Rubella vaccination: fertility control in a large-scale vaccination program for postpubertal women

Elective termination of pregnancy after vaccination reported to the Vaccine Adverse Event Reporting System (VAERS): 1990-2006

Generally, live-virus vaccines are contraindicated for pregnant women because of the theoretical risk of transmission of the vaccine virus to the fetus. Advisory groups recommend avoiding pregnancy in the immediate period after administration of such contraindicated vaccines (CVs) and stress benefit-to-risk evaluation for live or inactivated vaccines regarding pregnancy. Given the limited available data and theoretical risks associated particularly with live-virus vaccines, inadvertent immunization with CVs may lead to elective termination of pregnancy (ETP), despite advisory group statements that "vaccination is not ordinarily an indication to terminate the pregnancy." The Vaccine Adverse Event Reporting System (VAERS), a national passive surveillance system managed by the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), accepts reports of adverse events after vaccination. The objectives of this review were to describe reports of ETP in VAERS and characterize the circumstances of inadvertent administration of vaccines to pregnant women among ETP reports. We reviewed VAERS reports of ETP submitted from 1990 to 2006. Reports of ETP for reasons other than vaccination during or shortly before pregnancy, such as fetal abnormalities or deaths, were excluded. Of 80 ETP reports, 62 (78%) originated from the US; 79 (99%) were reported by manufacturers. Median age of vaccinees was 26 years (range: 13-43 years; 67 reports). Seventy-three vaccinees (91%) received a single vaccine; 65 (81%) received at least one live-virus vaccine. In 48 (60%) ETP reports, vaccinees were unaware of pregnancy at time of immunization. In 15 (19%) reports, vaccinees became pregnant within 3 months of vaccination; in 13 (16%) reports, vaccinees might have been pregnant before vaccination; in 4 (5%) reports, information was missing. All 80 reports of ETP involved vaccines for which possible effects on fetal development are unknown. However, no cases of vaccine-associated congenital rubella or varicella syndromes have been reported in the medical literature. Also, these syndromes have not been reported to varicella or rubella vaccine pregnancy registries. VAERS has the limitations of passive surveillance systems. Under-reporting of ETP in VAERS could be substantial. More attention may be needed to assess the likelihood of pregnancy when administering vaccines to women with child-bearing potential, and to inform women who learn they are pregnant shortly after being immunized of current information on risks. Quantifying the frequency of ETP related to CVs and the risk (if any) to the fetus of such vaccines can help to inform policy, practice, and individual decision making. Good quality information may be obtained from controlled observational studies.

Implications of rubella susceptibility in young adults

Rubella history and antibody titre were determined for 457 medical, graduate, and physician assistant students. Eighteen per cent were estimated at risk for rubella. There were no male-female differences. Health-profession students did not differ in rubella immune status from the general population. History was not helpful in assessing immune status. Approximately one-half of persons with low antibody titres had considered themselves immune, while one-half with moderate to high antibody titres had considered themselves at risk. Less than one-half of students with low antibody titres available themselves of immunization which was recommended and offered. With a high percentage of adult females at risk for rubella even in a health-motivated population and with poor follow-up on recommended immunization, current immunization practices must be improved if congenital rubella syndrome is to be further reduced. Mass inoculation of school age males and prepubertal school age females without prior determination of rubella antibody titres is suggested as a cost-effective means of decreasing incidence of congenital rubella syndrome.

[Fetal lung maturity in differen abnormal pregnancies (author's transl)]

The influence of pathological situations to fetal lung maturation during the last 9 weeks of pregnancy was studied. Lung maturity was determined by four different methods, analyzing the concentration of surfactant in amniotic fluid L/S ratio was measured planimetrically and densitometrically, foam test and surface tension of the liquor amnii were used on this purpose. 89 normal pregnancies for obtaining normal values served as a basis for comparison with pathological events. A general retardation of fetal lung maturity showed 26 patients with rhesus isoimmunization so as 26 patients with diabetes classes A, B and C (White). In three pregnancies complicated by diabetes class D a remarkable acceleration of fetal lung maturity was obvious. 30 patients with placental insufficiency sui generis presented a very inhomogenous development of the fetal lung, whereas in 35 patients with EPH-gestosis a minute acceleration between 33th and 37th week of gestation was found. A good correlation between all of the used methods for measuring the concentration of surfactant was noted. Best reliability in correct prediction of lung maturity showed the method of measuring the surface-tension of the amniotic fluid.