Abstract
BackgroundCountries of the Americas have been working towards rubella elimination since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009. To contribute towards monitoring of rubella elimination, we assessed rubella seroprevalence among prenatal screening tests performed in Ontario.MethodsSpecimens received for prenatal rubella serologic testing at the Public Health Ontario Laboratory, the provincial reference laboratory, between 2006 and 2010 were analyzed. A patient-based dataset was created using all tests occurring among 15–49 year-old females, where prenatal screening was indicated. Multiple tests were assigned to the same patient on the basis of health card number, name and date of birth. Only unique tests performed at least nine months apart were included. SAS version 9.2 was used for analysis.ResultsBetween 2006 and 2010, we identified 459,963 women who underwent 551,160 unique prenatal screening tests for rubella. Of these, 81.6%, 17.1% and 1.4% had one, two and three or more tests respectively.Rubella immunity remained stable at approximately 90% overall; the proportion of susceptible women was 4.4%. Additionally, 0.6% of women were initially susceptible and subsequently developed immunity. Across the province, susceptibility was highest in the north and declined with increasing age (p < 0.0001). Among women with multiple tests, the proportion who remained susceptible declined as the number of years between tests increased (p < .0001). Based on age at first test, younger women had the highest susceptibility (4.2% among 15–19 year-olds) and were significantly more likely to develop immunity if previously susceptible (p < .0001).ConclusionRubella susceptibility among prenatal women in Ontario supports elimination goals as population immunity in this group is relatively high. Higher susceptibility among young women and women living in the north highlights an opportunity for greater focus on identification and immunization of susceptible women in these groups.
Highlights
Countries of the Americas have been working towards rubella elimination since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009
Countries of the Americas have been working towards the goal of eliminating rubella and congenital rubella syndrome (CRS) since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009 [1,2]
The objectives of our study are to determine rubella susceptibility in a sample of prenatal rubella screening tests conducted in Ontario; to identify demographic factors associated with non-immune rubella titres and contribute towards monitoring of rubella elimination in Ontario and Canada
Summary
Countries of the Americas have been working towards rubella elimination since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009. Countries of the Americas have been working towards the goal of eliminating rubella and congenital rubella syndrome (CRS) since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009 [1,2]. With the guidance of a Plan of Action from the Pan American Health Organization (PAHO), member states are currently documenting and verifying interruption of endemic rubella virus transmission in their respective jurisdictions [2]. Introduced in 1975, it has been administered as part of a one-dose schedule of the combined measles, mumps, rubella (MMR) vaccine. As of August 2011, the second dose is administered as a combined measles, mumps, rubella and varicella (MMRV) vaccine among 4–6 year olds. In Ontario, as legislated by the Immunization of School Pupils Act, immunization with at least one dose of rubella-containing vaccine is required for school attendance, unless a valid medical exemption or statement of religious or conscientious objection is provided
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