DEAR DR. DONOHUE: My wife is due with our child in less than three weeks. She was told she has no resistance to German measles. The doctor says she needs a shot after the baby is born, and she cannot be nursing when she gets it. How prevalent are the German measles? Is the shot really necessary? – Anon.

ANSWER: German measles – rubella – was once a very common illness, striking mostly children. Prior to the rubella vaccine, more than 57,000 cases occurred annually. In 2004, there were only nine reported cases of it, and they were cases imported from other countries. The Communicable Disease Center says that rubella has been eliminated from the United States. The vaccine deserves credit for this.

Rubella enlarges lymph nodes and produces a red rash that starts in the face and moves down the body. For most children it is a mild illness.

Pregnant women face the greatest danger from rubella infection, as their fetus can be infected. Miscarriage is one possible outcome of such an infection. Congenital defects in the newborn are another possibility. Those defects include deafness, cataracts, heart defects and mental retardation.

Because there is live virus in the vaccine, it cannot be given to pregnant women. Since the vaccine’s appearance in 1969, it has inadvertently been given to hundreds of pregnant women without their babies having any defects. The theoretical risk is still there, however, so no chance can be taken by giving it during pregnancy.

The virus can find its way into breast milk and infect nursing babies. The manufacturer says that caution should be exercised when the vaccine is administered to nursing mothers. I take that to mean they should not get it.

As long as rubella exists in other countries, vaccinations have to continue, and unprotected women should receive the vaccine when they are not pregnant and not nursing.

DEAR DR. DONOHUE: My sister is 48, and I am 49. Last fall my sister’s doctor told her that she is diabetic. Last week, I was told I am diabetic. There has been no diabetes in our family, but we do have a history of pancreatic cancer. Our mother died of this cancer, but she did not have diabetes. My sister is worried that diabetes might be a prelude to pancreatic cancer. Will you give us your opinion and tell us the warning signs of this cancer? – T.T.

ANSWER: The warning signs of pancreatic cancer are so vague that most people pay little attention to them. It’s a very sneaky and silent cancer. By the time people have dull, gnawing stomach pain, the cancer has usually gotten quite large. The pain is centered in the middle of the stomach, and it often bores through to the back. Weight loss is another symptom.

Later, if the cancer blocks the drainage duct for bile – and it often does so -the skin and whites of the eyes turn yellow, and stools become the color of clay.

The abrupt onset of diabetes in a previously healthy person is a sign of pancreatic cancer, but it is not a common sign. Only about 10 percent of patients with pancreatic cancer have a mother, father, sister or brother who had it. The genetic influence is not strong.

DEAR DR. DONOHUE: I am a 67-year-old female in excellent health and on no medications. If I continue to eat a well-balanced diet, is there any value in adding vitamins to my diet? – S.L.

ANSWER: It is possible and desirable that diet provides us with all the minerals and vitamins that we need. However, quite a few people, particularly older people, do not get such a diet. For those people, a multivitamin is strongly recommended.

The only vitamin that you might need an extra boost of is vitamin D. It’s not found naturally in many foods. We get most of it from foods fortified with it. Dairy products and cereals are two such foods. We also get vitamin D from the action of sunlight on the skin. People in northern climates don’t get enough sunlight in the winter to effect this change, and many don’t get any sunshine in the summer, either.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com