The Ferrari Lab

Amidst the discussion of measles reestablishment in the US, the risk of rubella provides an instructive example of long-term delayed consequences that could resonate for decades ... or be stopped by coming to our senses 1/

Rubella virus infection is generally mild in kids and adults. But infection during early pregnancy can cause serious developmental outcomes called congenital rubella syndrome (CRS) in developing fetus -- loss of pregnancy, deafness, blindness, heart defects, intellectual impairment 2/

Thankfully, in the US, most people are vaccinated against rubella (the R in MMR) AND rubella virus is eliminated so those who are not unlikely to be exposed in the ~3m window of risk in early pregnancy 3/

Declining vaccination rates increase the number of pregnancies that could be at risk* and reestablishment of rubella increases the likelihood of exposure during the 1st trimester *but the thing is this would take years manifest before unvaccinated kids mature to reproductive age, in the US >20y 4/

Unvaccinated pregnancies would be immediately at risk, but those are currently few. The real risk is out two decades as kids born in a more vaccine hesitant world mature, get pregnant, and are exposed 5/

CRS is notoriously hard to diagnose and monitor because it requires connecting outcomes in a baby to a mild infection in mom ~6 months prior to birth. Rubella continues to circulate in places where low resources limit diagnostic confirmation during pregnancy 6/

But in the US, we have the resources and capability to tell folks they've been infected with a virus that could lead to devastating consequences for their pregnancy. Thankfully, we don't have to do so because vaccines protect individuals end elimination protects the population 7/

The actress Gene Tierney contracted rubella from an eager fan early in her pregnancy in 1943. Her daughter was born deaf, blind, and with intellectual deficiencies that required institutional care her whole life. Tierney suffered severe depression as a result 8/

And Agatha Christie wrote "The Mirror Crack'd from Side to Side" about a woman who suffered the same fate as Gene Tierney, later to murder the fan who had infected her with rubella 9/

Rubella is mild and its return could be easily overlooked. CRS is catastrophic and looms on the horizon. Modern diagnostics man that physicians would have to counsel mothers on carrying to term a pregnancy that carries significant risks. This is the entirely reversible course we're on 10/

Our actions today to turn away from established and effective prevention will doom our grandchildren to a future shouldering risks and burdens that we've forgotten the weight of /end