William C. Marshall

Clinical and laboratory studies with rubella vaccines in adults.

Three live attenuated rubella vaccines were tested in adult volunteers. Clinical reactions were mild, but were more noticeable in vaccinated non-immune subjects than in control subjects. With the exception of two individuals, all of the remaining 54 subjects developed an immune response; the level of antibodies found was somewhat lower than that resulting from natural infection. Though virus could be isolated from some of the seronegative volunteers after vaccination, no evidence was found of transmission of infection.

Congenital rubella deafness: a preventable disease.

Over a 4-year period (1972-75) an unselected sample of 568 children aged under 4 years attending the Nuffield Hearing and Speech Centre were tested for rubella antibody. Sensorineural deafness was subsequently diagnosed in 349 of these children, and 83 (24%) of this group had rubella antibody. In contrast, only 19 (9%) of the remaining 219 children in whom sensorineural deafness was excluded had rubella antibody. The seropositive and seronegative children with sensorineural deafness showed striking differences in family history, history of maternal rubella, adverse perinatal events, and presence of other defects. Congenital rubella is an important cause of deafness, and the rubella vaccination programme must be pursued more vigorously if this serious defect is to be prevented in the future.

Rubella vaccination of schoolgirls: factors affecting vaccine uptake.

In a national sample of 16-year-old girls who were aged 12 when the rubella vaccine programme was implemented in 1970, 71% were reported to have received rubella vaccine. There was a high regional disparity in the uptake of rubella vaccine: 81% of girls living in Scotland had been vaccinated but only 61% of girls living in Wales. Similarly there was a difference in reported vaccine uptake according to the family social background, the lowest proportion vaccinated came from professional and unskilled manual families. Girls attending independent schools also had a lower vaccine uptake than girls in schools maintained by the local educational authorities. If rubella immunisation is to be effective uptake of vaccine must increase to almost 100%.

TRANSFER-FACTOR TREATMENT IN CONGENITAL CYTOMEGALOVIRUS INFECTION

When two doses of transfer factor were given to three infants with congenital cytomegalovirus (C.M.V.) infection, urine cultures for C.M.V. became negative, briefly, after five of the six doses.

Immunological responses to early and late intrauterine virus infections.

Virological and immunoglobulin estimations were carried out in 4 groups of patients in which intrauterine infection was either established or suspected. In the congenital rubella group, persistence of rubella antibody was demonstrated in patients aged 4 to 16 years, and in a younger group aged 0 to 4 years antibody could be detected in all but one of the 21 patients. Increased levels of IgM were found in the majority during the first 6 months of life, with a tendency to fall from 4 to 6 months to levels within the normal range. IgM levels were also found to be raised in cases of congenital cytomegalovirus infection, but were not as high as in congenital rubella. Complement-fixing antibody to cytomegalovirus (CMV) was found in only a few patients, although virus was isolated from all of them. A high level of antibody and IgM at the upper limit of normal was found in one infant of 3 months of age exposed to maternal varicella in the first trimester. A raised IgM level was also found in a fatal case of neonatal varicella following maternal varicella shortly before birth. In a miscellaneous group of perinatal disease in which intrauterine infection was suspected, no specific evidence of viral infection could be established, but raised IgM levels for age were demonstrated in 3 of the 11 patients.

PARITY OF WOMEN CONTRACTING RUBELLA IN PREGNANCY: Implications with Respect to Rubella Vaccination

Data from the National Congenital Rubella Surveillance Programme showed that 44% of children with congenital rubella reported to the programme were born to primiparae. This high proportion is thought to be due to the fact that there was a two-fold increase in the rate of abortion for rubella in pregnancy for women with two or more children. This higher incidence of congenital rubella in firstborns emphasises the need for rubella vaccination prior to a womans first pregnancy.