Measles, Mumps and Rubella Measles illness during pregnancy leads to increased rates of premature labor, spontaneous abortion, and low birth weight among affected infants and also birth defects11 Mumps developed in women during the first trimester of pregnancy, leads to an increased risk for fetal death11 Rubella developed in women during preganancy may lead to Congential Rubella syndrome11

1. MMR
VACCINATIO
N
FOR
WOMEN
DR. SHARDA JAIN
…Caring hearts, healing hands

2. Measles, Mumps and Rubella
 Measles illness during pregnancy leads to
increased rates of premature labor,
spontaneous abortion, and low birth weight
among affected infants and also birth defects11
 Mumps developed in women during the first
trimester of pregnancy, leads to an increased
risk for fetal death11
 Rubella developed in women during
preganancy may lead to Congential Rubella
syndrome11
11. CDC MMWR1998 ; 47: 2-6

3. Congenital Rubella Syndrome
 Congenital Rubella Syndrome is the
most serious feature of rubella4
 It arises when pregnant women
become infected with the rubella virus
in the early stages of pregnancy4
 Infection of the foetus occurs when the
rubella virus spreads from the placenta
and enters the foetal circulation4
4. CDC pink book (http://www.cdc.gov/vaccines/pubs/pinkbook/index.html)

4. Incidence of Congenital Rubella
Syndrome (CRS)
 CRS is estimated to affect up to 85% of
infants born to women infected with rubella
during the first trimester of pregnancy4
 Over 100,000 cases per year of CRS occur in
the developing world alone#
 Congenital Rubella Syndrome is associated
with spontaneous abortion, premature
delivery and stillbirth4
4. http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html
# IAP Guidebook

5. Congenital Rubella Syndrome- Manifestations
Consequence of CRS12 Incidence (%)
Hearing Impairment 60
Heart Defect 45
Microcephaly 27
Cataracts 25
Low Birth Weight
(<2500g)
23
Mental Retardation 13
12. Scott R Lambert, Br J Ophthalmol 2007;91:1418–1419

6. A. A child with expanded or acute congenital rubella
syndrome who had hepatosplenomegaly,
thrombocytopenia, cataracts, deafness, Congenital
heart disease and mental retardation. Also Cutis
marmorata, a peculiar mottling common in infants and
young children with congenital rubella syndrome13
B. CRS patient showing cataracts13
13. MA South et al. Teratology 31:297-307 (1985)

7. CRS Burden of disease1 : A systematic Review
 1-15% of all infants suspected to have intra-uterine infection were
found to have laboratory evidence of CRS.
 About 3-10% of suspected CRS cases are ultimately proven to have
confirmed CRS with the aid of laboratory tests.
 CRS accounts for 10-15% of pediatric cataract. 10-50% of children
with congenital anomalies have laboratory evidence of CRS.
 10-30% of adolescent females and 12-30% of women in the
reproductive age-group are susceptible to rubella infection in India.
 RCVs are highly immunogenic in Indian adolescents and women.
 The coverage data of RCVs in India is not available.
 However, the coverage of MMR vaccine has been reported as 42%,
30% and 5% from Delhi, Chandigarh and Goa, respectively.
 RCV = Rubella containing vaccines
1 CONGENITAL RUBELLA SYNDROME IN INDIA, DHAWAN and GUPTA, INDIAN PEDIATRICS, VOLUME 49__MAY 16, 2012

8. Serological and molecular characterization of rubella
virus infection among children with Ocular defects of
Congenital Rubella Syndrome
 A study conducted among infants in
south India observed that 25% of
congenital cataracts in children were
due to maternal rubella [Eckstein et al
1996], 50% infants were found to have
cardiovascular anomalies and 34.8% to
have developmental and neurological
defects
[ Vijayalakshmi et al, 2002].1) Eckstein et al. Aetiology of childhood cataract in south India; British Journal of Ophthalmology 1996;80:628-632
2) Vijayalakshmi P, Kakkar G, Samprathi A, Banushree R. Ocular manifestations of congenital rubella syndrome in a developing country.
Indian J Ophthalmol [serial online] 2002 [cited 2016 Dec 26];50:307-11

9. Rubella in Delhi: In-utero Infection and
Congenital Rubella Syndrome
 A section of women (5-10%)
unexposed to natural or vaccinated
rubella virus remain susceptible and
add the burden of CRS in society by
contracting rubella infection during
pregnancy as can be seen from the
significant correlation between the in-
utero infection cases and CRS in new-
borns
1) I. Gandhoke, et al.; Indian Journal of Medical Microbiology; Vol. 26, Issue 4; 2008

10. Rubella Vaccine or combined
MMR vaccine?
 CDC emphasizes on the use of
Combined MMR vaccine for
any indication11
 CDC: Potential additional
benefit of protection against
measles and mumps11
11. CDC MMRW 1998 ; 47: 2-6

11. MMR Vaccination
 The MMR vaccine prevents measles, mumps
and rubella**
 MMR Vaccine [PriorixTM - Measles, Mumps
and Rubella vaccine (live)] is highly
immunogenic after one dose, with reported
seroconversion rates of:
 98.7% for measles14
 95.5% for mumps14
 99.5% for rubella14
14. Priorix Prescribing information
** http://www.cdc.gov/vaccines/vpd-vac/measles/faqs-dis-vac-risks.htm

12. MMR Vaccination
recommendations
 2 doses for all older than 12 months
recommended by…
Indian Academy of Pediatrics#
Advisory Committee on Immunization
Practices/Centre for Disease Control &
Prevention**
American Academy of Pediatrics^^
** http://www.cdc.gov/vaccines/vpd-vac/measles/faqs-dis-vac-risks.htm
# IAP Guidebook, Committee on Infectious Diseases
^^Age for Routine Administration of the Second Dose of Measles-Mumps-Rubella Vaccine Committee on Infectious Diseases Pediatrics

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