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The present study documents the relationship between the development of rubella vaccine-associated arthropathy and isotype-specific rubella antibody responses in a prospectively studied population of 44 adult rubella hemagglutination inhibition (HAI) seronegative females undergoing rubella immunization. Rubella-specific IgM, IgG, and IgA antibody responses were evaluated prior to and at 1, 2, 3, 4, 5, 6, 12, and 24 weeks postvaccine. Detectable preimmunization rubella antibody of the IgG or IgA class was present using ELISA techniques in 6 of 6 individuals developing acute arthritis, 13 of 17 developing acute arthralgia, and in 15 of 21 with no joint manifestations postvaccine. Significantly elevated HAI IgM responses were noted 3 and 4 weeks postvaccine in the acute arthritis group but no significant differences were found in IgG and IgA rubella antibody levels postvaccine in relation to the presence or absence of joint manifestations at any time period postvaccine. The data support rubella reinfection as an important feature of rubella vaccine-associated arthropathy but do not support a role for quantitative differences in rubella IgG and IgA antibody in the pathogenesis of this syndrome.

Six women developed chronic long-term arthropathy after postpartum immunization against rubella. All individuals developed acute polyarticular arthritis within 12 days to three weeks postimmunization and have had continuing chronic or recurrent arthralgia or arthritis for two to seven years after vaccination. Acute neurological manifestations, consisting of carpal tunnel syndrome or multiple paresthesiae, developed postvaccination in three women. Two have developed continuing active or chronic recurrent episodes of blurred vision, paresthesiae, and painful limb syndromes together with recurrent joint symptoms. Chronic rubella viremia has been detected in peripheral blood mononuclear cell (MNC) populations in five of the six women up to six years after vaccination. In addition rubella virus was isolated from breast milk MNCs in one individual at nine months postvaccination and from peripheral blood MNCs in two of four breast-fed infants studied at 12-18 months of age. Immune responses to rubella virus studied at sequential intervals after vaccination correlated with development of rheumatologic and neurological manifestations.