Safety profile of rubella vaccine administered to pregnant women: A systematic review of pregnancy related adverse events following immunisation, including congenital rubella syndrome and congenital rubella infection in the foetus or infant

Mangtani, Punam; Evans, Stephen; Lange, Berit; Oberle, Doris; Smith, Julianna; Drechsel-Baeuerle, Ursula; Keller‐Stanislawski, Brigitte

doi:10.1016/j.vaccine.2019.11.070

Cited by 16 publications

(8 citation statements)

References 42 publications

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“…The overall reported safety of rubella vaccine continues to be good in normal women and children, including pregnant women (in whom the vaccine is nevertheless contraindicated). Remarkably, although contraindicated, the RA27/3 vaccine strain in pregnant women does not cause CRS, despite the occasional transmission of virus to the fetus [ 47 ]. As a live virus vaccine, it is contraindicated in subjects with impaired immunity, which could allow the virus to persist despite vaccination [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Rubella Eradication: Not Yet Accomplished, but Entirely Feasible

Plotkin¹

2021

The Journal of Infectious Diseases

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Rubella virus is the most teratogenic virus known to science and is capable of causing large epidemics. The RA 27/3 rubella vaccine, usually combined with measles vaccine, has eliminated rubella and congenital rubella syndrome from much of the world, notably from the Western Hemisphere. Except in immunosuppressed individuals, it is remarkably safe. Together with rubella vaccine strains used in China and Japan, eradication of the rubella virus is possible, indeed more feasible than eradication of measles or mumps.

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Section: Discussionmentioning

confidence: 99%

Rubella Eradication: Not Yet Accomplished, but Entirely Feasible

Plotkin¹

2021

The Journal of Infectious Diseases

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“…LAV are burdened by the risk of transplacental vaccine-virus/bacterial infection. Furthermore, data regarding LAV safety during pregnancy are limited due to the exclusion of pregnant women from clinical trials ( 134 ).…”

Section: Maternal Vaccination In Clinical Practicementioning

confidence: 99%

“…The risk to develop CRS is higher if rubella infection occurs in the first 12 weeks of gestation. Live attenuated rubella vaccines, licensed since the late 1960s and available for childhood immunization program in several countries, alone or in combination with measles, mumps and varicella vaccines, have lead to a notable reduction in the CRS cases ( 134 ).…”

Section: Maternal Vaccination In Clinical Practicementioning

confidence: 99%

“…The same is true for other studies in which no cases of CRS have been detected following accidental rubella immunization ( 140 , 141 ). In a systematic review recently published by Mangtani et al the maximum theoretic risk of CRS following accidental vaccination in pregnant women has been estimated to be 0.099% ( 134 ). Despite these data, vertical transmission of this attenuated vaccine virus has been detected ( 142 ) and some infants can develop a completely asymptomatic vaccine-virus infection ( 134 ).…”

Section: Maternal Vaccination In Clinical Practicementioning

confidence: 99%

“…Specific studies regarding the safety of mumps and measles vaccines in pregnant women are lacking, yet no evidence of a higher risk of congenital malformations and spontaneous abortion has been demonstrated ( 134 ). Similarly, no case of congenital varicella syndrome has been reported in a study conducted on 981 women inadvertently exposed to varicella vaccine ( 143 ).…”

Section: Maternal Vaccination In Clinical Practicementioning

confidence: 99%

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The Protective Role of Maternal Immunization in Early Life

et al. 2021

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With birth, the newborn is transferred from a quasi-sterile environment to the outside world. At this time, the neonatal immune system is inexperienced and continuously subject to a process of development as it encounters different antigenic stimuli after birth. It is initially characterized by a bias toward T helper 2 phenotype, reduced T helper 1, and cytotoxic responses to microbial stimuli, low levels of memory, and effector T and B cells and a high production of suppressive T regulatory cells. The aim of this setting, during fetal life, is to maintain an anti-inflammatory state and immune-tolerance. Maternal antibodies are transferred during pregnancy through the placenta and, in the first weeks of life of the newborn, they represent a powerful tool for protection. Thus, optimization of vaccination in pregnancy represents an important strategy to reduce the burden of neonatal infections and sepsis. Beneficial effects of maternal immunization are universally recognized, although the optimal timing of vaccination in pregnancy remains to be defined. Interestingly, the dynamic exchange that takes place at the fetal-maternal interface allows the transfer not only of antibodies, but also of maternal antigen presenting cells, probably in order to stimulate the developing fetal immune system in a harmless way. There are still controversial effects related to maternal immunization including the so called “immunology blunting,” i.e., a dampened antibody production following infant's vaccination in those infants who received placentally transferred maternal immunity. However, clinical relevance of this phenomenon is still not clear. This review will provide an overview of the evolution of the immune system in early life and discuss the benefits of maternal vaccination. Current maternal vaccination policies and their rationale will be summarized on the road to promising approaches to enhance immunity in the neonate.

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