High seroprevalence of rubella in Thai children with a 2-dose MMR national immunization policy

Abstract

Rubella is generally a mild disease, but infection during pregnancy can cause congenital rubella syndrome. Thailand has implemented a two-dose MMR vaccination policy since 2010. This study aimed to describe the seroprevalence rate of rubella among children and adolescents in Thailand. We conducted a cross-sectional study of 132 healthy children (aged 3–9 years) who had received 2 doses of rubella vaccine and 424 adolescents (aged 10–18 years) who were expected to receive at least 1 dose of rubella vaccine. Stored serum samples from healthy children and recently drawn serum samples from adolescents were tested for rubella IgG antibody using a commercial enzyme-linked immunosorbent assay (ELISA) kit (EUROIMMUN). Seroprotection was defined as a rubella IgG level ≥ 10 IU/mL. The rubella seroprevalence rate among children and adolescents who had 2 documented doses of MMR was 97.0% (95 %CI 92.5–99.2%) and 85.4% (95% CI 78.8–90.6%, p < 0.01) respectively. The geometric mean titer of rubella was higher in children, 38.3 (95% CI 33.5–43.9) compared to adolescents, 22.5 (19.4–25.9) IU/mL. We observed an inverse correlation between the rubella titer and time interval from the second rubella containing vaccine dose (R = -0.30, p < 0.01). A 2-dose MMR vaccination course produces a high seroprevalence of rubella immunity in children, which decreases with time, suggesting waning of immunity.Thai clinical trials registry number TCTR20191120001.