Congenital rubella syndrome one reason vaccines remain critical

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I have been following all the concerns about exposure to measles but have not seen anything mentioned that it is dangerous for pregnant women to be exposed. In 1966, doctors felt that I was exposed during my third month of pregnancy, and our daughter was born with severe brain damage. The child of another woman in our community was born deaf because she also had measles. Is this no longer a concern? — P.S. ANSWER: I am very sorry to hear about it, even so many years later. Having a child with major health issues is an immense strain on a family. Measles (rubeola) certainly is very dangerous for pregnant women. There is a high risk for pneumonia and encephalitis (brain swelling). Sixty percent of pregnant women exposed to measles will have a bad outcome to themselves or their baby, and 12% of women died. However, I suspect you were more likely exposed to rubella, also called German measles, which is even more dangerous to the developing fetus, although it is a very mild illness to the mother. Before the vaccine was introduced in 1969, rubella was a feared infection in mothers. In a major outbreak in 1964, there were 12.5 million cases in the U.S., with 11,000 fetal deaths and 20,000 cases of congenital rubella syndrome. By contrast, between 2001 and 2004, there were 13 cases per year of rubella reported, with less than one case per year of congenital rubella syndrome, on average. The effects of congenital rubella syndrome can be devastating. Severe brain injury is most common when the developing fetus is exposed in the first three months, as your daughter was. Deafness occurs in about twothirds of those born with congenital rubella syndrome. Virtually every organ may be affected. Two doses of rubella vaccine are 97% effective. Successful vaccination means that neither a pregnant woman nor her fetus will be affected even if exposed. However, the 3% of women in whom the vaccine is not effective and those who cannot or will not get the vaccine are at risk for this devastating complication if exposed to a person with rubella, which is highly infectious for one to two weeks during which the person with rubella may have no symptoms. Congenital rubella syndrome is another reason why it is so critical to maintain high compliance with the MMR vaccine, which covers measles, mumps and rubella. *** DEAR DR. ROACH: I’ve been told I have ataxia.What is it? — R.M. ANSWER: Ataxia is a particular type of loss of muscular coordination. In adults, ataxia is generally caused by damage to the cerebellum, a large structure in the back of the brain that coordinates and regulates movement. Symptoms include loss of balance, loss of motor coordination, gait changes, slurred speech and difficulty swallowing. The diagnosis of ataxia is made by a careful physical exam done by an expert, such as a neurologist. There are many specific causes (140 or so listed in my textbook), and so the time and acuity of onset is a big clue to help determine the cause. Ataxias can be associated with drugs and toxins: Alcohol is probably the most common I see, but I have seen ataxia with amiodarone for heart rhythms, with lithium and valium-like drugs, and with chemotherapy. There are many genetic or hereditary disorders with ataxia with variable ages of onset; the list includes mitochondrial diseases; infectious causes; circulatory problems, including stroke; trauma; tumors; autoimmune diseases; and degenerative neurological diseases. There are a few treatable conditions to consider, including celiac disease, hypothyroidism and deficiency of vitamin E, B12 or thiamine. Wilson’s disease, an accumulation of copper, is yet another cause.