Rubella virus vaccine
المؤلف:
Baijayantimala Mishra
المصدر:
Textbook of Medical Virology
الجزء والصفحة:
2nd Edition , p197-198
2025-11-05
56
After the successful isolation of rubella virus in cell culture, the progress on rubella vaccine led to the development of an effective live attenuated vaccine. Licensed rubella vaccine is available since 1970. Globally, rubella vaccine containing RA 27/3 strain is the most commonly used. The other live attenuated rubella vaccine contains Takahashi, Matsuura, TO-336 and BRD-2 strains. RA 27/3 strain was derived from kidney of a rubella virus infected fetus. The isolate has been attenuated by passing 4 times in human diploid fibroblast cell line followed by 17–25 times in WI-38 fibroblast cells. In North America, presently RA 27/3 is the only vaccine strain used. In Japan, Matsuura and TO-336 strains are in use, whereas in China, BRD-36 is used.
Rubella vaccine is available as single preparation, but more commonly as combi nation with measles (MR) or measles, mumps (MMR) and measles, mumps and varicella (MMRV). The combination does not affect the efficacy of rubella vaccine.
The first dose of vaccine is recommended at the age of 12–15 months and second dose before entering into school.
Vaccine is administered subcutaneously. Protective antibody response occurs after around 4 weeks of first dose of vaccination in nearly 95% of the vaccinated individuals and around 100% after the second dose. The duration of protection by vaccination is around 20 years or more. Vaccination causes mild rubella symptoms and arthritis in up to 30% of adult women. Vaccine is contraindicated during pregnancy, febrile illness and in immunocompromised individuals. However, in an incident where more than 100 pregnant women were inadvertently vaccinated, no fetal or maternal complications were reported.
Most of the Western countries have rubella vaccination in their national immunization programe. With successful vaccination and surveillance program, rubella has been eliminated from regions of America while European and Western pacific regions have started accelerated rubella control and CRS prevention.
Integrated measles-rubella control: Measles rubella (MR) vaccination: Refer to “Measles” chapter.
Congenital rubella syndrome surveillance in India: Rubella infection during first trimester of pregnancy can seriously affect the foetus either in the form of spontaneous abortion or serious birth defects causing congenital rubella syndrome. Government of India is now implemented country wide measles–rubella vaccination program in order to eliminate measles and control of rubella and CRS. In December 2016, Indian Council of Medical Research and the Ministry of Health and Family Welfare, Govt of India initiated the laboratory supported surveillance of congenital rubella syndrome (CRS) in five sentinel sites in five Indian states. Infants of 0–11 months who were fulfilling the criteria of suspected CRS were enrolled. The case definition for CRS was kept in the line of WHO’s definition.
Suspected CRS: The criteria of suspected CRS were defined as an infant meeting any one of the following five criteria: (a) structural heart defects (excluding patent ductus arteriosus/ patent foramen ovale) that is confirmed by echocardiography; (b) hearing impairment (confirmed by brainstem evoked response audiometry (BERA), or auditory steady-state response); (c) one or more of the following eye signs such as, cataract, microphthalmos, microcornea, congenital glaucoma, and pigmentary retinopathy; (d) maternal history of suspected or confirmed rubella infection during pregnancy or (e) strong clinical suspicion.
Clinically confirmed CRS: The detection of two clinical signs from group A or one each from group A and group B in an infant is termed as clinically confirmed.
Group A: Cataract(s), congenital glaucoma, pigmentary retinopathy, congenital heart defect, or hearing loss.
Group B: Microcephaly, developmental delay, meningoencephalitis, splenomegaly, purpura, radiolucent bone disease, or jaundice with onset within 24 hours after birth.
Laboratory-confirmed CRS. The presence in an infant of one condition from Group A (as above) and detection of rubella IgM antibody and/or persistently detectable rubella IgG antibody on at least two occasions at age 6–12 months, in the absence of receipt of rubella vaccine.
During 2016–18 CRS surveillance, 21.2% were labelled as laboratory confirmed CRS , of which 78.8% had cardiac defects, 59.9% showed one or more signs as per criteria and hearing impairment was noted in 38.6% infants and 24.1% died over a period of two years.
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