Adverse Effects of Pertussis and Rubella Vaccines (1991) / Chapter Skim
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7 Evidence Concerning Rubella Vaccines and Arthritis, Radiculoneuritis, and Thrombocytopenic Purpura
7 Evidence Concerning Rubella Vaccines and Arthritis, Radiculoneuritis, and Thrombocytopenic Purpura
Pages 187-205
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From page 187... ...
Joint symptoms related to natural rubella or rubella vaccine usually begin within 1 week of the appearance of rash in wild-type rubella infection or within 10 to 28 days after immunization. The joints involved, in order of decreasing frequency, are fingers, knees, wrists, elbows, ankles, hips, and toes.
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From page 188... ...
In 1972, Spruance and colleagues reported recurrent joint symptoms in a group of children receiving one strain of rubella vaccine; however, it was not until the 1980s that more systematic investigation of the possible association of rubella vaccines with chronic arthritis was undertaken (e.g., Cunningham and Fraser, 1985; Tingle et al., 1983, 1985, 1986~. The lack of controlled studies, coupled with continued anecdotal reports of chronic arthritis following rubella vaccination (ABC News "20/20" report; J
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From page 189... ...
Occurrence of these reactions increases with age, and they are less frequent in men and prepubescent children. Rates of acute arthropathy and arthritis following rubella immunization differ by vaccine strain, with the HPV-77 (DK)
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From page 190... ...
Using data from this study and from 22 studies published elsewhere, the authors estimated the frequencies of joint symptoms following administration of the four different vaccine strains to be as shown in Table 7-1. The relationship of acute joint manifestations to age must be emphasized.
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From page 191... ...
Chronic Arthritis Case Reports and Case Series A case of acute arthritis following natural rubella that progressed to chronic arthritis was reported in 1968 by Martenis and colleagues, and it has been suggested that wild-type rubella virus might play a role in juvenile rheumatoid arthritis (Hart and Marmion, 1977; Martenis et al., 1968; Ogra et al., 1975~. These suggestions have raised concern that a possible similar progression of acute to chronic arthritis following rubella immunization might also occur.
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From page 192... ...
for 18 to 24 months after receipt of the RA 27/3 strain (Tingle et al., 1986~. As part of studies that began about a decade ago into the pathogenesis of the acute arthropathy following rubella immunization and the natural disease, Tingle and colleagues (1983)
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From page 193... ...
The patient was a 12-year-old boy who developed "juvenile rheumatoid arthritis" 2 years after receiving the vaccine. His HLA haplotype was B27, which has been associated with chronic arthritis.
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From page 194... ...
vaccine (Chantler et al., 1982~. In a separate study, rubella virus was isolated from mononuclear leukocytes from blood, synovial fluid, or both in 7 of 19 children with chronic arthritis of unknown cause (Chantler et al., 19851.
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From page 195... ...
Both acute arthropathy and acute arthritis are conditions whose diagnoses are reasonably reliable; thus, the vaccine exposure probably truly preceded onset of these adverse events in most cases. Although acute joint manisfestations can result from a number of different causes, their association with natural rubella infection and the recovery of rubella virus from the joint fluid of persons experiencing acute arthropathy or arthritis support the biologic plausibility of a relation with attenuated rubella virus vaccine.
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From page 196... ...
It is also difficult to establish whether the vaccination truly preceded the adverse event in many cases. The association of chronic arthritis with natural rubella infection and the recovery of a rubella virus from leukocytes from peripheral blood and synovial fluid of women with prolonged arthritis following rubella vaccination suggest, however, a biologically plausible relation between rubella vaccine and chronic arthritis.
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From page 197... ...
and chronic arthritis in adult women, although the evidence is limited in scope and confined to reports from one institution.2 Prospective, double-masked, controlled trials in which subjects are followed for at least 12 months after rubella vaccination are needed to establish this biologically plausible relation. Additional elements of a definitive study would include attempts to isolate rubella virus from the synovial fluid of affected joints of cases of arthropathy and arthritis and molecular-genetic analysis to determine whether the isolated strain is the one that was injected, a strain derived from the injected strain, or an unrelated strain.
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From page 198... ...
following rubella vaccination. Three of these occurred after receipt of the RA 27/3 strain (MortonKute, 1985; Tingle et al., 1985~.
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From page 199... ...
Three cases have been reported after administration of this vaccine strain. Evidence for biologic plausibility consists of the observation that radiculoneuritis and other neuropathies can occur, though uncommonly, after natural infection with wild-type rubella virus.
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From page 200... ...
The Meruvax II (Rubella Virus Vaccine Live, Merck Sharp & Dohme) package insert states, "In view of the decreases in platelet counts that have been reported, thrombocytopenic purpura is a theoretical hazard," but it also cites no evidence for this statement (Merck Sharp & Dohme, West Point, Pennsylvania)
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From page 201... ...
The relation is biologically plausible because thrombocytopenic purpura is believed to occur rarely as a complication of natural rubella infection. Conclusion There is insufficient evidence to indicate a causal relation between the currently used rubella vaccine (RA 27/3)
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1980. Cell-mediated immune responses in patients with recurrent arthritis following rubella immunization.
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From page 203... ...
1966. Thrombocytopenic purpura following rubella infection in children and adults.
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From page 204... ...
1973. Intermittent arthritis following rubella vaccination: a three year follow-up.
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From page 205... ...
1980. Clinical and laboratory studies of live attenuated RA 27/3 and HPV 77-DE rubella virus vaccines.
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