I received a call from a good friend of mine this week. We both found out we were pregnant earlier this year and are due within a few weeks of each other. We have different doctors and we like to talk about what’s going on with our growing bellies and ask each other questions. Her particular question during this phone call was about some paperwork she had received to get a rubella inoculation after she delivers her baby. She had been immune to the disease with her last baby in July 2007, but had tested not immune during this pregnancy. Knowing that I am passionate about knowledge of immunizations, she wanted to know what I knew about this one.
I have to admit I didn’t know much. I knew that pregnant women are screened for rubella immunity during their initial blood workup at the beginning of their pre-natal care. I knew that if you are not immune, you cannot get the shot during pregnancy and I knew that if you catch rubella during the first trimester it would most likely lead to miscarriage or severe birth defects. But by the time we were having this conversation she was 37 weeks along and out of the woods for risks. I told her that I also knew that without exposure to foreign people or international travel, her chances of catching rubella were slim to none since it is all but dead here in the US. And even if she did catch it the symptoms were mild, even in children, and would go away in about a week. The other facts that I was pretty sure of was that she would have to get the MMR shot since the vaccine’s manufacturer stopped making separate doses for measles mumps and rubella. And if she was planning to breastfeed there was a good chance that it would be in her milk. I also advised her to use caution with this since the MMR is the shot most widely accused of causing autism and it could be very dangerous to expose a newborn baby to that vaccine so early.
After we spoke, I felt compelled to do delve deeper into this subject. Not only did I want to give her more reliable info, but I was also a little curious myself. The first thing I came across was a FAQ page on the Center of Disease and Control website. http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmr/faqs-mmr-hcp.htm. It states that if a pregnant woman had a positive rubella titer (been immune) in the past, and now has a negative rubella titer (not immune), she would not need another MMR vaccination. Their reasoning was that even though her immune level was not detectable by the screening, in almost every case there is still enough immunity there to keep her from being susceptible to catching rubella. I was a little dismayed. The CDC is the entity that decides who needs what vaccinations when and on their Web site they clearly stated that my friend did not need another MMR shot. Yet her doctor was giving her papers to get one anyway. I also found out that rubella immunity is measured in titers. If your titers are 10 or above you are considered immune. If your titers are 9.5 your doctor will tell you that you need an MMR after delivery. I also found many women writing about their experiences of practically being forced to get the shot before they were allowed to leave the hospital.
Next, I looked to see if there were any studies about the affects a maternal rubella vaccination could have on her baby. There has been only one study done. It was conducted by a pediatrician named F. Edward Yazbak and linked here: http://www.jpands.org/hacienda/yazbak.html. He identified 60 rubella-susceptible mothers who were re-vaccinated in the postpartum period with either the MMR or the monovalent rubella vaccine and whose children later received MMR vaccine. Forty-five of these women have children diagnosed with autistic spectrum disorder (ASD); another 10 women have children with autistic symptoms, ADD/ADHD or other developmental delays; and 4 women have children with other health problems, mostly immunologic. Only one woman’s child was unaffected and in her case she did not breastfeed at all or have subsequent pregnancies. The doctor admits that this is not the large scale study that it should be, but that the appropriate study is not feasible in the US because of government mandates. He also goes on to say that even the rare occurrence of such severe effects warrant careful consideration of the current practice of post-partum rubella vaccinations. Here is an article that has a little background on Dr. Yazbak and how he got into this study: http://www.vaclib.org/email/autismom.htm
I called my friend and told her to print out the information at the CDC website and show it to her OB and tell him that she did not want this immunization. But it still scares me that this is common practice in many OB/GYN offices across the country. And it teaches us as patients to do a little bit of research before blindly following orders, even if that research goes no further than the CDC website.
(Photos By: Teresawer and Torsten)
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