Surveillance of congenital rubella in Great Britain, 1971-96
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7186.769 (Published 20 March 1999) Cite this as: BMJ 1999;318:769
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Dear Sir
Tookey and Peckham1 are mistaken in stating that current guidance is
that all pregnant women with suspected (rubella) symptoms or exposure
should only be offered diagnostic investigation in the first four months
of pregnancy. In fact, the current Department of Health guidance2 that
they
refer to places no such time limit on the need for appropriate
investigation.
The point is important because without appropriate investigation,
rubella can be mistaken for parvovirus B19 infection, and maternal
parvovirus B19 infection is associated with foetal loss beyond the first
four months of
pregnancy3.
AJL Turner
Consultant Virologist
Newcastle Public Health Laboratory
Newcastle General Hospital
Newcastle upon Tyne NE4 6BE
1 Tookey PA, Peckham CS. Surveillance of congenital rubella in Great
Britain, 1971-1996. BMJ 1999;318: 769-770.
2 UK Health Departments. Immunisation against Infectious Disease.
London:HMSO, 1996.
3 Public Health Laboratory Service Working Party on Fifth Disease.
Prospective study of human parvovirus B19 infection in pregnancy. BMJ
1990;300: 1166-1170.
Competing interests: No competing interests
Pat Tookey and Catherine Peckham's article on the incidence of
Congenital Rubella Syndrome (CRS) in the UK since the introduction of the
rubella vaccine leaves out one very important point; in an age when
abortion is cheap and available, the fact that there has been a decline in
the number of babies born with CRS does not necessarily mean that there
are fewer babies being affected - simply fewer being born.
According to the Lancet (1/1/83 p 39),
"In the UK, there has been, as predicted, little change in the
secular trend of rubella occurence. Two sizable epidemics occurred in
1969-81 with substantial increases in the number of infants born with
congenital rubella syndrome and in the number of therapeutic abortions for
rubella infections."
Until these researchers take the time to include the number of
therapeutic abortions performed as a result of rubella exposure in
pregnant women, they are only telling half the story.
Meryl Dorey,
President
The Australian Vaccination Network
Competing interests: No competing interests
Re: Only Half The Story
These researchers did take the time to include the number of
therapeutic abortions performed as a result of rubella exposure in
pregnancy. As reported in the paper, rubella terminations in England and
Wales averaged 742 per year 1971-1975 and nine per year 1991-1995 (data
from ONS). The decline in abortions due to rubella exposure has been even
more dramatic than the decline in reported cases of congenital rubella.
Competing interests: No competing interests