• Anyone with a diagnosed weakness of their immune system.
• Anyone who has received another live injected vaccine, including varicella (chickenpox) or BCG vaccines, within the previous
month.
• Women who are currently pregnant (women are recommended to delay pregnancy for one month after having the vaccine).
What if a woman has MMR and then finds out she is pregnant?
Research in the US, Germany, Latin America, Iran, Mexico, and the UK found no injury to the unborn baby when the MMR vaccine
was inadvertently given just before or during pregnancy. Receipt of MMR vaccine during pregnancy is no longer considered an
indication for termination of pregnancy.
Who should seek more advice before having the MMR vaccine?
• Anyone who has received immunoglobulin or a blood transfusion within the previous 11 months.
• Anyone who is unsure if they have a weakness of their immune system, or is taking medication to suppress their immune system.
Disease
Effects of disease
Possible vaccine responses
Rubella, also known as German measles,
is caused by a virus. It is usually a mild
disease, but when it occurs in a pregnant
woman can result in severe damage to the
developing baby.
»» Some cases have no symptoms, which
increases the risk of exposing pregnant
women to the disease
»» Rash and painful swollen glands
»» Joint pain in adolescents and adults
»» Encephalitis (brain inflammation) for
around 1 person out of 6,000 cases
»» Rubella during early pregnancy is very
likely to cause severe abnormalities
in unborn babies, including deafness,
blindness, heart defects, brain damage
Common responses
»» Measles component: Fever and/or mild
rash 6–12 days after immunisation
»» Mumps component: Fever and/or mild
swelling under the jaw 10—14 days
after immunisation
»» Rubella component: Fever, mild rash
and/or swollen glands 2—4 weeks after
immunisation
»» Temporary joint pain 2—4 weeks after
immunisation is more common in adult
women than children
Rare responses
»» Temporary low platelet count
»» Encephalitis (brain inflammation)
occurs once in a million doses. There
may be some long-term effects from
this.
»» Aseptic (infection free) meningitis
»» Convulsion associated with fever
»» Severe allergic reaction (anaphylaxis)
Vaccines are prescription medicines. Talk to your doctor or nurse about the benefits or any risks.
References
• Badilla X, Morice A, Avila-Aguero M, Saenz E, Cerda I, Reef S, et al. Fetal risk associated with rubella vaccination during pregnancy. Pediatr
Infect Dis J. 2007;26(9):830-5.
• Clark AT, Skypala I, Leech SC, Ewan PW, Dugue P, Brathwaite N, et al. British Society for Allergy and Clinical Immunology guidelines for the
management of egg allergy. Clin Exp Immunol. 2010;40(8):1116-29.
• Fox A, Lack G. Egg allergy and MMR vaccination. Br J Gen Pract. 2003;53(495):801-2.
• Ministry of Health. Communicable disease control manual 2012 [Internet]. Wellington: Ministry of Health; 2012 - updated 2016. Available
from: http://www.health.govt.nz/publication/communicable-disease-control-manual-2012 Ministry of Health.
• Immunisation handbook 2014 (2nd edition) [Internet]. Wellington: Ministry of Health; 2016. Available from: http://www.health.govt.nz/
publication/immunisation-handbook-2014-2nd-edn
• Reyna J, Herbas I, Gomez M, Vidal P, Cruz E, Puente A, et al. Perinatal outcome of inadvertent immunization with the measles-rubella
Vaccine in pregnant Mexican women during the campaign for the eradication of congenital rubella in 2008. World Journal of Vaccines.
2011;1(1):1-4.
• Reef SE, Plotkin SA. Rubella vaccine. In: Plotkin S, Orenstein W, Offit P, editors. Vaccines. 6th ed. London: W.B. Saunders; 2013. p. 688-717.
Fact sheet August 2016