As always, my Microbiology class is reading Paul Offit’s Vaccinated this year. Recently, we have started into the chapters concerning Hilleman’s involvement in making vaccines against Measles, Mumps, and Rubella, each taking a chapter in the book.
Rubella is often overlooked as an unimportant disease with milder symptoms than other vaccine-preventable illnesses such as Measles, Smallpox, or Polio. However, Rubella represents a different threat, less visible during the acute phase of infection.
From the Latin, Rubor, meaning red. Rubella (little red) was initially identified by its similarity to measles, resulting in a shorter-duration (aka 3-Day Measles) episode of red spots. Because of the similarity to Measles and being first described by a number of German scientists, Rubella took a third name, German Measles.
Although Rubella is not typically a dangerous disease for older children, it can be difficult for babies and is particularly destructive when contracted by women in the first trimester of pregnancy. Early in the pregnancy rubella infection can lead to serious problems in approximately 50% of babies. So common are these outcomes that they bear their own name, Congenital Rubella Syndrome (CRS). Effects include blindness, deafness, congenital heart disease, and intellectual disabilities.
During the course of the 1963-65 epidemic, “In the United States alone, about 11,000 babies died and 20,000 babies developed birth defects from rubella.” CDC
Following this epidemic, a vaccine against Rubella was approved for use in the US in 1969 and was followed by an abrupt decline in the number of cases as seen in this graph illustrating the number of rubella cases occurring in the US from 1966-1993. (taken from Centers for Disease Control and Prevention Summary of notifable diseases—United States, 1993 Published October 21, 1994 for Morbidity and Mortality Weekly Report 1993) Although not depicted in this graph, the resulting CRS incidence followed a similar pattern.
Until recently, the most common mechanism for vaccinating against Rubella was the Measles/Mumps/Rubella (MMR) combination vaccine. However, in 2004 a MMRV combination containing varicella (chickenpox virus) was approved adding additional protection to the single shot. Currently, the MMR/MMRV vaccine is recommended at age 12-14 months, with a booster at age 4-6.
When the MMR vaccine came under suspicion following the 1998 publication of Andrew Wakefield’s notorious (and now retracted) article suggesting a link between vaccination and autism, Measles cases began to re-emerge.
Concurrently, Rubella cases have also rebounded in countries that had previously nearly eliminated the disease (see data below from Poland).
Ultimately, the future for these viruses depends on how we, the public choose to use the information available to us – and where we choose to get that information, from talk show hosts and celebrities, or from the agencies we have built to protect the health of the country.