Risk Of Congenital Rubella Syndrome Research Articles

Considerable doubt about rubella screening and vaccination among unvaccinated orthodox protestant women: a mixed-methods study

BackgroundWomen who are susceptible to rubella are advised to vaccinate against rubella to prevent infection in future pregnancies, and thus avert the risk of congenital rubella syndrome in their unborn child. Rubella outbreaks periodically occur in the under-vaccinated orthodox Protestant community in the Netherlands. The objective of this mixed-methods study was to determine and understand personal experience with rubella, perceived rubella susceptibility, and intention to accept rubella screening and vaccination among unvaccinated orthodox Protestant women. The ultimate aim of this study was to inform policy and practice and contribute to the prevention of cases of congenital rubella syndrome.MethodsA mixed-methods study was conducted combining an online survey and semi-structured interviews among unvaccinated Dutch orthodox Protestant women aged 18–40 years. Descriptive analysis was used for quantitative data. Qualitative data was analysed using codes and categories.ResultsResults of the survey (167 participants) showed that most participants had personal experience with rubella (74%, 123/167) and 101 women (61%, 101/167) indicated they had had rubella themselves. More than half of the women were undecided whether to accept rubella susceptibility screening (56%; 87/156) or rubella vaccination (55%; 80/146). Qualitative findings (10 participants) showed that most women thought they were not susceptible to rubella. Indecisiveness and negative attitudes to accept rubella vaccination were related with religious arguments to object vaccination and with women’s perception of absence of imminent threat of rubella. Furthermore, results showed presence of misconceptions among women in the interpretation of their susceptibility and high confidence in their parents’ memory that they had experienced rubella as a child although no laboratory screening had been conducted.ConclusionsIn light of an imminent rubella outbreak in the Netherlands, a tailored education campaign should be prepared aimed at and established in cooperation with the under-vaccinated orthodox Protestant community. Health care providers should provide adequate information on rubella and support decision-making in order to stimulate women to make a deliberate and informed decision on rubella screening and, if necessary, subsequent vaccination.

Seroprevalence of Rubella Immunity in Rural Pregnant Women Attending Antenatal Clinics at a Tertiary Care Centre in Piparia, Gujarat, India

Introduction:Rubella viral infection in pregnant women is a Global Public Health concern as it has a devastating effect on developing foetus causing adverse foetal outcome or Congenital Rubella Syndrome (CRS). Aim: To recognise the proportion of pregnant women susceptible to Rubella infections so as to discern the risk of CRS. Materials and Methods: A prospective cross-sectional study was conducted on 90 rural pregnant women attending the Tertiary Care Centre, from September 2019-December 2019. Informed consent was obtained and a comprehensive structured questionnaire was noted regarding the sociodemographic details and reproductive history. Five mL of venous blood was tested for the presence of anti-rubella IgG using Enzyme-Linked Immunosorbent Assay (ELISA) kits. Data analysis were conducted using Statistical Package for Social Sciences version 15.0. Results: The mean age of the population was 23.26±5 years. Overall, seroprevalence was 88.9% (80/90). Immunity was higher (100%) in women of 30-35 years age, 100% in lower upper class, 93.3% with higher education, 90.9% with second trimester, 90.3% multigravida and 90.5% parity. It was also observed that in all the women with low immunity (11.1%) had a history of adverse foetal outcome. Conclusion: A significant proportion of pregnant females are still susceptible to rubella virus infection shows that rubella is endemic in the study area, so antenatal screening for rubella should be mandatory and rubella vaccination in adolescent girls and women of child bearing age is the only way to reduce the menace of CRS in India.

Rubella Immunity among Italian Female Healthcare Workers: A Serological Study.

Rubella, also known as German measles or three-day measles, is an infectious disease caused by virus of the genus Rubivirus, which may be prevented by vaccination. The infection is potentially dangerous for non immune subjects, although 20–50% of infected subjects are asymptomatic. Healthcare workers (HCWs) have an increased potential exposure to rubella in comparison to the general population, putting them and their patients at risk of infection and its complications. In 2019, 20 cases of rubella have been reported in Italy. According to the Italian National Immunization and Prevention Plan, HCWs should provide a written certification of vaccination for rubella or serological evidence of protective antibodies. The aim of the study was to evaluate the rubella immunization status in female HCWs of the teaching hospital Policlinic Rome Tor Vergata (PTV) of childbearing age. For this purpose, we retrospectively checked the serologic values of rubella-specific IgG antibodies analyzing the clinical records of the HCWs of undergoing the occupational health surveillance program from January 1st to June1st 2020. Five hundred fourteen HCWs with a mean age of 23.19 (range 19–37, DS: 2.80) were included: 90.3% (464) showed a protective antibody titre. The mean value of the anti-rubella IgG was 49.59 IU/mL. Our study shows a non-protective anti rubella IgG titre in a substantial percentage of HCWs (9.7%). As vaccine protection decreases over the years and the risk of congenital rubella syndrome (CRS) in vaccinated subjects should not be underestimated, we suggest routine screening of the immunological status followed by the administration of a third dose of vaccine if the antibody titre becomes non-protective.

Rubella IgM epidemiology in the pre-rubella vaccination era in Uganda

BackgroundControl of Rubella and Congenital Rubella Syndrome using vaccination has shown great success in the America’s. Uganda is due to introduce the Rubella vaccine however the magnitude of transmission is not well documented. Therefore this study was done to determine IgM sero-prevalance for Rubella in order to help monitor vaccine effectiveness post introduction of the vaccine in routine vaccination programme.MethodsA retrospective review of suspected measles cases data for the reporting period January 2007 to December 2016 in Uganda was Done. rubella IgM testing was done on 15,296 of the cases and the data was analyzed using STATA version 13.ResultsIn total 15,296 cases were tested and 4255 (27.8%) tested positive and among females aged 15-49 years 88 out of 322 (27%) tested positive. The age distribution range was 0–80 years, rubella IgM positivity was reported in all the 15 regions of Uganda and throughout the ten year period in every month. Age group 5–15 years had OR 2.5 p-value < 0.001 of being rubella IgM positive compared to age < 5 years and testing measles IgM negative OR 6.3 p-value < 0.001.ConclusionRubella is endemic in Uganda and although rubella IgM positivity is highest in the age 5-15 years even the younger, older and women of reprodutive age are affected. This means the risk of Congenital Rubella Syndrome is high hence the need to introduce the rubella vaccine for infants and pregnant mothers and continued surveillance to enhance its control.

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism.

Rubella is a systemic virus infection that is usually mild. It can, however, cause severe birth defects known as the congenital rubella syndrome (CRS) when infection occurs early in pregnancy. As many as 8%–13% of children with CRS developed autism during the rubella epidemic of the 1960s compared to the background rate of about 1 new case per 5000 children. Rubella infection and CRS are now rare in the U.S. and in Europe due to widespread vaccination. However, autism rates have risen dramatically in recent decades to about 3% of children today, with many cases appearing after a period of normal development (‘regressive autism’). Evidence is reviewed here suggesting that the signs and symptoms of rubella may be due to alterations in the hepatic metabolism of vitamin A (retinoids), precipitated by the acute phase of the infection. The infection causes mild liver dysfunction and the spillage of stored vitamin A compounds into the circulation, resulting in an endogenous form of hypervitaminosis A. Given that vitamin A is a known teratogen, it is suggested that rubella infection occurring in the early weeks of pregnancy causes CRS through maternal liver dysfunction and exposure of the developing fetus to excessive vitamin A. On this view, the multiple manifestations of CRS and associated autism represent endogenous forms of hypervitaminosis A. It is further proposed that regressive autism results primarily from post-natal influences of a liver-damaging nature and exposure to excess vitamin A, inducing CRS-like features as a function of vitamin A toxicity, but without the associated dysmorphogenesis. A number of environmental factors are discussed that may plausibly be candidates for this role, and suggestions are offered for testing the model. The model also suggests a number of measures that may be effective both in reducing the risk of fetal CRS in women who acquire rubella in their first trimester and in reversing or minimizing regressive autism among children in whom the diagnosis is suspected or confirmed.

Rubella transmission and the risk of congenital rubella syndrome in Liberia: a need to introduce rubella-containing vaccine in the routine immunization program

BackgroundRubella is an RNA virus in the genus Rubivirus within the Matonaviridae family. Rubella remains a leading vaccine-preventable cause of birth defects. Most African countries including Liberia do not currently provide rubella-containing vaccine (RCV) in their immunization program. We analyzed the existing surveillance data to describe rubella cases and identify the at-risk population.MethodsWe conducted a retrospective descriptive statistics on the suspected-measles case-based surveillance data that obtained from the national database. Suspected-measles cases who were negative and indeterminate for measles IgM and tested for rubella IgM were extracted from the database. We used only rubella IgM positive cases to calculate trends and percentages by person, place and time. The cumulative-percent curve was used to visually describe the age distribution of rubella cases.ResultsDuring 2017–2018, a total of 2027 suspected-measles cases with known laboratory results were reported; of which, 1307 were tested for rubella IgM. Among tested cases, 472 (36%) were positive, 769 (59%) were negative and 66 (5%) were indeterminate for rubella IgM. Female contributed 269 (57%) of the confirmed rubella cases respectively. The median age was 7 years with an interquartile range of 5–10 years. From the total rubella cases, 6 (1%) were under 1 year, 109 (23%) were 1–4 years, 207 (44%) were 5–9 years, 87 (18%) were 10–14 years and 56 (12%) were more than or equal to 15 years. Women in their reproductive-age contributed 23 (5%) of rubella cases with 17% positivity rate. Two-thirds or 307 (65%) of the cases were reported from February to May which is dry season in Liberia.ConclusionsOur analysis revealed that rubella was widely circulating in Liberia. Majority of the cases were reported among children < 15 years. However, rubella was also reported among women of reproductive age and infants < 1 year with no report of congenital rubella syndrome (CRS). Detail investigation of rubella cases among infants of < 1 year and women of reproductive age is important to uncover CRS. Establishment of CRS surveillance and the introduction of RCV in the immunization program are crucial to prevent rubella infection and avert the risk of CRS.

The risk factors of exposure to rubella among pregnant women in Zaria 2013.

Introductionrubella virus usually causes a mild disease, but maternal infection early in pregnancy often leads to birth defects known as congenital rubella syndrome (CRS). Rubella remains poorly controlled in Africa despite being a vaccine preventable disease. The objective of this study was to determine the risk factor of expose of rubella and prevalence of rubella IgG antibodies among pregnant women in Zaria. The results of this study will provide data which may be used to advise the government of Kaduna State on the need to include rubella vaccine in the free routine immunization particularly for women of childbearing age.Methodsa cross-sectional study was carried out. Pregnant women attending antenatal clinics from three different health facilities in Zaria. A questionnaire was administered, to determine the proportion of pregnant women vaccinated and the sera of these women were tested for rubella IgG antibody using commercially produced enzyme-linked immunosorbent assay (ELISA) Kit. Statistical variables were compared with univariate (frequencies) bivariate (chi- square), multivariate analyses (logistic regression). A p-value of < 0.05 was considered significantly associated at 95% confidence intervals.Resultsof the 246 pregnant women screened, 222 (90.2%) were positive for rubella IgG. Prevalence was highest 82/222 (36.9%) among age group 20-24 years. Those positive of those who had completed secondary school education were 104/222 (46.8%) A large number among those who tested positive with 197/222 (88.7%) were married. The Hausa tribe 155/222 (69.9%) had the highest positivity for rubella IgG. Only 2 (0.9%) women claimed to have received rubella vaccine and 159/222 (71.6%) women were seropositive for IgG among the unemployed group.Conclusionthe serological evidence of rubella virus is an indication that rubella is endemic in Nigeria. Nigeria should include rubella vaccination in the routine immunization exercise for women before they get pregnant to reduce the risk of CRS.

Rubella natural immunity among adolescent girls in Tanzania: the need to vaccinate child bearing aged women

BackgroundRubella primary infection during early stages of pregnancy is associated with high risk of congenital Rubella syndrome (CRS). Prevention of CRS in the resource-limited countries requires multiple strategies. Here, we document the data on the magnitude of Rubella natural immunity among adolescent girls which is a crucial group in devising effective control strategies to prevent CRS.MethodsA cross sectional study involving 397 adolescent girls was conducted in the city of Mwanza involving five secondary schools. Socio-demographic and other relevant information were collected using pre-tested data collection tool. Rubella IgG antibodies were determined using enzyme immunoassay. The presence of Rubella IgG titers of >10 IU/ml indicated natural immunity.ResultsThe mean age of the study participants was 15.18 ± 1.48 years. Of 397 girls, 340 (85.6%) and 57 (14.4%) were from secondary schools representing peri-urban and rural areas, respectively. Out of 397 girls, 90.4% (95% CI: 87-93) were found to be naturally immune with median Rubella IgG antibodies titers of 56.7 IU/ml interquartile range (IQR): 40.8-137. The median Rubella IgG antibodies titers were significantly high in adolescent girls from families with high socio-economic status (63.96 vs. 47.13 IU/ml, P < 0.001) and in adolescent girls from peri-urban areas of the city (63.33 vs. 39.9 IU/ml, P < 0.001).ConclusionThe majority of adolescent girls in the city of Mwanza are naturally immune to Rubella virus. There is a need to compare the effectiveness of screening and vaccinating susceptible adolescent girls with the effectiveness of vaccinating all women of childbearing in controlling CRS in low-income countries.

Seroprevalance of Rubella in an Urban Infertility Clinic - Observations and Challenges Ahead.

Background:Rubella is a contagious viral illness that can be prevented by vaccination. Currently, vaccination is being offered to children and adolescents. Since an infection in pregnancy can have teratogenic effects, identification of susceptive women and vaccination before conception would be ideal.Aims:The aim of this study is to estimate the deficiency in immunity against Rubella in women planning conception.Settings and Design:Retrospective data collected from all women who attended a private assisted reproduction center for evaluation of infertility or for pre-pregnancy counseling between January 2012 and October 2017.Materials and Methods:Women underwent measurement of the rubella-specific immunoglobulin G using enzyme-linked fluorescent assay.Statistical Analysis:Data between age groups were compared using the Chi-squared test. P < 0.05 was considered statistically significant.Results:Of the 1671 cases analyzed, 418 lacked sufficient immunity and therefore needed vaccination.Conclusions:One in four women was at risk of developing rubella during pregnancy. It is important to screen and vaccinate susceptible women to reduce the risk of congenital rubella syndrome.

Vaccination in secondary school students expedites rubella control and prevents congenital rubella syndrome.

BackgroundIn order to control the spread of rubella and reduce the risk for congenital rubella syndrome, an additional rubella vaccination program was set up for all secondary school students since 2008 in Zhejiang, China.MethodsWe conducted a descriptive analysis of rubella incidence among different age groups from 2005 to 2015 and a serosurvey of female subjects aged 15–39 years to understand the possible effects of this immunization program.ResultsThe average annual rubella incidence rate had decreased from 15.86 per 100,000 population (2005–2007) to 0.75 per 100,000 population (2013–2015) in Zhejiang. The decrease in the rate of rubella incidence in girls aged 15–19 years was more accelerated (from 138.30 to 0.34 per 100,000) than in the total population during 2008–2015 (from 32.20 to 0.46 per 100,000). Of 1225 female subjects in the serosurvey, 256 (20.9%) were not immune to rubella. The proportion of subjects immune to rubella was significantly different among different age groups (Wald χ2 = 22.19, p = 0.000), and subjects aged 15–19 years old had the highest immunity (88.0%). Rubella antibody levels were significantly lower in women aged 25–30 years with 26.7% of them not immune, followed by the group aged 20–24 years (25.0%) and 30–35 years (24.5%).ConclusionsRubella vaccine included in the Expanded Program on Immunization together with vaccination activities for secondary school students can help in rubella control, particularly in targeted age groups in the program. Seroprevalence of antibodies to the rubella virus amongst the female population within childbearing age in Zhejiang, China, is still too low to provide immunity. In addition to vaccination programs in the secondary schools, rubella vaccination should also be encouraged in women of childbearing age, which can be done effectively combined with pre-marital examination in China.

Serological evidence of acute rubella infection among under-fives in Mwanza: a threat to increasing rates of congenital rubella syndrome in Tanzania.

BackgroundControl of rubella infection is essential for preventing congenital rubella syndrome (CRS) and one of the important steps is to define a target population for vaccination. Therefore this study was done to determine serological evidence of acute rubella infection among under-fives in order to anticipate the magnitude of rubella virus transmission in Tanzania.MethodsA cross-sectional study involving children aged between 1 and 59 months was conducted between September and October 2014 before national rubella vaccination campaigns commenced. Rubella IgM antibodies were detected using commercial indirect enzyme-linked immunosorbent assay (ELISA). Data were analyzed using STATA version 11.ResultsA total of230 under-fives were enrolled, their median age was 14 (Interquartile range (IQR) 7–26) months. The overall seroprevalence of rubella IgM antibodies was 10.9 % (25/230) with two confirmed cases of CRS. Two-sample Wilcoxon rank-sum test showed that the median age of rubella IgM seropositive children was significantly higher than that of IgM seronegative children (39 IQR: 18-51months vs. 14 IQR: 7–24 months, P < 0.001). On multivariate logistic regression analysis increase in age (OR: 1.07, 95 % CI; 1.03–1.1, P < 0.001) and residing in rural areas (OR: 8.07, 95 % CI; 1.43–45.6, P = 0.018) were independently found to predict acute rubella infection among under-fives.ConclusionOur findings indicate that rubella virus is prevalent in our setting posing a risk of transmitting to childbearing aged women hence increasing the risk of CRS. Increasing prevalence of acute infection with age in under-fives indicates the protective role of maternal antibodies among infants. The sustained vaccination programme of under-fives as effective measure to control CRS should be emphasized in developing countries.

Rubella immunity among pregnant women aged 15-44 years, Namibia, 2010.

The level of rubella susceptibility among women of reproductive age in Namibia is unknown. Documenting the risk of rubella will help estimate the potential burden of disease in Namibian women and the risk of congenital rubella syndrome (CRS) in infants, and will guide strategies for the introduction of rubella vaccine. A total of 2044 serum samples from pregnant Namibian women aged 15-44 years were tested for rubella immunoglobulin G antibody; the samples were obtained during the 2010 National HIV Sentinel Survey. The proportion of women seropositive for rubella was determined by 5-year age strata, and factors associated with seropositivity were analyzed by logistic regression, including age, gravidity, HIV status, facility type, and urban/rural status. Overall rubella seroprevalence was 85% (95% confidence interval (CI) 83-86%). Seroprevalence varied by age group (83-90%) and health district (71-100%). In the multivariable model, women from urban residences had higher odds of seropositivity as compared to women from rural residences (odds ratio 1.40, 95% CI 1.09-1.81). In the absence of a routine rubella immunization program, the high level of rubella seropositivity suggests rubella virus transmission in Namibia, yet 15% of pregnant Namibian women remain susceptible to rubella. The introduction of rubella vaccine will help reduce the risk of rubella in pregnant women and CRS in infants.

A theoretical estimate of the risk of microcephaly during pregnancy with Zika virus infection

ObjectivesThere has been a growing concern over Zika virus (ZIKV) infection, particularly since a probable link between ZIKV infection during pregnancy and microcephaly in the baby was identified. The present study aimed to estimate a theoretical risk of microcephaly during pregnancy with ZIKV infection in Northeastern Brazil in 2015. MethodsTemporal distributions of microcephaly, reported dengue-like illness and dengue seropositive in Brazil were extracted from secondary data sources. Using an integral equation model and a backcalculation technique, we estimated the risk of microcephaly during pregnancy with Zika virus infection. ResultsIf the fraction of Zika virus infections among a total of seronegative dengue-like illness cases is 30%, the risk of microcephaly following infection during the first trimester was estimated at 46.7% (95% CI: 9.1, 84.2), comparable to the risk of congenital rubella syndrome. However, the risk of microcephaly was shown to vary widely from 14.0% to 100%. The mean gestational age at delivery with microcephaly was estimated at 37.5 weeks (95% CI: 36.9, 39.3). ConclusionsThe time interval between peaks of reported dengue-like illness and microcephaly was consistent with cause–outcome relationship. Our modeling framework predicts that the incidence of microcephaly is expected to steadily decline in early 2016, Brazil.

Prevalence of rubella-specific IgG antibodies in unimmunized young female population.

Context:Rubella is a mild self-limiting disease all over the world; nevertheless, it is of significant public health importance due to its teratogenic effect of congenital rubella syndrome. Rubella vaccine is currently not included in the national immunization program in India. Rubella-specific IgG in the unvaccinated population is a marker of previous rubella infection. Rubella IgG estimation in children will provide data for initiation and necessary modification to the immunization strategy.Aims:In this background, this study was conducted with an aim to know the age-specific susceptibility of acquiring rubella infections and future risk of congenital rubella syndrome (CRS) among girls.Settings and Design:This was a community-based, observational study.Participants and Methods:The study was conducted at a randomly selected rural area Mavoor Panchayath of Kozhikode District, Kerala, among adolescent girls. The estimation of rubella-specific IgG antibody was done by quantitative enzyme-linked immunosorbent assay method. IgG titer value of >15 IU was taken positive, 8–15 IU as equivocal, and <8 IU as negative.Statistical Analysis Used:Statistical analysis was performed using Statistical program for Social science version 16 for Windows. Chi-square test was applied to find out significant difference and Fisher's exact test wherever applicable.Results:The data and blood sample collection was done from 250 girls. The mean IgG titer was 151.93 ± 128.78 IU, and as per the criteria, 68.3% were positive, 28.5% were negative, and 3.2% were equivocal. At this age, majority (68.3%) of the girls get protection by natural infection without any vaccine. Some girls (32%) may remain susceptible to infection during adulthood and pregnancy.Conclusions:Natural rubella infection was widely prevalent among child population and at this age. An immunization policy recommending rubella-containing vaccine is highly desirable to prevent rubella and CRS.

Rubella: An overview of the symptoms and complications

Although rubella is usually a mild condition, which resolves spontaneously, it can lead to serious complications in pregnant women, including the risk of congenital rubella syndrome. This article looks at the symptoms, complications and prevention of rubella.

“Rubella seroprevalence of the 9–15 years old female children with congenital heart anomalies: Is vaccination necessary at puberty?’’

Abstract Background The risk of getting baby with congenital rubella syndrome (CRS) increases 10 folds for a rubella seronegative female if she has an accompanying congenital anomaly (cardiac defect, deafness, cataract etc.) and infected during pregnancy. Aim To define the rubella seroprevalence of the female children with congenital anomaly (cardiac anomalies) and vaccinate them before reaching the childbearing age due to the increased risk of CRS. Methods 9–15 years old 240 female children followed in our hospital between 15th March, 2013–15th March, 2014 were included. They were non vaccinated against rubella. The correlations between the rubella seroprevalences and the age, maternal educational status, socioeconomic levels, accompanying cardiac diseases of these children and their parents were analyzed statistically. Results The mean age was 11.5 ± 1.87 years. 38 female children out of 240 were rubella IgG negative, so the seronegativitiy and seropositivity ratios were 15.8% and 84.2% respectively (9–10 years group 20%–80% and 14–15 years 12.5%–87.5%) at 95% confidence interval(0.60–1.19).However, the correlations between sociodemographic factors and the rubella seroprevalences were statistically insignificant (p > 0.05). Conclusion Our seronegativity ratio is low, but not negligable.We recommend the rubella vaccination of the female children at puberty to prevent the CRS especially for those with accompanying congenital anomalies.

Congenital rubella syndrome and immunity status of immigrant women living in southern Italy: A cross-sectional, seroepidemiological investigation

A National Programme to eliminate Measles and Congenital Rubella was implemented in Italy in 2003. It aimed to achieve elimination by 2010 in line with the targets set by the World Health Organization (WHO) European Region. The aim of this study was to determine the prevalence of rubella antibodies in samples of immigrant women living in southern Italy. A seroepidemiologic study was conducted from 1 January 2008 to June 30 2009. 489 immigrant women resident in Messina were enrolled in the study. The detection of rubella antibodies was performed using a microparticle enzyme immunoassay. A questionnaire was used to collect demographic data including age, country of origin, educational level and knowledge about rubella. The results of the seroepidemiological survey to detect rubella antibodies showed an overall seropositivity rate of 82.2%. Generally, knowledge about rubella and congenital rubella syndrome was lacking. Many immigrants are susceptible to rubella and may benefit from vaccination programmes. Additional catch-up vaccination strategies are urgently needed to eliminate the risk of congenital rubella syndrome for future generations.

Apropos “Congenital rubella syndrome and immunity status of immigrant women living in southern Italy: A cross-sectional, seroepidemiological investigation”

Summary Objectives A National Programme to eliminate Measles and Congenital Rubella was implemented in Italy in 2003. It aimed to achieve elimination by 2010 in line with the targets set by the World Health Organization (WHO) European Region. The aim of this study was to determine the prevalence of rubella antibodies in samples of immigrant women living in southern Italy. Method A seroepidemiologic study was conducted from 1 January 2008 to June 30 2009. 489 immigrant women resident in Messina were enrolled in the study. The detection of rubella antibodies was performed using a microparticle enzyme immunoassay. A questionnaire was used to collect demographic data including age, country of origin, educational level and knowledge about rubella. Results The results of the seroepidemiological survey to detect rubella antibodies showed an overall seropositivity rate of 82.2%. Generally, knowledge about rubella and congenital rubella syndrome was lacking. Conclusion Many immigrants are susceptible to rubella and may benefit from vaccination programmes. Additional catch-up vaccination strategies are urgently needed to eliminate the risk of congenital rubella syndrome for future generations.

風疹HI 抗体価別によるワクチン接種ブースターの長期効果

This study was performed to clarify which titers of a pre-existing antibody could be efficiently boosted by vaccination and to assess the persistence of the antibodies. Two hundred healthy volunteer students with HI antibody titers of < or = 1:32 were enrolled. There were 6-16% of subjects with the negative HI antibody who had B-cell memory against rubella, because the EIA-IgM antibody remained negative and/or the avidity of the EIA-IgG antibody was high after vaccination. Furthermore most of them had already been vaccinated just once before. The ratio of those in whom the antibody levels increased significantly at one month after vaccination were 98%, 87%, 67% and 32% in subjects with an HI antibody titer of <1:8, < or =1: 8, < or =1:16 and < or =1:32 at pre-vaccination, respectively. The titers decreased significantly at two years after vaccination, however the ratio of decrease under each original level being 4%, 21.9%, 42.6% and 73.5% in each group of <1:8, < or =1: 8, < or =1:16 and < or = 1: 32, respectively. In comparison with the numbers of the subjects with <1: 8, the ones with < or = 1: 8, < or = 1:16 and < or = 1:32 increased 1.5-, 2.5- and 4.7-fold, respectively. Therefore, the recommendation of an HI antibody titer < or = 1:16 for vaccination in Japan is thought to be loose, although this is to decrease the risk of congenital rubella syndrome. We think that a new assay for cellular immunity for rubella should be developed in the future in order to ascertain whether congenital rubella syndrome will be prevented or not.

Ongoing rubella outbreak among adults in Tokyo, Japan, June 2012 to April 2013

A large rubella outbreak has been occurring in Tokyo, Japan since June 2012. Rubella vaccination, introduced in Japan in 1976, has targeted different age groups, resulting in a large proportion of the current population being unvaccinated. Rubella cases reported in Tokyo from 2 January 2012 to 21 April 2013 were analysed. A clinical case had generalized maculopapular rash, fever and lymphadenopathy; a laboratory-confirmed case was a clinical case with a positive serology or polymerase chain reaction test for rubella. A descriptive analysis of cases by age, sex, vaccination history and other epidemiological information was conducted. A total of 2382 cases were reported from all areas of Tokyo. Three-quarters were male (n=1823; 76.5%); the highest number of cases occurred among males aged 35-39 years and females aged 20-24 years. About a third of males (27%) and females (32%) reported never receiving rubella vaccination, with 68% and 56%, respectively, having an unknown vaccination status. This outbreak reflects the changing, yet incomplete, immunization policies for rubella in Japan that may increase the risk of congenital rubella syndrome (CRS). To suppress the outbreak of rubella and prevent CRS cases, we recommend vaccination for the entire susceptible population.