MMR

1. case
Done by :Dr. Raya al-Harthi
FMR4

2.  Fatema is 30 yrs old lady came asking
came for MMR vaccine .
 No complain today
 PMH :nil
 LMP :2wk back
 Would you give the MMR today?
 Nurse ask her to come with next period to
make sure that she is not pregnant

3.  As MMR is CI during pregnancy HOW
can we make sure theptis not pregnant??

4.  She came during her day 4 of the period .
 MMR was given .
 counseld not to conceive for the next 4 wks
 5 wks later came anxious as she missed
her period and UPT +ve .
 She read about MMR and congenital
malformation in rubella .

5.  Rubella infection in a susceptible (non-
immune)woman during the months of pregnancy
can lead to congenital rubella syndrome (CRS)in
the neonate.
 the congenital anomalies risk is :
 85% if maternal infection occurs during the first 12
wks .
 54% if infection occurs duringweeks 13–16,
 25% if infection occurs at the end of the second
trimester

6. Vaccine risk in pregnacy

9.  In the Islamic Republic of Iran, a study identified
117rubella-susceptible women who had been
inadvertently vaccinated during pregnancy.
 All had normal pregnancies and deliveries, without
evidence of CRS over a 6-monthfollow-up period.
 Cord blood from 35 subjects was tested for anti-
rubella IgM and two (5.7%) were positive.

10.  In several studies, rubella vaccine-like virus
has been isolated from the products of
conception, obtained from women who had
been inadvertently vaccinated with rubella
vaccine during pregnancy and subsequently
experienced a spontaneous or induced
abortion

11.  Vertical transmission of the vaccine virus
determined by nucleotide sequence analysis
from the susceptiblemother to foetus was
demonstrated in 2000 .
 The infection of the foetus did not result in a
congenital defect.

12. Conclusion

13.  Reference
 World Health Organization 2014,Safety of
Immunization during Pregnancy – A review of
the evidence