Primary Rubella Research Articles

Successful Elimination of Endemic Rubella in the WHO European Region. Is It Proper to Remove the Recommendation for Preconceptional Immunization?

Rubella is a contagious viral infection that has garnered significant attention in the field of public health due to its potential consequences, especially during pregnancy. In recent decades, it has been recommended that non-immune women receive immunization during the preconceptional and/or postpartum periods. The goal of this strategy is to prevent primary rubella infection in order to protect pregnant women against congenital rubella syndrome. In November 2022, the WHO's Regional Verification Commission declared the elimination of rubella infection in Italy. In recent years, the main migration flows to Italy have originated from regions where rubella has not yet been eliminated and where no program is in place to achieve this goal. The aim of this study was to retrospectively assess rubella immunity in pregnant women who have attended three delivery centers in Rome over the past three years, from January 2021 to May 2023. Data about the rubella serological status of 7937 non-consecutive pregnant women were collected. Univariate analysis was performed to verify any difference between the study groups in terms of age distribution. Anti-rubella IgG antibodies were found in 7224 (91%) women while 713 (9%) were susceptible to rubella (IgG negative), without differences in terms of immunity rate between Italian and non-Italian women. Age analysis showed a statistically significant older age of immune women than receptive women and of Italian immune women than non-Italian immune women. The National Plan for the Elimination of Measles and Congenital Rubella aimed to achieve a percentage of susceptible women of childbearing age below 5%. These data indicate the relevance of maintaining the recommendation for preconceptional rubella vaccination in Italy.

Seroprevalence of Rubella Virus Infection in Susceptible Women of Childbearing Age Group Seeking Preconceptional Counselling and Infertility Treatment- A Cross-sectional Study from Eastern India

Introduction: Rubella is an acute viral infection predominantly affecting children and adults. Although natural infection with rubella provide lifelong immunity, but, primary infection in pregnant women during the initial days of pregnancy may result in spontaneous abortion, stillbirth, or a baby born with Congenital Rubella Syndrome (CRS), which can be prevented by vaccinating the susceptible non immune females one month prior to planning conception. Aim: To determine rubella virus immune status and demographic profile of women in childbearing age group, and counsel all Rubella virus infection susceptible women for vaccination prior to planning pregnancy. Materials and Methods: A cross-sectional observational study was done at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna , Bihar, India, on 112 apparently healthy, asymptomatic women in the 18-45 years age group coming for preconceptional counselling and primary and secondary infertility treatment during April 2017 to March 2019, whose serum rubella Immunoglobulin G (IgG) antibody testing was done by Enzyme- linked Immunosorbent Assay (ELISA). The data regarding their rubella virus immune status, age, parity and occupations were coded and recorded in MS Excel spreadsheet program. The Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp.) was used for data analysis. Results: Out of the total 112 women {92 (82.1%) housewife and 20 (17.9%) professionals} included in this study , a total of 67 (59.8%) women tested positive for rubella IgG antibody and 45 (40.2%) tested negative for rubella IgG antibody. The mean age of the rubella virus seropositive immune patients and seronegative susceptible women was 27.72±4.83 years was 26.09±4.68 years respectively. Among the 67 seropositive patients, maximum antirubella virus IgG seropositivity (71.4%) was seen in more than 35 years age group and maximum seronegativity 23 (46.9%) was seen in 18-26 years age group. There was no direct association of occupation and parity with rubella immune status. Conclusion: Higher rate of antirubella IgG seronegativity amongst younger age groups and nulliparous women renders them susceptible to primary Rubella virus infection. Hence, Rubella IgG antibody screening, proper counselling and prompt rubella vaccination for all primary Rubella virus infection susceptible women is necessary one month prior to planning conception, to avoid foetal congenital malformations during subsequent pregnancies.

Prevalence of Rubella Antibodies among Fertile Women in the West of Romania, 18 Years after the Implementation of Immunization.

Seronegative women are susceptible to primary rubella virus (RV) infection during pregnancy, which can cause fetal damage. Vaccination represents the main strategy in rubella prevention. The aim of this study was to analyze changes in the rubella seroprevalence and identify populations with a high susceptibility to RV. A cross-sectional study was performed on 6914 Caucasian fertile women who had Toxoplasma gondii, other viruses, Rubella, Cytomegalovirus, and the herpes simplex virus (TORCH) screening in two distinct periods—1452 at the Timișoara Municipal Hospital, Romania (Group 1: 2008–2010) and 5462 at the laboratory Bioclinica S.A., Timișoara, Romania (Group 2: 2015–2018). The RV seroprevalence decreased (Group 1 versus Group 2; 94.1% (92.7–95.2) versus 91.4% (90.6–92.1), OR = 0.76 (p = 0.0007)). According to the year of birth and eligibility to vaccination program, RV seroprevalence rates were 82.4% (76.8–86.8)/1997–2004, 85.4% (80.5–89.3)/1995–1996, 90.1% (89.0–91.1)/<1989, and 95.8% (94.7–96.6)/1989–1994. No significant difference in the RV seropositivity according to the place of residence was found. The overall RV susceptibility increased from 2008–2010 to 2015–2018. The highest susceptibility was found in women born between 1997–2004 eligible for measles-mumps-rubella (MMR) vaccine through the family practice system and the lowest in women born between 1989–1994 eligible for monovalent rubella vaccine conducted in schools.

Maternal infections with an increased risk of transmission to the foetus; a literature review

Screening testing for infectious diseases with vertical transmission, from mother to foetus, decreases the prevalence of foetal malformations. The most common infections with teratogenic potential are found in the TORCH test (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex virus). Early identification of these pathogens results in better neonatal outcomes. Most foetuses with congenital toxoplasmosis are asymptomatic or have no apparent birth defect, while the primary infection of pregnancy with varicella-zoster virus (VZV) can lead to congenital foetal abnormalities with devastating consequences. Treponema pallidum can easily infect the placenta, with transplacental transmission to the foetus that can occur from about 9-10 weeks of gestation. Also, hepatitis B and C are the most common causes of chronic viral hepatitis in children and adults. In the case of HIV-positive pregnant women, the early association of ART, together with the choice of birth by scheduled caesarean section and the complete lack of breastfeeding determine expected neonatal results, the risk of vertical transmission decreasing up to 1-2%. Primary rubella infection during pregnancy can significantly affect foetal development, as does Herpes simplex virus (HSV) infection, but if it occurs as close as possible to birth, the disease may be self-limiting with mild forms. No teratogenic agent should be described qualitatively, as a teratogenic exposure includes not only the agent but also the dose and time of pregnancy when the exposure will occur. Screening tests are recommended to be performed both preconceptionally and during pregnancy.

Rubella in Pregnancy

AbstractRubella, commonly known as ‘German Measles’ is a common childhood viral disease that may affect adults as well. More than half of the infections are either asymptomatic or present with mild flu like illness with a typical maculopapular rash. In contrast, primary rubella infection in pregnancy, especially in the first trimester, can have serious consequences, namely miscarriage, intrauterine fetal demise or congenital rubella syndrome (CRS). WHO recognizes CRS as the ‘leading vaccine preventable cause of birth defects’. Antenatal management primarily is based on testing for immunity in the first trimester and recognizing acute maternal infection. A correct interpretation of maternal serology using IgG avidity along with IgM and IgG is imperative to avoid false positive diagnoses. Diagnosis of fetal infection is by detection of Rubella virus specific RTPCR in amniotic fluid and is indicated if maternal seroconversion is seen in the periconceptional period and/or the first trimester or if there are ultrasound features suggestive of fetal infection. Since there is no treatment available to either prevent mother to child transmission or to treat fetal infection, the mainstay is prevention. India is amongst the 11 countries of WHO South East Asia Region who are committed to control of Rubella and CRS by 2020.

Outcomes for Nitazoxanide Treatment in a Case Series of Patients with Primary Immunodeficiencies and Rubella Virus-Associated Granuloma.

Nitazoxanide was recently reported as having in vitro effectiveness against the rubella virus. Immunodeficiency-related vaccine-derived rubella occurs in some patients who have an inherited immunodeficiency and who received the MMR vaccine. This study investigated the in vivo effectiveness of nitazoxanide therapy. This is a retrospective analysis of seven patients treated with nitazoxanide as salvage therapy for immunodeficiency-related vaccine-derived rubella infection. The patients were recruited from an ongoing rubella detection surveillance project. Seven patients with persistent rubella were treated with nitazoxanide and one demonstrated significant clinical improvement. Two additional patients exhibited diminished viral capsid production with one patient having transient slowing of progression. The cohort overall generally had low T cell counts and had a high burden of comorbidities. There were three deaths. Two deaths were from PML and one was related to hematopoietic stem cell transplantation. Nitazoxanide has limited in vivo anti-viral effects for immunodeficiency-related vaccine-derived rubella. Most patients did not exhibit clinical improvement.

Congenital Rubella Syndrome in The African Region - Data from Sentinel Surveillance

Rubella is a mild febrile rash illness caused by the rubella virus. The most serious consequence of rubella is congenital rubella syndrome (CRS), which occurs if the primary rubella infection occurs during early pregnancy, with subsequent infection of the placenta and the developing fetus. WHO supported countries to set up sentinel surveillance for CRS using standard case definitions, protocols, and case classification scheme. This descriptive analysis summarises the data from 5 countries which have been regularly reporting. A total of 383 suspected cases of CRS were notified from the 5 countries as of December 2016, of which 52 cases were laboratory confirmed and 67 were confirmed on clinical grounds.The majority (43%) of confirmed CRS cases were in the age group 6 - 11 months. The most common major clinical manifestation (Group A) among the confirmed cases is congenital heart disease (72%) followed by cataracts (32%) and glaucoma (10%). The number of years of reporting from these sentinel sites is too short to describe trends in CRS occurrence across the years. However, the limited surveillance data has yielded comparable information with other developing countries prior to introduction of rubella vaccine. As more countries introduce rubella vaccine into their immunisation programs, there is a need to ensure that all rubella outbreaks are thoroughly investigated and documented, to expand sentinel surveillance for CRS in more countries in the Region, and to complement this with retrospective record reviews for CRS cases in selected countries.

Common findings on head computed tomography in neonates with confirmed congenital Zika syndrome.

ObjectiveTo describe head computed tomography (CT) findings in neonates with congenital Zika virus infection confirmed in cerebrospinal fluid.Materials and MethodsThis was a study of 16 newborn infants who exhibited abnormal head CT findings during an outbreak of Zika virus infection. Those infants had the following features: brain imaging suggestive of congenital infection; brain calcifications and negative results on tests for other main infectious causes of primary microcephaly, namely toxoplasmosis, cytomegalovirus, rubella, and HIV; positivity for Zika virus on IgM antibody capture enzyme-linked immunosorbent assay in cerebrospinal fluid.ResultsDecreased brain volume was observed in 13 (81.2%) of the infants. All of the infants showed cortico-subcortical calcifications, mainly located in the frontal lobe. In 15 neonates (93.7%), ventriculomegaly was observed. Colpocephaly was a common finding, being observed in 10 patients (62.5%). A prominent occipital bone was identified in 9 patients (56.2%).ConclusionOur study proves that Zika virus infection can cause congenital brain damage, with or without microcephaly. Some predominant head CT findings in neonates with congenital Zika virus infection, although not pathognomonic, are strongly suggestive of a pattern.

Epidemiology of primary rubella infection in the Central African Republic: data from measles surveillance, 2007-2014.

BackgroundAlthough rubella is generally considered a benign childhood disease, infection of a pregnant woman can cause foetal congenital rubella syndrome, which results in embryo-foetal disease and malformations. The syndrome is still a public health problem in developing countries where the vaccine has not yet been introduced, such as the Central African Republic (CAR). The aim of the study reported here was to define the epidemiology of primary rubella infection, in order to determine its effect on morbidity rates in the country.MethodsData derived from epidemiological surveillance of measles and rubella were analysed retrospectively between 1 January 2007 and 31 December 2014. The database includes cases of suspected measles, according to the WHO clinical case definition. In this algorithm, samples that are negative or doubtful by ELISA for measles (presence of immunoglobulin M) are tested in another ELISA for detection of rubella-specific IgM. Descriptive analyses were conducted for socio-demographic characteristics, including age, sex and health region, for patients tested for rubella.ResultsOf the sera tested for rubella, 30.2 % (425/1409) were positive, 62.3 % (878/1409) were negative, and 7.5 % (106/1409) were doubtful. Among the 425 positive cases, 213 (50.1 %) were female and 212 (40.9 %) were male with a sex ratio of 1.03. The mean age was 8 years (range, 6–37 years). The highest prevalence (47.3 %; 116/425) was seen in 2007 and the lowest (8.9 %; 11/425) in 2012. Primary infections were always more frequent during the first 3 months of the year, with a peak at the same time, between January and February which is the hottest period of the year in the CAR. In both sexes, rubella IgM was rarely found before the age of 1 year (0.5 %; 2/425). The highest rate (43.5 %; 185/425) was observed at ages 5–9 years; however, at least 8 % (18/213) of girls aged 15 or more had primary infections.ConclusionsSentinel sites for surveillance of congenital rubella syndrome are urgently needed, and introduction of vaccination against rubella in the Expanded Programme of Immunization should be considered, to ensure immunization of girls of reproductive age.

Gregg syndrome: With blueberry muffin rash and congenital cataract

Rubella, though a mild, vaccine-preventable disease, can manifest with severe teratogenic effects in the fetus due to primary maternal rubella infection. A case of a full-term neonate with blueberry muffin lesions and classical as well as rare systemic features of Gregg syndrome is reported.

Standardization of Assays That Detect Anti-Rubella Virus IgG Antibodies.

Rubella virus usually causes a mild infection in humans but can cause congenital rubella syndrome (CRS). Vaccination programs have significantly decreased primary rubella virus infection and CRS; however, vaccinated individuals usually have lower levels of rubella virus IgG than those with natural infections. Rubella virus IgG is quantified with enzyme immunoassays that have been calibrated against the World Health Organization (WHO) international standard and report results in international units per milliliter. It is recognized that the results reported by these assays are not standardized. This investigation into the reasons for the lack of standardization found that the current WHO international standard (RUB-1-94) fails by three key metrological principles. The standard is not a pure analyte but is composed of pooled human immunoglobulin. It was not calibrated by certified reference methods; rather, superseded tests were used. Finally, no measurement uncertainty estimations have been provided. There is an analytical and clinical consequence to the lack of standardization of rubella virus IgG assays, which leads to misinterpretation of results. The current approach to standardization of rubella virus IgG assays has not achieved the desired results. A new approach is required.

Prenatal diagnosis of congenital rubella infection in São Paulo

Objective: rubella during the early stages of pregnancy can lead to severe birth defects known as congenital rubella syndrome (CRS). Samples collected from pregnant women with symptoms and suspected of congenital rubella infection between 1996 and 2008 were analyzed. Methods: a total of 23 amniotic fluid samples, 16 fetal blood samples, 1 product of conception and 1 placenta were analyzed by serology and RT-PCR. Results: all patients presented positive serology for IgG / IgM antibodies to rubella virus. Among neonates, 16 were IgG-positive, 9 were IgM-positive and 4 were negative for both antibodies. Of the 25 samples analyzed in this study, 24 were positive by RT-PCR. Changes in ultrasound were found in 15 (60%) of 25 fetuses infected with rubella virus. Fetal death and miscarriage were reported in 10 (40%) of the 25 cases analyzed. The rubella virus was amplified by PCR in all fetuses with abnormal ultrasound compatible with rubella. Fetal death and abortion were reported in 10 of 25 cases analyzed. Conclusion: this study, based on primary maternal rubella infection definitely confirms the good sensitivity and specificity of RT-PCR using amniotic fluid and ultrasound. The results showed that molecular assays are important tools in the early diagnosis of rubella and congenital rubella syndrome.

Evaluation of fully automated assays for the detection of Rubella IgM and IgG antibodies by the Elecsys® immunoassay system

Screening for acute rubella infection in pregnancy is an important element of antenatal care. This study compared the sensitivity, specificity and reproducibility of two new, fully automated Elecsys® Rubella IgM and IgG immunoassays designed for the Elecsys 2010, Modular Analytics E170, COBAS e-411 and COBAS e-601 and e602 analytical platforms, with current assays using serum from patients with primary rubella infections, vaccinated patients, patients with potentially cross-reacting infections and on routine samples in clinical laboratories in France, Germany and Italy. Both assays showed good within-run and within-laboratory precision. A sensitivity of 79.8–96.0% was demonstrated for Elecsys IgM in primary, early acute infection, consistent with existing assays. In samples obtained from routine antenatal screening, the Elecsys Rubella IgM assay revealed high specificity (98.7–99.0%). A significantly (p<0.0001) lower reactivity was demonstrated in samples from previously infected patients where acute rubella infection was excluded, and the incidence of false positives in patients with potentially cross-reacting infections was lower with Elecsys Rubella IgM compared with other. The Elecsys Rubella IgG assay exhibited a relative sensitivity of 99.9–100.0% and specificity of 97.4–100.0% in samples from routine antenatal screening. The Elecsys Rubella IgM and IgG assays allow convenient, rapid and reliable determination of anti-rubella antibodies. Sensitivity, specificity and reproducibility were comparable with existing assay systems. Assay results were available in approximately half the time required for currently employed methods and the assays are compatible with widely used analytical platforms.

Seroprevalance of rubella in women with bad obstetric history

Rubella is a common cause of rash and fever during childhood. However, its public health importance relates to the teratogenic effects of primary rubella infection occurring in pregnant women, which can lead to fetal death with spontaneous abortion or to congenital defects in surviving infants. Most of the cases are asymptomatic and difficult to diagnose on clinical grounds. Detection of specific IgM antibodies by the enzyme-linked immunosorbent assay (ELISA) technique is a useful method for diagnosis. The present study was conducted on 180 pregnant women attending antenatal clinics at Government Maternity Hospital, Tirupati. All the serum samples were tested for Rubella-specific IgM antibodies. A seropositivity of 12.67% was observed among cases with bad obstetric history and 6.67% in normal pregnant women. Within the test group, high sero-positivity (13.33%) was observed in women with repeated abortions followed by in cases of intrauterine death (12.73%). The results indicate high prevalence of rubella in our population. All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and fetal outcome.

Burden of congenital rubella syndrome (CRS) in India: A systematic review

Rubella, though a mild, vaccine-preventable disease, can manifest with severe teratogenic effects in the fetus labeled as congenital rubella syndrome (CRS) due to primary maternal rubella infection. Despite a reduction in disease burden of several vaccine-preventable diseases through childhood immunization, CRS continues to account for preventable severe morbidity including childhood blindness, deafness, heart disease, and mental retardation. To conduct a systematic review to describe the prevalence of CRS and its contribution to major long-term handicaps in Indian population. Another objective was to estimate the susceptibility to rubella infection in Indian adolescent girls and women of reproductive age-group. We also explored strategies to decrease CRS in India by identifying the immunogenicity of rubella containing vaccines (RCV) in Indian children and women, as well as their coverage in India. Publications reporting CRS prevalence in general population as well as selected subgroups i.e., suspected intra-uterine infection, congenital ocular abnormalities, deafness, congenital heart disease, mental retardation, and congenital malformations, seroprevalence to rubella (IgG) amongst women and adolescents, and immunogenicity and coverage of RCVs in Indian population were retrieved through a systematic search. Primary databases employed were Medline through PubMed and IndMed, websites of the WHO, and UNICEF. No restrictions were applied in terms of study designs. The primary outcome measure was congenital rubella syndrome (CRS) which was further categorized as suspected CRS and confirmed CRS as defined by World Health Organization (WHO). Comprehensive evidence about the true burden of CRS in India is not available. Almost all studies have been done in nstitutional/hospital set-ups and community-based studies are grossly lacking. There are no studies assessing the prevalence of CRS in general population. All studies have evaluated the CRS burden in symptomatic cohorts of children. 1-15% of all infants suspected to have intra-uterine infection were found to have laboratory evidence of CRS. About 3-10% of suspected CRS cases are ultimately proven to have confirmed CRS with the aid of laboratory tests. CRS accounts for 10-15% of pediatric cataract. 10-50% of children with congenital anomalies have laboratory evidence of CRS. 10-30% of adolescent females and 12-30% of women in the reproductive age-group are susceptible to rubella infection in India. RCVs are highly immunogenic in Indian adolescents and women. The coverage data of RCVs in India is not available. However, the coverage of MMR vaccine has been reported as 42%, 30% and 5% from Delhi, Chandigarh and Goa, respectively. This systematic review identifies and explores factors associated with the prevalence of CRS in India. There is a need for urgent action in terms of revamping the national immunization policy and introduction of RCVs in the national immunization program. Active surveillance of rubella and CRS is needed to redress the burden of CRS in India.

Seroprevalance of rubella in women with bad obstetric history in Tirupati of Andhra Pradesh state of India

Introduction: Rubella is a common cause of rash and fever during childhood. However, its public health importance relates to the teratogenic effects of primary rubella infection occurring in pregnant women, which can lead to fetal death with spontaneous abortion or to congenital defects in surviving infants. Most of the cases are asymptomatic and difficult to diagnose on clinical grounds. Materials and Methods: Detection of specific IgM antibodies by enzyme linked immunosorbent assay (ELISA) technique is a useful method for diagnosis. This study was conducted on 180 pregnant women attending antenatal clinics at Govt. Maternity Hospital, Tirupati. All the serum samples were tested for rubella-specific IgM antibodies. Results: A seropositivity of 12.67% was observed among cases with bad obstetric history and 6.67% in normal pregnant women. Within the test group, high seropositivity (13.33%) was observed in women with repeated abortions followed by in cases of intrauterine death (12.73%). Conclusions: The results indicate high prevalence of rubella in our population. All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and fetal outcome.

Diagnosis of recent primary rubella virus infections: Significance of glycoprotein-based IgM serology, IgG avidity and immunoblot analysis

Reliable serodiagnosis of rubella virus (RV) infections requires discrimination of specific IgM induced by primary rubella from persistent, reactivated or non-specific IgM reactivity. Sera from 130 pregnant women with recent or past RV infection/vaccination, persistent IgM or negative rubella serology, 26 patients with other acute infections and 5 patients with rheumatoid factor-positivity were analyzed for RV-specific IgM by ELISA coated with whole-virus lysate or native glycoprotein, followed by determination of IgG avidity and E2-specific IgG using lysate-coated ELISA and non-reducing immunoblot. Compared to a reference μ-capture IgM ELISA, the sensitivity for diagnosing recent rubella infection/vaccination was 90.0% and 100% for the lysate-based and glycoprotein-based IgM ELISA, respectively. With respect to women with past RV infections or negative histories of RV infection/vaccination, both assays were 97.5–100% specific, whereas for patients with other acute infections the glycoprotein substrate provided a specificity of 92.3% compared to only 80.8% using whole-virus antigen. Analyzing anti-RV IgG avidity and anti-E2 IgG reactivity allowed the time point of primary infection to be determined unambiguously in >86% of samples. In conclusion, using RV glycoprotein antigen improves the specificity of indirect IgM ELISA. In cases of RV-specific IgM reactivity, recent primary rubella infection can be confirmed or excluded efficiently by specific IgG avidity and immunoblot analysis.

Pregnant Women in and Around Dhaka City: Are Their Children at Risk of Developing Congenital Rubella Syndrome?

Rubella Virus (RUBV) is a common cause of childhood rash and fever in non-immunized populations, and its public health importance relates to teratogenic effects of primary rubella infection in women with early pregnancy. Infection of the fetus may lead to congenital rubella syndrome (CRS). This work aimed to assess the degree of risk associated in acquiring rubella virus infection by the women during pregnancy and developing CRS among their children in Bangladesh. The study population (n=275) included pregnant mothers (15-38years) from various socioeconomic backgrounds attending a women health care based hospital. All subjects were personally interviewed, clinically examined and a standardized questionnaire was filled up for each of them. From each participant 3ml blood was taken and serum was separated. Commercially available ELISA kit was used for the qualitative and quantitative determination of IgM and IgG class antibodies against RUBV in collected serum samples. 209 women were found to contain detectable level of antiRUBV IgG antibodies, but did not possess IgM antibodies against rubella. Only 9% participants were vaccinated previously against rubella virus among the whole antenatal population studied. Ninety-two percent of these vaccinated pregnant women contained serum anti-rubella IgG antibody which was significantly (P=0.05) higher than that of the nonvaccinated study population (75%). Pregnant women from lower middle and poor socioeconomic class had significantly (P=0.05) more intra uterine growth retardation (IUGR) of fetus than the upper middle class. 20% of the women of child bearing age examined in this work were not yet exposed to RUBV and at risk of acquiring this virus during pregnancy and subsequently transmitting the virus to the fetus. Our work demonstrates rubella attack rate among antenatal population in Bangladesh as 14.5 in 1000 during pregnancy. A proper and reliable vaccination policy against rubella virus is not yet adopted at the national level in many developing countries including Bangladesh. This work identifies the requirement of detailed study for the identification of intrauterine rubella infection and its related influence on perinatal morbidity and mortality. Thorough epidemiological studies are also considered necessary prior to the development and acceptance of national immunization program against rubella virus in Bangladesh.

Evaluation of the new ARCHITECT Rubella IgM assay

Background Rubella infections are usually characterized by mild self-limiting courses in immunocompetent individuals. However, infections in pregnant women during the first trimester of pregnancy pose a high risk of congenital rubella syndrome possibly resulting in severe defects in the unborn child. Rubella serology of a primary rubella infection is mainly determined by diagnostic confirmation of levels of specific IgM. Study design Here, we report on the performance of the Rubella IgM assay in development on the ARCHITECT instrument, a fully automated high throughput chemiluminescent microparticle immunoassay platform. Sensitivity was examined using commercially available seroconversion panels from vaccinated individuals; specificity was addressed by testing populations of pregnant women, blood donors and hospitalized patients. In addition, the potential for assay interference was evaluated by testing samples of several disease states. As methods of comparison AxSYM, BioMérieux VIDAS and Behring Rubella IgM assays were used. Results The study demonstrates that the ARCHITECT Rubella IgM assay shows improved specificity compared to AxSYM and Behring. Seroconversion sensitivity is equivalent on all assays evaluated. Conclusion Together with high throughput, optimized specificity and suppression of rheumatoid factor (RF) interference the ARCHITECT assay provides a useful improvement for the diagnosis of rubella serology.

Humoral Immune Response after Primary Rubella Virus Infection and after Vaccination

We measured rubella virus immunoglobulin G (IgG) and IgM levels, as well as IgG avidity indexes, in serum samples taken before or after 6 months either after infection or after vaccination. The results obtained indicate that humoral immune responses are different after primary infection and after vaccination. This may have important consequences on the serological diagnosis of rubella virus infection.