What is rubella?

Rubella (German measles) is usually a mild illness causing a rash, sore throat and swollen glands. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child or cause a miscarriage. Rubella can lead to damage to the heart, brain, hearing and sight. The baby is likely to be born with a very serious condition called the congenital rubella syndrome. Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome.

The vaccine

Rubella vaccine is only available as part of the MMR vaccine. The first dose of vaccine is usually given as the MMR (measles, mumps and rubella) vaccine at about 13 months. It is usually given at the same time as the pneumoccocal vaccine (given as a separate injection). A second dose is usually given aged 3-5 years at the same time as the pre-school booster of DTP-polio (given as a separate injection). If a dose of MMR is delayed for any reason it can still be given at a later age. If necessary, MMR vaccine can be given at any age.

Before you become pregnant

Even if you have had a rubella immunisation, or have had rubella (German measles), there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunisation has worked is to have a blood test. This checks for rubella antibodies. Because the congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time you should have a blood test to check that you are protected.

This blood test may be offered to younger women in routine health checks. But if you have not had it, ask your practice nurse for the blood test. In particular, women who have come to the UK from overseas and have not been immunised are at greatest risk of having a baby with congenital rubella syndrome.

When you are pregnant

One of the routine blood tests taken in early pregnancy checks for rubella antibodies:

• In most women the test is positive, which means that you are protected from rubella.
• If your test is negative (no antibodies), you are at risk if you come in contact with rubella. You should keep away from people who might have rubella. Once your baby is born, you should then have a rubella immunisation to protect against rubella in future pregnancies.

Are there any side effects from the vaccine?

Serious problems with the rubella vaccine are rare. However, mild reactions such as a slight fever, a mild sore throat and joint pains sometimes occur about 1-3 weeks after the injection. These soon subside and are of no consequence.

Who should not receive the vaccine?

• Pregnant women. Also, you should not become pregnant for one month after having a rubella (MMR) immunisation. It is safe, however, to have if you are breastfeeding.
• If you are having chemotherapy or if your immune system is suppressed for other reasons.
• If you are allergic to the drugs neomycin or polymyxin (which are part of the vaccine). It is safe to give if you are allergic to eggs.

Further information

Information on immunisation from the NHS

Web: www.nhs.uk/Planners/vaccinations/Pages/Vaccinationchecklist.aspx

Rubella and MMR

Web: www.sense.org.uk/what_is_deafblindness/rubella_mmr/
Information about rubella, congenital rubella syndrome, and immunisation against rubella from Sense. Sense was founded in 1955 as a support group for the parents of children born deafblind as a result of their mothers catching rubella in pregnancy.

References

• Immunisation against infectious disease - 'The Green Book', Dept of Health (various dates)
• McIntyre P, Leask J; Improving uptake of MMR vaccine. BMJ. 2008 Apr 5;336(7647):729-30. Epub 2008 Feb 28.