[back] RubellaRubella in babies and pregnant women
by Hilary Butler
In 1973 at the age of 19, my then boss told me to go and have a rubella vaccine, because my records showed I hadnt, and rubella was going around. He didnt want me off work, since we dairy-herd testers worked 24 days on, rest of the month off. Anyone who got sick was a pain in the neck.
Being a conforming dutiful employee, I trotted off, had the jab and carried on working. Within three weeks I had carpal tunnel syndrome and very sore joints which, I was told, was the price you pay for doing something as stupid as full-on gymnastics in earlier years. The carpal tunnel was operated on, and the joints settled down into a pattern of progressively worsening and "learning to live with it" each winter and "freedom" in the summer.
In August 1980, having got married, my then doctor (an American), on hearing of the prospect of "pregnancy", made me have a blood test. Happily, he told us that since I had beautifully high levels of rubella antibodies, I could go ahead and get pregnant, so I did.
At about 8 weeks pregnant I got as sick as a dog, and couldnt figure it out, so went to the doctor who took a blood test. I didnt think of rubella, because I had "immunity", but did discuss "viral infections" with a friend of mine who was a midwife. She explained several things, the most important of which at that time was that ALL VIRUSES CAN CAUSE DEFECTS.
The medical people use an acronym called TORCH to define these defects. This acronym stands for:
T = Toxoplasma gondii
O = Other viruses (HIV, herpes simplex, chicken pox, human parvovirus, Treponema pallidum, measles, mumps )
R = Rubella
C = Cytomegalovirus
H = Herpes simplex.
In order of severity of the first 5:
1 = HIV,
2 = Cytomegalovirus,
3 = Toxoplasma gondii,
4 = Rubella,
5 = Chickenpox, etc8.
My friend explained that the reason all these different nasties could cause almost identical defects was that viruses pull Vitamin A out of the system. If you feed a pregnant dog a diet deficient in Vitamin A (but no viruses) you will get TORCH defects in the puppies. If children in Africa who are malnourished get measles, they can go blind (as can babies born with congenital rubella effects, except in babies the blindness is permanent.). But the blindness in malnourished children is reversible with Vitamin A. The reason for these defects in babies is that in the first few weeks that a baby is forming, cells divide very quickly. One of the nutritional keys to proper cell division is vitamin A, and if a mother contracts any virus, the body uses that Vitamin A to fight the infection but the baby keeps on forming minus one essential building block.
The problem with this Vitamin A information is that the studies done on animals are old, and have not been recently corroborated, nor have any studies been done on pregnant women. I dont suppose they thought it worthy of study.
According to the medical literature, if a pregnant woman gets rubella in the first 4 weeks of gestation, 30 50% of babies run the risk of congenital malformations. Infection between the fifth and eighth week gives a risk of 25%; and during the ninth to twelfth weeks it is 8%, giving an overall risk in the first trimester of 20%1.
The logical thought, to me, is not, "That is high, have the jab", but, "How is it that 80% of babies come through rubella in utero, in the first trimester, with no problems? What went wrong in the babies who had deformities?" I believe that diet and Vitamin A in the mother is the answer.
But this line of thought was not "there" in my first pregnancy because I had not even considered that the vaccine-produced antibodies might not work. I was sick, and all I knew then was that if any virus could cause defects, something had to be done. So, at 8 weeks, really sick, funny rash, glands up on back of neck and behind ears, the shot-gun approach was used vitamin A, B, C, D, E, F, G, H, the lot.
Another blood test was taken at the next antenatal visit, but I felt fine, and nothing further was said during the pregnancy. Neither did we think to ask.
I enjoyed the winter during that pregnancy. No joint-pain what a way to go. And Ian was born with no signs of any "TORCH" problems.
But what a rotten winter the following one was! However, by the next winter No 2 was on the way. Another pain-free fantastic winter, bouncing around like a spring donkey, which is pretty hard to do when you carry like an elephant with twins!
The winter after Davids birth was so bad that a lot of time was spent in tears (wont use painkillers), and the two following it were not that much better. In desperation, when David was four, I went to my GP with a whole load of questions like:
His only reply was to question 4. "Get pregnant every year."
I lost my rag and stormed out of his rooms taking my file. In the car, I decided to have a read, and staring up at me were the blood tests done when I was pregnant with Ian. I had had rubella. I went back in and asked the doctor why he hadnt told me. His response ensured I never went back. So I found another more sympathetic (I thought) GP. (My second thought was to query how was it that someone who, a few weeks before the pregnancy, could have "immunity" then get rubella when pregnant?)
The new GP had no idea where to start with my "arthritis", so ticked everything in the immunology boxes on the basis that if something abnormal came up , wed look at that and figure from there. I went to the medical library and ran a Med-line search on every relevant word for rubella, only to find lots of cases of carpal tunnel syndrome and arthritis following the use of the rubella vaccine. I also found documented cases of women with laboratory proof of immunity who caught rubella while pregnant, and some of their babies had congenital rubella.2,3,4,5,6,7
I knew that this was common with cytomegalovirus but not with rubella. My GPs response was that this was so rare (1 in a million!) that no one he knew of had come across this. Later, when I went to teach gymnastics, and the subject came up during one of the Health Departments scareness campaigns, I found that three of us within the gym club had had the same experience. I hadnt realised that 3 million women lived in Franklin District!
In the meantime the GP decided that the tests showed an "immunodeficiency" so maybe the vaccine was not the culprit. (Usual tactic blame the patient). So my file and all my tests were sent to the rubella expert in America. He sent a nice letter back saying that since I was in New Zealand, and not the States and so couldnt sue anyone, he could easily confirm that my arthritis was actually rubella vaccine-induced, but I should take heart, because had I got it "naturally" it would have been much worse. Do something about it? No just learn to live with it.
Ian and David both got rubella in their second year diagnosed not by the doctor, who couldnt tell, but by the Plunket nurse on the basis of low fever, swollen glands behind the ears, and a rash that did not leave a stain. The question of whether or not they could pass it on to other pregnant women never came up, for several reasons. The first was that it was my policy never to take my babies anywhere if they were lethargic, or grizzly, or I knew they were sick. Secondly, in an area where most women were tested, immune or vaccinated, why should the issue even arise? The conventional wisdom is "immunity means you wont get it" and at that time it was never questioned.
During the last measles vaccination campaign I started to look for data of how much rubella was around now, but could find very little information on this. The "experts" arent studying it. After all, why should they with a vaccine to stop it all? In the past, all they studied was the levels of 15-year-olds who had natural immunity. That has not been done now for nearly 20 years. So, last year, this parent got caught out, to my embarrassment. I really should have known better.
After all, I had just written an article on rubella!
Ian got sick. Very strange, I thought. Definitely a virus, with him not liking the light (in goes the Vitamin A and Vitamin C), bit of a mild headache, didnt want to eat, mild sore throat. Just a low temperature and sleeping a lot. Sort of nothing much, but not right. Then he said, "Whats this rash, Mum?" I took one look, and straight away felt around the neck and behind the ears, and there were the telltale glands. And no, the rash did not leave a stain.
Rubella. I had just written about it, and missed the obvious! Why? Because it never occurred to me that the children would get it twice. And where did he get it from? I never found out. Could have been anywhere, anyone even a casual contact with a recently vaccinated child in Woolworths.
I rang the doctors surgery, detailed the symptoms, progression etc, and they agreed it was most likely rubella. I really wanted some blood tests done this time, because I wanted proof, but was laughed off the phone. Waste of resources, hes not going to die, etc same excuses as when David had measles the second time so I havent the "proof" Id really have liked.
So, in answer to the issues raised in the letter in Wavelets:
Every pregnant woman should make it her business to find out her immune status for rubella, even if previously vaccinated. Even so, this does not guarantee immunity.
Every pregnant woman should know that every virus could cause TORCH. It is her responsibility to ensure that her diet is such that she can fight off any virus without depleting nutrients needed to build a baby. Damage done at this stage is irreversible.
No one knows how much rubella is around at any one time. You cant tell when a child might get something. Or, for that matter, an adult. My husband taught in schools with "mumpy" children for years but didnt catch mumps until the age of 63.
Every parent who decides not to immunise their children should, out of fairness to everyone else, keep a close watch on their child. If they are not all-go as normal, dont take them out, or risk exposing visitors to them.
When discussing risks, ask your parents how you fared with rubella as a child. Amongst my children, and my friends, rubella has proven to be nuisance value only. Subclinical infections with no symptoms, but which give immunity are estimated at 25%1.
The risks to normal children from rubella are remote. Complications from rubella are rare, with the following observed in large epidemics where virus load is heavy:
Transient arthralgia/arthritis Rates vary from epidemic to epidemic London, 1962; 33% in 40 female adults, 6% in 34 males; Bermuda, 1971; 24% under 11 yrs, 52% in 11 yrs and over1.
Encephalitis usually cited at 1 in 6,000 cases1.
Purpura (reduction in platelet count) complicates rubella in rare instances. Most patients become symptom-free in 2 weeks and platelet count returns to normal values. May last from weeks to months1.
Prognosis " the prognosis is almost uniformly excellent. Rubella is one of the most benign of all infectious diseases in children. However, the rare complications of encephalitis and thrombocytopenic purpura may alter the prognosis. Many reported deaths attributed to rubella infection reflect errors in diagnosis".1
The likelihood of a baby becoming congenitally deformed is mother-dependant, in that her diet (Vitamin A, folic acid) and how many weeks pregnant she is are the important factors. After all, 80% of pregnant women who catch rubella in the first trimester do not have babies with congenital deformities.
This leads to another problem not mentioned in the letter. What happens if a mother finds out at the beginning of her pregnancy that she is not immune? This is becoming more common, as children who were vaccinated as babies, and again when they were 11, often lose their immunity. The standard line from the Health Department is that the two shots result in immunity for life. This is not true. A problem also exists where some doctors, if a young mother has a history of vaccination, do not test for immunity. They should, regardless.
If you are told that despite being vaccinated, you are no longer immune, you will be offered a vaccination immediately after your baby is born. In my opinion there are some very good reasons why you should not do this.
In mothers vaccinated 2 4 days after birth, significant amounts of infectious rubella virus is shed from nasopharyngeal secretions and in the breastmilk for two to three weeks after vaccination, although a period of 34 days has been noted in the literature. Infectious virus was recovered from 56% of babies, none of whom showed any clinical evidence of rubella. 25% developed transient antibodies to rubella virus which became undetectable after 18 20 weeks9.
So breastfed babies can mount a response to virus from their mothers, but the response is not sustained. Natural, long-term immunity is not acquired. Possible reasons for babies not developing permanent immunity are that babies are selectively competent to mount immune responses. That competence is age dependent, with certain immune components only reaching adult levels at about 8 yrs of age. Research using the measles virus shows very clearly that babies immune systems are quite different to adults,10 and that there are some viruses and bacteria which a baby might fend off, but will not develop immunity to, in the early months.
If a mother vaccinated with the rubella vaccine can excrete significant quantities of rubella virus, can vaccinated infants also excrete virus? I think so. Usually parents with babies have pregnant friends, but never have I heard anyone query whether their vaccinated 15-month-old could pass the rubella virus on to a pregnant friend or her children. This possibility also needs considering since, to be consistent, parents who vaccinate their children should make sure they are quarantined from all pregnant women or her children for at least 21 days. In reality, this is never going to happen, because mothers who vaccinate assume their child is "clean".
So where did Ian get rubella? Who knows but Ian got sick just over three weeks after the local area had had their Form 1 MMR shots. Co-incidental or causal? With an excretion time of up to 3 weeks after vaccination, and an incubation time of around 14 days, Id say the timing was impeccable.References:
[Vaccination] [Hilary Butler] [Rubella]