3c.15 What are the pros and cons of vaccinating all infants for rubella versus vaccinating females only at puberty?
Description
This article is from the Childhood Vaccinations FAQ, by Lynn Gazis-Sax lynng@alsirat.com with numerous contributions by others.
3c.15 What are the pros and cons of vaccinating all infants for rubella versus vaccinating females only at puberty?
There is still some uncertainty about the most desirable rubella
vaccination policy. In 1969, when the vaccine came out, it was decided
to avert the expected epidemic by vaccinating all children over one
year, so that they would not spread rubella to their possible pregnant
mothers - the first time one group of people was vaccinated to avoid
having them spread a disease to a different group of
people. Supporters of this policy point out that the expected epidemic
didn't occur. The possible disadvantage is that we aren't sure how
long the immunity lasts. Now that generation of children is old enough
to have children, and some of them may no longer be immune. In the
past, 80% of the population was immune due to having had rubella in
childhood.
Some countries follow a policy of vaccinating girls at puberty if they
don't have rubella antibodies (Pantell, Fries, and Vickery). The
disadvantage is that vaccine side effects are more common at this
age. The most common is joint pain, which occurs in 10% of women who
are vaccinated in adolescence or later. In some cases, it has lasted
as long as 24 months. (Pantell, Fries, and Vickery) The PDR describes
this same side effect in somewhat milder terms, saying that it
generally does not last very long and "Even in older women (35-45
years), these reactions are generally well tolerated and rarely
interfere with normal activities." It does agree with Pantell, Fries,
and Vickery that the incidence of this side effect increases with age:
0-3% of children and 12-20% of women have joint pain, and the pain is
more marked and of longer duration in the adult women. A few women
(between 1 in 500 and 1 in 10,000) experience peripheral neuropathy
(tingling hands). Another risk of vaccinating later is the risk that a
woman may be pregnant. So far, no connection with birth defects has
been demonstrated, but women are advised to avoid pregnancy for three
months after getting the vaccination.
Current US policy is to vaccinate all children at 15 months, and give
a booster during school years. Adult women are advised to get an
antibody test before becoming pregnant, and, if it comes up negative,
get vaccinated and wait three months before getting pregnant.
There has not been a rubella epidemic since 1964, either in countries
which vaccinate all children at 15 months, or in countries which
vaccinate girls only at puberty.
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