Prevalence Of Serological Markers Research Articles

Acceptability, Feasibility, Drug Safety, and Effectiveness of a Pilot Mass Drug Administration with a Single Round of Sulfadoxine-Pyrimethamine Plus Primaquine and Indoor Residual Spraying in Communities with Malaria Transmission in Haiti, 2018.

For a malaria elimination strategy, Haiti's National Malaria Control Program piloted a mass drug administration (MDA) with indoor residual spraying (IRS) in 12 high-transmission areas across five communes after implementing community case management and strengthened surveillance. The MDA distributed sulfadoxine-pyrimethamine and single low-dose primaquine to eligible residents during house visits. The IRS campaign applied pirimiphos-methyl insecticide on walls of eligible houses. Pre- and post-campaign cross-sectional surveys were conducted to assess acceptability, feasibility, drug safety, and effectiveness of the combined interventions. Stated acceptability for MDA before the campaign was 99.2%; MDA coverage estimated at 10 weeks post-campaign was 89.6%. Similarly, stated acceptability of IRS at baseline was 99.9%; however, household IRS coverage was 48.9% because of the high number of ineligible houses. Effectiveness measured by Plasmodium falciparum prevalence at baseline and 10 weeks post-campaign were similar: 1.31% versus 1.43%, respectively. Prevalence of serological markers were similar at 10 weeks post-campaign compared with baseline, and increased at 6 months. No severe adverse events associated with the MDA were identified in the pilot; there were severe adverse events in a separate, subsequent campaign. Both MDA and IRS are acceptable and feasible interventions in Haiti. Although a significant impact of a single round of MDA/IRS on malaria transmission was not found using a standard pre- and post-intervention comparison, it is possible there was blunting of the peak transmission. Seasonal malaria transmission patterns, suboptimal IRS coverage, and low baseline parasitemia may have limited the effectiveness or the ability to measure effectiveness.

Comparative Analysis of the Vertical Risk of Transmission of Some Blood-Borne Infections in the Republic of Guinea

The aim of our work was to compare the HBV, HCV and HIV vertical transmission risk in the Republic of Guinea.Materials and methods. The material for the study was 305 blood plasma samples from pregnant women living in Conakry, Republic of Guinea. The samples were examined for the presence of serological (HBsAg, antibodies antiHBs IgG, anti-HBcore IgG, anti-HCV IgG, Ag/Ab-HIV) and molecular (HBV DNA, HCV RNA, HIV RNA) markers.Results and discussion. When assessing the overall prevalence of serological markers among patients, the incidence of HBV markers was 76.06 %. Antibodies to HCV were detected only in 1 case, which amounted to 0.32 %. HIV markers were detected in 3 cases, which amounted to 0.98 %. The prevalence of HBsAg in the group under examination significantly differed between the groups of pregnant women aged 13–19 years (17.33 %) and 20–24 years (12.12 %), p<0.0001, RR=5.107 with 95 % CI: 2.458–10.612. When assessing the overall prevalence of molecular-biological markers among patients, we did not detect HIV RNA, in one patient, HCV RNA was determined, which was 0.32 %, while the incidence of HBV DNA was 20 %. Among HBsAg-positive individuals, HBV DNA was detected in 86.11 %, which was 10.16 % of the total group. Among the HBsAg-negative individuals, HBV DNA was detected in 11.15 % (9.84 % of the total group). It should be noted that in nine cases, HBV DNA was detected without any serological markers, which amounted to 14.75 % (2.95 % of the total group). Assessment of the blood-borne infections prevalence in pregnant women is significant for the subsequent identification of pathogen transmission routes in order to control and/or prevent the spread of infection.

Exposure to hepatitis E virus in hemodialysis patients from west-central Poland.

Hepatitis E virus (HEV) causes travel-related but also locally acquired infections in industrialized parts of the world, including European countries. Food and blood transfusions are possible sources of transmission. Infections caused by zoonotic variants of the virus (particularly HEV-3) may progress to chronic liver disease in a nonnegligible proportion of immunocompromised people. The aim of this study was to assess the prevalence of serological markers of HEV infection in 189 patients on renal replacement therapy (RRT, currently on hemodialysis, HD) living in west-central Poland and to determine the factors related to HEV exposure in this group. Testing was carried out using commonly used commercial assays (Wantai Biological Pharmacy Enterprise Co, Beijing, China). Anti-HEV IgG was detected in 94 patients (49.7%); none of the participants had anti-HEV IgM or HEV Ag. Patients on RRT (HD) for less than 6 months were significantly more likely to be anti-HEV IgG-positive than dependent of RRT (HD) for more than half a year (80% vs 47%; P = .014). Exposure to HEV in patients from west-central Poland is frequent, but no clear sources of this infection have been identified. There were no serological features of ongoing liver disease caused by HEV in the study subjects.

Prevalence of Serologic Markers for Celiac Disease in China

Data are limited on the prevalence of autoimmune markers associated with celiac disease in China. To address this issue, investigators obtained samples

Hepatitis B virus strains from Rwandan blood donors are genetically similar and form one clade within subgenotype A1

BackgroundRwanda is a central African country with about 12 million inhabitants. The 1994 genocide against the Tutsi destroyed much of the infrastructure, including the health system. Although this has improved significantly, many challenges remain to be addressed. In this study, the prevalence of serological markers of past and ongoing hepatitis B virus (HBV) infection and HBV vaccine related immunity was investigated in samples from blood donors from all regions of Rwanda.MethodsThe results from hepatitis B surface antigen (HBsAg) analyses of all (45,061) blood donations collected countrywide in 2014 from 13,637 first time and 31,424 repeat blood donors were compiled. Samples from 581 HBsAg negative blood donors were selected for further analysis for antibodies against HBV, anti-HBs and anti-HBc. Additional 139 samples from HBsAg positive donors were analyzed for HBeAg/anti-HBe (132 samples) and for HBV DNA. The S-gene was amplified by PCR, products sequenced, and phylogenetic analysis was performed.ResultsHBsAg was found in 4.1% of first time donors with somewhat higher prevalence among those from the Central and Eastern regions than from other parts of the country. Indications of past infection was found in 21% of the HBsAg negative donors, 4.3% had only anti-HBs suggesting HBV vaccination. HBeAg was detected in 28 (21%), anti-HBe in 97 (73%), and both HBeAg and anti-HBe in 4 of 132 HBsAg positive donors. HBV DNA was found in 85 samples, and the complete S-gene was sequenced in 58 of those. Phylogenetic analysis of the sequences revealed that all HBV strains belonged to subgenotype A1, and formed one clade in the phylogenetic tree. In addition, 12 strains from first time donors had a unique 18 amino acid deletion in the N-terminal part of the pre-S2 region.ConclusionThis study indicated that the prevalence of hepatitis B is intermediate in Rwanda and that the vaccination coverage is relatively low in young adults. All surveyed Rwandan blood donors were infected with similar subgenotype A1 strains, and a high frequency of those with anti-HBe had detectable HBV DNA. Several strains had in addition a unique pre-S2 deletion, the virulence of which needs to be further studied.

Prevalence of Serologic Markers and Risk Factors for Hepatitis B Virus among Pregnant Women in Brazzaville, Congo

Prevalence of Serologic Markers and Risk Factors for Hepatitis B Virus among Pregnant Women in Brazzaville, Congo

A study on confidential unit exclusion at Shiraz Blood Transfusion Center, Iran.

Background:Confidential unit exclusion (CUE) system has been designed to enhance transfusion safety as an extra additive approach.Aims:This study was designed to survey demographic characteristics, prevalence of serologic markers, and reasons of opting CUE.Materials and Methods:The cross-sectional study was performed at Shiraz Blood Transfusion Center (Southern Iran). CUE is used for all individuals who refer for blood donation, and donors can choose their blood not to be used if they have any doubt about their blood suitability for transfusion. The prevalence rate of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) was compared between the blood donors who opted into and out of CUE. Then, the donors were contacted to give another blood sample and the reasons of deferral. Researchers also determined whether their reasons were logical or not. Data were analyzed using comparison of proportions in MedCalc software 7.Results:Out of all the donors, 2365 ones (2.3%) opted for CUE. CUE was more frequent among men, singles, donors with low education levels, between 18 and 25 years old, and with history of previous donation (P < 0.05). The prevalence rate of HCV was higher among the donors who opted for CUE (P < 0.05), but it was not the case regarding HBV and HIV (P>0.05). Furthermore, 91.5% of the donors had opted for CUE by mistake and only 8% had chosen CUE logically.Conclusion:It is necessary to review the process of CUE, make some changes both in procedure and design, and then survey its effectiveness in blood safety.

Mutual blood donation is safer at small blood collection stations in China

BackgroundThe assumption that the level of safety of voluntary non-remunerated donors is significantly higher than that of family replacement donors is supported by global data without stratifying for first-time or repeat volunteer, or according to age, but the viral marker prevalence between replacement donors and first-time voluntary non-remunerated donors is similar. Materials and methodsFrom 2006 to 2013, replacement and voluntary donors were respectively recruited by the hospitals and the Center Blood Station in Zhaoqing, Guangdong, according to the existing procedures, and all the donors were screened for hepatitis B virus (HBV) surface antigen (HBsAg), antibodies against hepatitis C virus (anti-HCV), human immunodeficiency virus (anti-HIV) (1 + 2) and Treponema pallidum (anti-TP) by the enzyme immunoassays (EIAs), and alanine aminotransferase (ALT) in the Center Blood Station by kinetic analysis method. The risk factors related to blood safety were analyzed by Binary logistic regression analysis. ResultsBetween 252,202 volunteers and 2771 replacement donors, the prevalences of ALT > 40 U/L and anti-HIV (4.88% and 0.01% vs 4.44% and 0.07%, respectively) were not significantly different. The prevalences of HBsAg, anti-HCV and anti-syphilis in replacement group were higher than those in voluntary group, which were related to donor's sex, age and donation time. Overall prevalence of serological markers was higher in male replacement donors than in female, and in replacement donor over 30 years than in those below 30 years, but the positive prevalence in repeated replacement donors was lower than that in first-time replacement donors. ConclusionsWith appropriate intervention measures, such as pre-donor screening and other donor selection policy, replacement donors and voluntary donors provide a similar level of viral safety. Our donor selection policy in future should focus on retaining both young replacement and young voluntary donors as repeat donors and promoting the donation proportion of females, which will improve blood safety.

Hepatitis C: Prevalence of serologic markers and risk factors in blood donors at a large blood centre in South-eastern Brazil (2007–2010)

This study aimed to evaluate the trends of HCV seropositivity rates in first time blood donors from a reference blood centre in Southeast Brazil. Data from the period of 2007–2010 were analysed according to anti-HCV antibodies, donor demographic characteristics and type of donation. There was a marked and continuous decline in prevalence in the analysed period, and in 93,534 first time donors, the prevalence of anti-HCV was 0.09%. Anti-HCV were associated with less education and older age (≥35 years). The rates of anti-HCV observed in the present study were lower than in Brazil, but considerably higher than developed countries.

A study of prevalence of serological markers in Late-Onset Rheumatoid Asrthritis

A study of prevalence of serological markers in Late-Onset Rheumatoid Asrthritis

Anti-flagellin Serological Markers Are Earlier Markers of Crohnʼs Disease Progression than ASCA Serological Markers

Purpose: Up to 1.4 million Americans of all ages suffer from inflammatory bowel disease (IBD). IBD tends to be more aggressive in younger people, however, more often resulting in complicated disease phenotypes. Serological markers to predict complicated clinical Crohn's disease (CD) phenotypes are extensively described in the literature. Interestingly, not all these markers have equal immunogenicity. Indeed, evidence suggests that glycans (ASCA-like structure) are relatively weakly immunogenic. Conversely, flagellins are strongly recognized by the specific innate immune receptor Toll-like receptor 5 (TLR5), and have high immunogenic potential. These observations suggest that longer maturation times are required to develop ASCA response in IBD, compared to anti-flagellin response. Finally, in CD patients, serological positivity of ASCA and flagellins is additionally influenced by the age of diagnosis. To study the prevalence and magnitude of serological markers in relation to inflammation and complicated CD. Methods: Samples from well-characterized patients, including data on disease complications, were collected from 15 North American GI centers. Samples from 147 CD young adult patients were analyzed. The prevalence of serological markers (ASCA-A, ASCA-G, ANCA, pANCA, and anti-OmpC), anti-flagelins (CBir1, A4-Fla2, and Fla-X), and inflammatory markers (CRP, SAA, ICAM, VCAM, and VEGF) were calculated. Per-subject Quartile Sum Scores (QSS) were calculated from serological markers. This was achieved by assigning a score from 0-3 for each marker, based on which quartile the marker value was in, followed by summation over these per-marker scores. Markers were deemed positive if they were in the fourth quartile. Results: In this young adult CD cohort, elevated anti-flagellins were associated with aggressive CD behavior (p<0.05), while ASCA-IgA and ASCA-IgG were not (p>0.05). Patients with complications have a significantly higher QSS (p = 0.0157). When ASCAs contributions are removed from the QSS, the relationship between QSS and the complications is even stronger (p = 0.0053). High QSS are also associated with a higher disease burden: Median CRP for high QSS (>=16) was 12.14 mg/L, while for low QSS (<16), median CRP was 2.33 mg/L (p < 0.001). In contrast, no relationship was found between ASCA-IgA or ASCA-IgG and CRP. Conclusion: These results show that anti-flagellin serological markers are strongly associated with inflammatory burden and complicated disease phenotype. ASCA markers did not correlate with inflammation or with disease complications in this young adult cohort. This suggests that anti-flagellin serological markers are earlier markers of CD progression than ASCA. Disclosure - Fred Princen, Steven Lockton, Jordan Stachelski, Cheryl Triggs, Michelle Brown and Sharat Singh - Employees of Prometheus Labs, Inc.

Combined Serological IBD Markers Correlate with High Inflammatory Burden in a Large Cohort of Patients Presenting IBD-like Gastrointestinal Symptoms

Purpose: Some patients with inflammatory bowel disease (IBD) will experience a benign clinical course. However, other patients face a progressive disease course, which can include high inflammatory burden, leading to a complicated disease that ultimately requires surgery. Several studies have shown that early aggressive therapy can benefit patients with aggressive disease. It is also established that both the presence and magnitude of serological markers are correlated with specific phenotypes and with the need for intestinal surgery. The aim of this study was to investigate the relationship between serological markers and inflammatory burden in patients with a suspected diagnosis of IBD. Methods: Marker data from 43,679 de-identified patients between ages 2 and 85 years old were collected from Prometheus Labs CLIA laboratory. The patient diagnosis was unknown. The prevalence of serological markers (ASCA-A, ASCA-G, ANCA, pANCA, and anti-OmpC), anti-flagellins (CBir1, A4-Fla2 & FlaX), and inflammatory markers (CRP, SAA, ICAM, VCAM, and VEGF) were compared. Quartile Sum Scores (QSS) were calculated from serological markers by assigning a score from 0-3 for each marker based on the quartile; the marker value was followed by summation of these per-marker scores. Inflammatory markers were combined to form an inflammatory index by centering their values at the reference range for each assay, scaling each marker, then summing them on a per-patient basis. Results: QSS values combining the eight serologic markers ranged from 0 to 19. High QSS score above >=16 or >=17 represented 22.4% and 11.5% of the population, respectively. Higher QSS was correlated with an increased acute inflammation as assessed by CRP. High CRP prevalence increased from 66.7%, to 71.8%, to 77.5% in individuals presenting QSS =17, =18 and =19, respectively. When the ASCA markers were removed from the QSS calculation (QSS range 0 to 13 for combining the remaining six markers), the top two QSS values, >=12 and >=13, still correlated with a high CRP prevalence of 64.2% and 70.2%, respectively. Similarly, the higher QSS correlated with higher inflammatory indices. High inflammatory index prevalence increased from 28.1%, 33.3%, to 41.6% in individuals presenting QSS =17, =18 and =19, respectively. Conclusion: In this large cohort of patients presenting IBD-like gastrointestinal symptoms, we observed a relationship between serological value (QSS) with both acute inflammation and high inflammatory index score. These results demonstrated the benefit of a multi-marker diagnostic panel for detecting those patients with high chance of developing aggressive disease. Our results also showed the minimal contribution of ASCA in the QSS correlation with inflammation. Disclosure - Fred Princen, Steven Lockton, Jordan Stachelski, Cheryl Triggs, Michelle Brown and Sharat Singh - Employees of Prometheus Labs, Inc.

Epidemiological and serological aspects of hepatitis A among children and teenagers in the city of Santos: a cross-sectional study.

Viral hepatitis A is still a concern at public health level in Brazil and around the world, due both to the number of affected subjects and the possibility of complications in the acute forms. The Brazilian Ministry of Health estimates that at least 70% of this country's population has already had contact with the hepatitis A virus (HAV). The aim here was to discover the prevalence of serological markers for the hepatitis A virus among children and teenagers at daycare facilities, kindergartens and elementary schools in the city of Santos. Cross-sectional study in kindergartens and elementary schools within the municipal education network in several regions of the city of Santos. Students' family members were surveyed using a questionnaire and 4,680 finger-prick blood samples were taken and assayed by means of the ELISA technique. The general prevalence of anti-HAV IgG was 9.72% and, of these cases, 74.6% were reactive to anti-HAV IgM. There was higher prevalence of anti-HAV IgG among older children, females, children who played in streams, those whose homes were not connected to the sewage system, those whose parents had low education levels, those with low household income and those who did not live along the seashore. The prevalence of anti-HAV IgM peaked in the early years and subsequently fell, and it was lower on the hills and in the Northwestern Zone. The general prevalence of serological markers for hepatitis A was low in Santos.

Study of hepatitis B and C prevalence and adherence to standards of biosecurity on manicures and/or pedicures in Brazil

The habit of removing the nails cuticles of hands and feet is a typical cultural practice in Brazil and can be an important factor for hepatitis B and C infection. We conducted a seroepidemiological survey of hepatitis B and C in professional manicures/pedicures in salons in Sao Paulo - Brazil, with the aim of estimating the prevalence of serological markers of HBV and HCV infection on manicures/pedicures; get to know the information level of that have about transmission routes and Prevention of Hepatitis B and C, evaluate the perception degree of risk exposure accidental infectious agents and check the use of biosafety norms in the work routine of these professionals.

Demographic characteristics and prevalence of serologic markers among blood donors who use confidential unit exclusion (CUE) in São Paulo, Brazil: implications for modification of CUE polices in Brazil

This study evaluated demographic profiles and prevalence of serologic markers among donors who used confidential unit exclusion (CUE) to assess the effectiveness of CUE and guide public policies regarding the use of CUE for enhancing safety versus jeopardizing the blood supply by dropping CUE. We conducted a cross-sectional analysis of whole blood donations at a large public blood center in São Paulo from July 2007 through June 2009, compared demographic data, and confirmed serologic results among donors who used and who have never used CUE (CUE never). There were 265,550 whole blood units collected from 181,418 donors from July 2007 through June 2009. A total of 9658 (3.6%) units were discarded, 2973 (1.1%) because CUE was used at the current donation (CUE now) and 6685 (2.5%) because CUE was used in the past (CUE past). The CUE rate was highest among donors with less than 8 years of education (odds ratio [OR], 2.78; 95% confidence interval [CI], 2.51-3.08). CUE now donations were associated with higher positive infectious disease marker rates than CUE never donations (OR, 1.41; CI, 1.13-1.77), whereas CUE past donations were not (OR, 1.04; CI, 0.75-1.45). The CUE process results in a high rate of unit discard. CUE use on an individual donation appears predictive of a high-risk marker-positive donation and, thus, appears to contribute modestly to blood safety. The policy of discarding units from donors who have previously CUE-positive donations does not improve safety and should be discontinued.

Soroprevalência de infecções por vírus da hepatite B e vírus da hepatite C em indivíduos do Estado do Pará

Hepatitis B and C continue to be important public health problems in Brazil. In this study, the prevalence of serological markers for hepatitis B and C in individuals from the State of Pará, attended at the Central Public Health Laboratory of Pará between January 2002 and December 2005, was determined. 11,282 tests to investigate HBsAg, 2,342 for anti-HBc and 5,542 for anti-HCV were performed. The prevalence of HBsAg was 3.6% and it was predominantly found in the age range of 20 to 29 years old, while anti-HBC was observed in 37.7% of the subjects. The prevalence of anti-hepatitis C virus was 3.6% and it was predominantly found in individuals over 50 years old. Thus, the frequencies of the markers found in Pará were higher than many other states in Brazil, hence suggesting that there is a need for public health measures of greater effectiveness for combating these illnesses in this region.

Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies for inflammatory bowel disease: high prevalence in patients with celiac disease.

Both celiac disease and inflammatory bowel disease (IBD) are characterized by chronic diarrhea and the presence of distinct (auto)antibodies. In the present study we wanted to determine the prevalence of serological markers for inflammatory bowel disease, i.e., perinuclear antineutrophil cytoplasmic antibodies (pANCA) and/or anti-Saccharomyces cerevisiae antibodies (ASCA), in 37 patients with biopsy-confirmed celiac disease (Marsh IIIb/c). The majority of the patients was positive for IgA (auto)antibodies typically associated with celiac disease, i.e., antiendomysium antibodies (EMA) (86.5%), antigliadin antibodies (AGA) (73%), and antirecombinant human tissue transglutaminase antibodies (rh-tTGA) (86.5%). Four patients with selective IgA deficiency could be identified by analyzing EMA, AGA, and rh-tTGA for the IgG isotype. The prevalence of pANCA and ASCA, markers that are used for IBD, was unexpectedly high in our cohort of patients with celiac disease: 8 patients were positive for pANCA (IgG) and 16 patients were positive for ASCA (IgG and/or IgA). These results indicate that the presence of pANCA or ASCA in the serum of patients with chronic diarrhea does not exclude celiac disease. A prospective study is required to determine whether pANCA and/or ASCA identify patients at risk for developing secondary autoimmune disease.

Prevalence of Serological Markers against Measles, Rubella, Varicella, Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus among Medical Residents in Mexico

Background. Vaccination programs among health care workers are based on seroprevalence studies, which seldom include medical residents or students. The objective of this study was to determine the seroprevalence of antibodies against measles, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) among medical residents.Methods. This study was designed as a prospective survey. A self-reported questionnaire was used to obtain the information. Serum samples were tested for antibodies by commercial immunoenzymatic assays. Statistical analysis was descriptive; history of exposure was evaluated as a diagnostic test and sensitivity, specificity, and predictive values were calculated according to Bayes theorem.Results. Eighty-nine residents were included, the median age was 27 years, and 58 (65.2%) were female. Seventy-two (79.7%) had been vaccinated against HBV, but vaccination was complete in only 30/72 (41.6%). All were positive for measles and varicella, with the exception of one case for each. The serology for rubella was negative in 12 residents (10 women). Three residents had anti-core against HBV, with negative surface antigen. One positive case for HCV was confirmed by Western blot. All were negative for HIV. A history of prior varicella had a 100% positive predictive value; in contrast, the negative predictive value was quite low (7%).Conclusions. Negative serology for rubella among women and incomplete vaccination against HBV support the implementation of vaccination programs in medical schools in Mexico.

Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control.

Hepatitis-B virus infection is globally ubiquitous, but its distribution is very heterogeneous, with prevalence of serological markers in various nations ranging from less than 1% to more than 90%. We propose an explanation for this diversity using a mathematical model of hepatitis-B virus transmission dynamics that shows, for the first time, 'catastrophic' behavior using realistic epidemiological processes and parameters. Our major conclusion is that the prevalence of infection is largely determined by a feedback mechanism that relates the rate of transmission, average age at infection and age-related probability of developing carriage following infection. Using the model we identify possible, highly non-linear, consequences of chemotherapy and immunization interventions, for which the starting prevalence of carriers is the most influential, predictive quantity. Taken together, our results demand a re-evaluation of public health policy towards hepatitis-B.

Modelling rubella in Europe.

The prevention of congenital rubella syndrome (CRS), as a complication of rubella infection during pregnancy, is the main aim of rubella vaccination programmes. However, as vaccination of infants leads to an increase in the average age at which those who were not immunized become infected, certain rubella vaccination programmes can lead to an increase in the incidence of CRS. In this paper we use a mathematical model of the transmission dynamics of rubella virus to investigate the likely impact of different vaccination policies in Europe. The model was able to capture pre- and post-vaccination patterns of infection and prevalence of serological markers under a wide variety of scenarios, suggesting that the model structure and parameter estimates were appropriate. Analytical and numerical results suggest that endemic circulation of rubella is unlikely in Finland, the United Kingdom, The Netherlands, and perhaps Denmark, provided vaccine coverage is uniform across geographical and social groups. In Italy and Germany vaccine coverage in infancy has not been sufficient to interrupt rubella transmission, and continued epidemics of CRS seem probable. It seems unlikely that the immunization programmes in these countries are doing more harm than good, but this may be partly as a result of selective immunization of schoolgirls. Indeed, in both these countries, selective vaccination of schoolgirls with inadequate vaccination histories is likely to be an important mechanism by which CRS incidence is suppressed (unlike the other countries, which have had sufficiently high infant coverage rates to withdraw this option). Reducing inequalities in the uptake of rubella vaccine may bring greater health benefits than increasing the mean level of coverage.