Pregnancy is contraindication for rubella vaccination still

EDITOR—Some of the statements in Josefson's news report of the Canadian study on inadvertent rubella vaccination in pregnancy might mislead a British audience.1 Since 1990 the Department of Health for the United Kingdom has advised that conception should be avoided for one month, rather than three months, after rubella vaccination. Furthermore, termination of pregnancy is no longer recommended even if vaccination does occur shortly before conception or during pregnancy.2 This was in the light of data collected in the United States, Germany, Sweden, and the United Kingdom, in which the outcome of pregnancies affected by inadvertent rubella vaccination was monitored.3

In England and Wales fewer than 40 terminations associated with rubella vaccination have been reported over the past 10 years, compared with over 400 in the previous 10 years.4 Over 100 live born infants have been reported to the rubella vaccination in pregnancy study, which is part of the national congenital rubella surveillance programme; 60% of their mothers were known to be susceptible to rubella at vaccination. No infant has been reported with congenital rubella syndrome. Nevertheless, among 25 tested infants whose susceptible mothers were vaccinated more than one week after conception, four had rubella immunoglobulin M at birth. Although it is reassuring that no child has been born with symptoms attributable to congenital rubella infection, it is quite another matter—and not appropriate—to suggest that rubella vaccine is safe in early pregnancy.