Rubella vaccine: Difference between revisions

{{Short description|Vaccine used to prevent rubella}}

{{Use dmy dates|date=July 2024}}

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| image =MMR vaccine.jpg

|caption=MMR vaccine contains rubella vaccine

<!-- Vacine data -->

| type = vaccine

| target = [[Rubella]]

| vaccine_type = attenuated

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| tradename = Meruvax, other

| MedlinePlus = a601176

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| legal_CA = <!-- Schedule I, II, III, IV, V, VI, VII, VIII -->

| legal_UK = <!-- GSL, P, POM, CD, or Class A, B, C -->

| legal_US = <!-- OTC / Rx-only / Schedule I, II, III, IV, V -->

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| CAS_number = 1704526-12-4

| ATC_prefix = J07

| ATC_suffix = BJ01

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<!-- Definition and medical uses -->

'''Rubella vaccine''' is a [[vaccine]] used to prevent [[rubella]].<ref name=WHO2011>{{cite journal | vauthors = ((World Health Organization)) | title = Rubella vaccines : WHO position paper | journal = Weekly Epidemiological Record | date = July 2020 | volume = 95 | issue = 27 | pages = 306–24 | pmid = | hdl = 10665/332952 | author-link = World Health Organization }}</ref> Effectiveness begins about two weeks after a single dose and around 95% of people become immune.<!-- <ref name=WHO2011/> --> Countries with high rates of immunization no longer see cases of rubella or [[congenital rubella syndrome]].<!-- <ref name=WHO2011/> --> When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease.<!-- <ref name=WHO2011/> --> Therefore, it is important for more than 80% of people to be vaccinated.<ref name=WHO2011/> By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020.<ref name="Domachowske2020.27">{{cite book |vauthors=Suryadevara M |veditors=Domachowske J, Suryadevara M |title=Vaccines: A Clinical Overview and Practical Guide |date=2020 |publisher=Springer |location=Switzerland |isbn=978-3-030-58413-9 |pages=323–332 |chapter-url=https://books.google.com/books?id=8KIGEAAAQBAJ&pg=PA323 |chapter=27. Rubella |access-date=11 July 2022 |archive-date=11 July 2022 |archive-url=https://web.archive.org/web/20220711134528/https://books.google.com/books?id=8KIGEAAAQBAJ&pg=PA323 |url-status=live }}</ref>

<!-- Recommendations -->

The [[World Health Organization]] (WHO) recommends that the rubella vaccine be included in [[vaccination schedule|routine vaccinations]].<!-- <ref name=WHO2011/> --> If not all people are immunized then at least women of childbearing age should be immunized.<!-- <ref name=WHO2011/> --> It should not be given to those who are [[pregnant]] or those with very poor immune function.<!-- <ref name=WHO2011/> --> While one dose is often all that is required for lifelong protection, often two doses are given.<ref name=WHO2011/>

<!-- Safety and formulations -->

Side effects are generally mild.<!-- <ref name=WHO2011/> --> They may include fever, rash, and pain and redness at the site of injection.<!-- <ref name=WHO2011/> --> Joint pain may be reported at between one and three weeks following vaccination in women.<!-- <ref name=WHO2011/> --> [[Anaphylaxis|Severe allergies]] are rare.<!-- <ref name=WHO2011/> --> The rubella vaccine is a [[live attenuated]] vaccine.<!-- <ref name=WHO2011/> --> It is available either by itself or in combination with other vaccines.<!-- <ref name=WHO2011/> --> Combinations include with [[measles vaccine|measles]] (MR vaccine), measles and [[mumps vaccine]] ([[MMR vaccine]]) and measles, mumps and [[varicella vaccine]] ([[MMRV vaccine]]).<ref name=WHO2011/>

<!-- History, society, and culture -->

A rubella vaccine was first licensed in 1969.<ref name=CDC2012Pink>{{cite book |vauthors=Lanzieri T, Haber P, Icenogle JP, Patel M |chapter=Rubella |chapter-url=https://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html |veditors=Wodi AP, Hamborsky J, Morelli V, Schillie S |title=Epidemiology and Prevention of Vaccine-Preventable Diseases |publisher=Centers for Disease Control and Prevention |edition=14th |location=Washington, D.C. |year=2021 |access-date=8 September 2017 |archive-date=1 May 2017 |archive-url=https://web.archive.org/web/20170501031314/https://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html |url-status=live }}</ref> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> {{As of|2019}}, more than 173 countries included it in their routine vaccinations.<ref name=WHO2011/>

==Medical uses==

Rubella vaccine is used to provide protection against infection by the [[rubella]] virus.<ref name=WHO2011 />

Rubella vaccine is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd" />

===Schedule===

There are two main ways to deliver the rubella vaccine.<!-- <ref name=WHO2011/> --> The first is initially efforts to immunize all people less than forty years old followed by providing a first dose of vaccine between 9 and 12 months of age.<!-- <ref name=WHO2011/> --> Otherwise simply women of childbearing age can be vaccinated.<ref name=WHO2011/>

While only one dose is necessary two doses are often given as it usually comes mixed with the measles vaccine.<ref name=WHO2011/>

===Pregnancy===

Women who are planning to become pregnant are recommended to have rubella immunity beforehand, as the virus has a potential to cause miscarriage or serious birth defects.<ref name=":0">{{Cite web|url=https://www.cdc.gov/vaccines/pregnancy/pregnant-women/index.html|title=Pregnancy and Vaccination|date=21 August 2019|website=[[Centers for Disease Control and Prevention]] (CDC)|access-date=3 October 2019|archive-date=2 October 2019|archive-url=https://web.archive.org/web/20191002075212/https://www.cdc.gov/vaccines/pregnancy/pregnant-women/index.html|url-status=live}}</ref> Immunity may be verified by pre-pregnancy blood test, and it is recommended that those with negative results should refrain from getting pregnant for at least a month after receiving the vaccine.<ref name=":0" />

The vaccine theoretically should not be given during pregnancy.<!-- <ref name=WHO2011/> --> However, more than a thousand women have been given the vaccine when they did not realize that they were pregnant and no negative outcomes occurred.<!-- <ref name=WHO2011/> --> Testing for pregnancy before giving the vaccine is not needed.<ref name=WHO2011/>

If a low titre is found during pregnancy, the vaccine should be given after delivery. It is also advisable to avoid becoming pregnant for the four weeks following the administration of the vaccine.<ref>{{cite journal | vauthors = Marin M, Güris D, Chaves SS, Schmid S, Seward JF, ((Advisory Committee on Immunization Practices)), ((Centers for Disease Control and Prevention)) | title = Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR Recomm Rep | date = June 2007 | volume = 56 | issue = RR-4 | pages = 1–40 | pmid = 17585291 | url = https://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf | url-status = live | archive-url = https://web.archive.org/web/20200209061806/https://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf | archive-date = 9 February 2020 }}</ref>

==History==

[[File:Nlm nlmuid-101679498-img.tif|thumb|Laboratory monkey inspected by Drs. Harry M. Meyer Jr. (left) and Paul D. Parkman (right), assisted by Rudyard Wallace, technician (center).]]

Since the [[1962–1965 rubella epidemic]] that swept Europe in 1962-1963 and the US in 1964–1965, several efforts were made to develop effective vaccines using attenuated viral strains, both in US and abroad.<ref name=":1">{{cite journal | vauthors = Parkman PD | title = Making vaccination policy: the experience with rubella | journal = Clinical Infectious Diseases | volume = 28 |issue=Suppl 2 | pages = S140-6 | date = June 1999 | pmid = 10447033 | doi = 10.1086/515062 | jstor = 4481910 | doi-access = }}</ref>

=== HPV-77 ===

The first successful strain to be used was the HPV-77, prepared by passing the virus through the cells of an African green monkey kidney 77 times. The efforts to develop the vaccine were conducted by a team of researchers at the [[National Institutes of Health]]'s Division of Biologics Standards. Led by Harry M. Meyer and [[Paul D. Parkman]], the team included [[Hope E. Hopps]],<ref>{{Cite web|vauthors=Bowen A|date=6 September 2018|title=Finding Hope: A Woman's Place is in the Lab|url=https://circulatingnow.nlm.nih.gov/2018/09/06/finding-hope-a-womans-place-is-in-the-lab/|access-date=20 January 2021|website=Circulating Now from NLM|archive-date=18 February 2021|archive-url=https://web.archive.org/web/20210218072623/https://circulatingnow.nlm.nih.gov/2018/09/06/finding-hope-a-womans-place-is-in-the-lab/|url-status=live}}</ref> [[Ruth L. Kirschstein]], and Rudyard Wallace among others, the team began serious work on the vaccine with the arrival of a major rubella epidemic in the United States in 1964. Prior to arriving at the [[National Institutes of Health]] (NIH), Parkman had been working on isolating the rubella virus for the Army. He joined the laboratory of Harry Meyer.<ref name="Parkman Oral History">{{cite web | vauthors = Parkman PD |title=Dr. Paul Parkman Oral History |url=https://history.nih.gov/archives/downloads/paulparkman.pdf |website=Office of NIH History |publisher=National Institutes of Health |access-date=13 October 2018 |url-status=dead |archive-date=13 December 2019 |archive-url=https://web.archive.org/web/20191213170952/https://history.nih.gov/archives/downloads/paulparkman.pdf }}</ref>

Parkman, Meyer, and the team from the NIH tested the vaccine at the Children's Colony in Conway, Arkansas in 1965 while a rubella epidemic still raged across the United States.<ref>{{cite web |vauthors=Milford L |title=Arkansas Children's Colony aka: Conway Human Development Center |url=http://www.encyclopediaofarkansas.net/encyclopedia/entry-detail.aspx?entryID=2575 |website=Encyclopedia of Arkansas History and Culture |access-date=13 October 2018 |archive-date=14 October 2018 |archive-url=https://web.archive.org/web/20181014053050/http://www.encyclopediaofarkansas.net/encyclopedia/entry-detail.aspx?entryID=2575 |url-status=live }}</ref> This residential home provided care for children with cognitive disabilities and children who were ill. The ability to isolate children in their cabins and control access to the children made it an ideal location for testing a vaccine without starting an epidemic of rubella. Each of the children's parents provided consent for the participation in the trial.<ref name="Parkman Oral History" />

In June 1969, the NIH issued the first license for commercial production of the rubella vaccine to the pharmaceutical company Merck Sharp & Dohme.<ref>{{cite web |vauthors=Wendt D |title=Combating infectious disease and slaying the rubella dragon, 1969-1972 |url=http://americanhistory.si.edu/blog/combating-infectious-disease-and-slaying-rubella-dragon-1969-1972 |website=O Say Can You See? |date=30 September 2015 |publisher=National Museum of American History |access-date=13 October 2018 |archive-date=14 October 2018 |archive-url=https://web.archive.org/web/20181014053027/http://americanhistory.si.edu/blog/combating-infectious-disease-and-slaying-rubella-dragon-1969-1972 |url-status=live }}</ref> This vaccine made use of the HPV77 rubella strain and was produced in duck embryo cells. This version of the rubella vaccine was in use for only a few years before the introduction of the combined [[MMR vaccine|measles, mumps, and rubella (MMR) vaccine]] in 1971.<ref>{{cite web|url=https://www.historyofvaccines.org/content/articles/rubella|title=Rubella|date=7 February 2019|access-date=29 January 2020|website=historyofvaccine.org|archive-date=1 May 2021|archive-url=https://web.archive.org/web/20210501040150/https://www.historyofvaccines.org/content/articles/rubella|url-status=dead}}</ref>

=== RA 27/3 ===

Most of the modern Rubella vaccines (including the combination vaccine [[MMR vaccine|MMR]]) contain the RA 27/3 strain,<ref>{{Cite web|title=Information Sheet Observed Rate of Vaccine Reactions Measles, Mumps and Rubella Vaccines|url=https://www.who.int/vaccine_safety/initiative/tools/MMR_vaccine_rates_information_sheet.pdf|access-date=25 October 2021|website=WHO|date=May 2014|archive-date=17 December 2019|archive-url=https://web.archive.org/web/20191217095809/https://www.who.int/vaccine_safety/initiative/tools/MMR_vaccine_rates_information_sheet.pdf|url-status=live}}</ref> which was developed by [[Stanley Plotkin]] and [[Leonard Hayflick]] at the [[Wistar Institute]] in Philadelphia. The vaccine was attenuated and prepared in the [[WI-38]] normal human diploid cell strain which was developed by Hayflick<ref>{{cite journal | vauthors = Hayflick L, Moorhead PS | title = The serial cultivation of human diploid cell strains | journal = Experimental Cell Research | volume = 25 | issue = 3 | pages = 585–621 | date = December 1961 | pmid = 13905658 | doi = 10.1016/0014-4827(61)90192-6 }}</ref><ref>{{cite journal | vauthors = Hayflick L | title = The limited in vitro lifetime of human diploid cell strains | journal = Experimental Cell Research | volume = 37 | issue = 3 | pages = 614–636 | date = March 1965 | pmid = 14315085 | doi = 10.1016/0014-4827(65)90211-9 }}</ref> and gifted to Plotkin by him.

In order to isolate the virus, instead of taking swab samples from the throats of infected patients, which could have been contaminated with other resident viruses, Plotkin decided to utilize aborted fetuses provided by the department of Obstetrics and Gynecology of the [[Hospital of the University of Pennsylvania]]. At the time, [[Abortion in the United States by state|abortion]] was illegal in most of the United States (including Pennsylvania), but doctors were allowed to perform "therapeutic abortions" when the life of the woman was in danger. Some started to perform them also on women infected with rubella.<ref>{{Cite web | date=5 February 2016| vauthors = Little B |title=Way Before Zika, Rubella Changed Minds on Abortion|url=https://www.nationalgeographic.com/news/2016/02/160205-zika-virus-rubella-abortion-brazil-birth-control-womens-health-history/ | archive-url=https://web.archive.org/web/20200807014722/https://www.nationalgeographic.com/news/2016/02/160205-zika-virus-rubella-abortion-brazil-birth-control-womens-health-history/| url-status=dead|archive-date=7 August 2020|access-date=|website=National Geographic}}</ref> Several dozens of aborted fetuses were collected and studied by Plotkin. The kidney tissue from fetus 27 produced the strain that was used to develop the attenuated rubella vaccine. The name RA 27/3 refers to "Rubella Abortus", 27th fetus, 3rd organ to be harvested (the kidney).<ref>{{Cite book| vauthors = Wadman M |url=https://books.google.com/books?id=McMiDAAAQBAJ&q=plotkin+fetuses&pg=PT231|title=The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease|date=7 February 2017|publisher=Penguin|isbn=978-0-698-17778-9 }}</ref>

The vaccine was first approved by the UK in 1970. The strain became the preferred vaccine used by pharmaceutical companies over the HPV-77, due to several considerations, including its higher immunogenicity; [[Merck & Co.|Merck]] made it its mainstay rubella vaccine in 1979.<ref name=":1" />

Parkman and his team did not monetize their patents, wanting the vaccine to be freely available.<ref>{{Cite news |last=Roberts |first=Sam |date=21 May 2024 |title=Dr. Paul Parkman, Who Helped to Eliminate Rubella, Dies at 91 |url=https://www.nytimes.com/2024/05/21/health/paul-parkman-dead.html |access-date=6 July 2024 |work=The New York Times |issn=0362-4331 |archive-date=21 May 2024 |archive-url=https://web.archive.org/web/20240521193818/https://www.nytimes.com/2024/05/21/health/paul-parkman-dead.html |url-status=live }}</ref>

==Types==

[[File:Priorix.jpg|thumb|Measles, mumps and rubella combined vaccine ([[MMR vaccine]])]]

Rubella is seldom given as an individual vaccine and is often given in combination with [[measles]], [[mumps]], or [[varicella]] (chickenpox) vaccines.<ref name=WHO2017Vac>{{cite journal | vauthors = ((World Health Organization)) | author-link = World Health Organization | title = Measles vaccines: WHO position paper – April 2017 | journal = Weekly Epidemiological Record | volume = 92 | issue = 17 | pages = 205–27 | date = April 2017 | pmid = 28459148| hdl=10665/255377 }}</ref><ref name="who.int 2020">{{cite web | title=Summary of the WHO position on Measles Vaccine- April 2017 | website=who.int | date=13 September 2020 | url=https://www.who.int/immunization/policy/position_papers/WHO_PP_measles_vaccine_summary_2017.pdf?ua=1 | archive-url=https://web.archive.org/web/20220307201458/https://www.who.int/immunization/policy/position_papers/WHO_PP_measles_vaccine_summary_2017.pdf?ua=1 | archive-date=7 March 2022 | url-status=dead}}</ref> Below is the list of measles-containing vaccines:

* Rubella vaccine (standalone vaccine)

* Measles and rubella combined vaccine ([[MR vaccine]])

* Measles, mumps and rubella combined vaccine ([[MMR vaccine]])<ref name="package insert">{{cite web | title=M-M-R II- measles, mumps, and rubella virus vaccine live injection, powder, lyophilized, for suspension | website=DailyMed | date=24 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862 | access-date=29 January 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406003823/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862 | url-status=live }}</ref><ref>{{cite web | title=M-M-RVaxPro EPAR | website=[[European Medicines Agency]] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/m-m-rvaxpro | access-date=29 January 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406174101/https://www.ema.europa.eu/en/medicines/human/EPAR/m-m-rvaxpro | url-status=live }}</ref><ref>{{cite web | title=Priorix - Summary of Product Characteristics (SmPC) | website=(emc) | date=14 January 2020 | url=https://www.medicines.org.uk/emc/product/1159/smpc | access-date=29 January 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406003828/https://www.medicines.org.uk/emc/product/1159/smpc | url-status=live }}</ref>

* Measles, mumps, rubella and varicella combined vaccine ([[MMRV vaccine]]).<ref name="ProQuad label">{{cite web | title=ProQuad- measles, mumps, rubella and varicella virus vaccine live injection, powder, lyophilized, for suspension | website=DailyMed | date=26 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=73eae9fc-507b-4c9c-883d-63eb2e3cc6f6 | access-date=29 January 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406003810/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=73eae9fc-507b-4c9c-883d-63eb2e3cc6f6 | url-status=live }}</ref> The measles vaccine is equally effective for preventing measles in all formulations, but side effects vary depending with the combination.<ref name=WHO2017Vac />

== Further reading ==

* {{cite book | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 20: Rubella | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html | url=https://www.cdc.gov/vaccines/pubs/pinkbook/index.html }}

==External links==

* [http://www.medicinenet.com/rubella_virus_vaccine-injection/article.htm Rubella virus vaccine] on MedicineNet

* [http://www.vaccines.gov/diseases/rubella/ Rubella] on vaccines.gov

* {{MeshName|Rubella Vaccine}}

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