Rubella and CRS

Rubella and Congenital Rubella Syndrome

 

     Rubella had a natural virulence cycle of every 6-9 years and was once a disease of school-aged child that was typically caught between the ages of 5-9 year old. 80% thus developed natural antibodies to Rubella and protected them into adulthood, while 15% remained susceptible to the disease. The goal of the Rubella vaccine program was to prevent fetal infection, or CRS, in women in the childbearing years who had not acquired natural immunity in childhood.  Unfortunately, the original goal has not been obtained. The exact opposite is occurring as young adult women in their childbearing years now have the highest rate of Rubella incidence. Is this a new phenomenon occurring in today’s generation? No. To spite the large Rubella vaccine program, since 1969 there has been a shift in incidence and a shift in age susceptibility.

 
 
 
 
 
 
 

 

              

“During the 1990s, the characteristics (ie, age distribution, sex, and race/ethnicity) of rubella cases changed significantly. In 1990, incidence was higher among children younger than 15 years than among persons aged 15 to 44 years… since the mid 1990s, incidence has increased among persons aged 15 to 44 years and decreased among children younger than 15 years. In 1990, children younger than 15 years accounted for 69% of cases. Since 1996, the highest percentage of cases occurred among persons aged 20 to 29 years, with a high in 1999 of 49%.  

  

     According to a 1980 Pediatrics study, the susceptibility rate of 6th graders was 15% in those vaccinated. (2) The susceptibility rate has remained the same rate as in the pre-vaccine era, even after the late 1970’s initiative to re-immunize all females during the child bearing years.

 

 

      

     Has the Rubella vaccine reduced Congenital Rubella Syndrome? You be the judge. Rubella was not a nationally notifiable disease until 1966. Rubella vaccine was licensed and recommended in 1969 for girls and boys in infancy and/or the preschool years, and then eventually recommended for adolescents. Since 1969, Rubella cases have declined, yet CRS cases increased after the introduction of the vaccine. In 1966, the pre-vaccine era, there were 11 cases of CRS. In 1969, after the introduction of the vaccine, there were 31 CRS cases. By 1970, there was an increase of 77 cases and in 1971, 68 cases. During the 1980’s, CRS cases declined once again but still remained higher than the pre-vaccination era. In 1992, there were 11 cases of CRS which is the same exact number of cases in 1966 before the Rubella vaccine was routinely used.  In 2000, there were 9 cases of CRS and in 2006, one case.

 

     As you can see, the Rubella vaccine has had little impact on reducing the number of CRS cases over the last 40 years since its introduction, yet it increased CRS cases in some years. There are even incidences were women had high levels of antibodies to Rubella before pregnancy, yet the babies had CRS. There are also some women who will never seroconvert (show positive antibodies) no matter how many times they are vaccinated.

      

     What has vaccination really accomplish if immunity wanes from infancy, if vaccinated young women are made more susceptible when they need immunity the most, and the increase in congenital rubella syndrome? Yet, natural immunity in early childhood can protect for a lifetime. Think about this statement made in 1964, before there was a Rubella vaccine implemented, by Dr. Hugh Paul in The Control Of Diseases:

     “The disease (rubella) cannot be prevented, and in view of its very mild character, and the possibility that it may have catastrophic effects if contracted by an expectant mother, it is questionable if it should be prevented in childhood and adolescence even if this were possible.  It has been suggested that female children should be deliberately exposed to infection in order to achieve a life-long immunity from the disease and possibly from malformation in the offspring in later life.  This idea is not an unreasonable one… Rubella does not kill, and even complications are uncommon.” 

 

      

 

 

 

 

 

 

 

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