Introduction

Rubella vaccine is available either as a single antigen vaccine or combined with measles and mumps (MMR). It contains live attenuated RA 27/3 strain of rubella virus, propagated in human diploid cells. It should be stored at 2°-8°C and protected from light. The route of administration is subcutaneous. Each dose contains >1000 TCIDSO of active virus particles.

Age of Administration

Rubella vaccine is usually given at age 12-15 months, but can also be administered to children as young as 9 months of age. It may also be administered to older children, adolescents, students, childcare personnel, health care workers, military personnel, and adult men in contact with women of childbearing age.

Rubella Vaccine and Pregnancy

Rubella vaccination should be avoided in pregnancy because of the theoretical risk of teratogenicity. There is no need to screen women for pregnancy before rubella vaccination. If pregnancy is being planned, then an interval of one month should be observed after rubella vaccination. Rubella vaccination is not an indication for abortion.

Rubella Vaccine Precautions

• Asymptomatic HIV positive persons can be immunized.
• Children with a malignant disease or who have had a bone marrow transplant should be immunized against rubella six months after immunosuppressant treatment is stopped.

• Persons with active tuberculosis should not be vaccinated until treatment has been established.
• Persons who received blood products should wait at least 3 months before vaccination because rubella antibodies present in the blood may interfere with the vaccine. Blood products should be avoided for up to 2 weeks post-vaccination.

Need for Rubella Vaccine

The primary purpose of rubella vaccination is to prevent the occurrence of congenital rubella infection, which is an important cause of deafness, blindness, and mental retardation in the child affected.

It is estimated that more than 100,000 cases of congenital rubella syndrome may occur each year in developing countries alone. Large-scale rubella vaccination during the last decade has drastically reduced or practically eliminated rubella and congenital rubella syndrome in many developed countries. Studies assuring the cost-benefit of rubella vaccination have demonstrated that the benefits outweigh the costs and that rubella vaccination is economically justified, particularly when combined with the measles vaccine.

WHO position on rubella vaccines

WHO recommends the use of the rubella vaccine in all countries with well-functioning childhood immunization programs where reduction or elimination of congenital rubella syndrome is considered a public health priority. All countries undertaking rubella elimination should ensure that women of childbearing age are immune and that routine coverage in children is sustained at over 80%. Two approaches are recommended:

• WHO recommends the use of the rubella vaccine in all countries with well-functioning childhood immunization programs where reduction or elimination of congenital rubella syndrome is considered a public health priority. All countries undertaking rubella elimination should ensure that women of childbearing age are immune and that routine coverage in children is sustained at over 80%.
• Elimination of rubella as well as congenital rubella syndrome through universal immunization of infants. Surveillance and assuring immunity in women of childbearing age.

Rubella Vaccine - Efficacy

RA 27/3 Rubella vaccine is highly efficacious. In clinical trials, 95%-100% of susceptible individuals aged 12 months or above-developed rubella antibodies by 3-4 weeks after vaccine administration. Vaccine-induced immunity is generally lifelong.

Rubella Vaccine - Contraindications

History of anaphylactic reaction to neomycin or an anaphylactic reaction after a previous dose of rubella.

Advanced immunodeficiencies e.g. congenital immune disorders, malignancies, and immunosuppressive therapy.

Rubella Vaccine - Adverse Events

They are generally mild. Common symptoms are pain, redness, and induration at the site of injection, low-grade fever, rash, lymphadenopathy, myalgia & parasthesia. Joint symptoms tend to be rare in children (0-3%) and in men, but are common among vaccinated adolescent & adult females. Anaphylactic reactions are rare.