Risk Of Congenital Rubella Syndrome Research Articles

Directly transmitted infections modeling considering an age-structured contact rate-epidemiological analysis

Many directly transmitted diseases present a strong age dependent pattern of infection. Such dependency is analyzed by a mathematical model encompassing an age-structured pattern of contacts. From an age-structured contact rate modeling, we estimate the parameters related to the contact rate based on the age dependent force of infection calculated from a seroprevalence data obtained from a nonimmunized population. This model, with parameters completely determined, is used to assess the effects of vaccination strategies. This is done by calculating the new equilibrium age dependent force of infection and its correlated variables: the average age of the acquisition of the first infection, the rate of new cases of infection, and the risk of Congenital Rubella Syndrome. Also, we present a rough estimation of the basic reproduction ratio and the vaccination rate at which the disease can be considered eradicated (threshold).

Changing Epidemiology of Congenital Rubella Syndrome in the United States

To describe clinical presentation and epidemiology of US infants with congenital rubella syndrome (CRS) and to identify missed opportunities for maternal vaccination, data from CRS cases reported to the National Congenital Rubella Syndrome Registry (NCRSR) from 1985 through 1996 were analyzed. Missed opportunities for maternal vaccination were defined as missed postpartum, premarital, and occupational opportunities, that is, times when rubella vaccination is recommended but was not given. From 1985 through 1996, 122 CRS cases were reported to the NCRSR. The most frequent CRS-related defect was congenital heart disease. Of the reported infants with CRS, 44% were Hispanic. Of 121 known missed opportunities for rubella vaccination among 94 mothers of infants with indigenous CRS, 98 (81%) were missed postpartum opportunities. CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. Missed opportunities for postpartum rubella vaccination were identified for 52% of indigenous CRS cases.

Changing epidemiology of congenital rubella syndrome in the United States.

To describe clinical presentation and epidemiology of US infants with congenital rubella syndrome (CRS) and to identify missed opportunities for maternal vaccination, data from CRS cases reported to the National Congenital Rubella Syndrome Registry (NCRSR) from 1985 through 1996 were analyzed. Missed opportunities for maternal vaccination were defined as missed postpartum, premarital, and occupational opportunities, that is, times when rubella vaccination is recommended but was not given. From 1985 through 1996, 122 CRS cases were reported to the NCRSR. The most frequent CRS-related defect was congenital heart disease. Of the reported infants with CRS, 44% were Hispanic. Of 121 known missed opportunities for rubella vaccination among 94 mothers of infants with indigenous CRS, 98 (81%) were missed postpartum opportunities. CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. Missed opportunities for postpartum rubella vaccination were identified for 52% of indigenous CRS cases.

Rubella and pregnancy: failed prevention policies

Objective: Postpartum rubella immunization can prevent 33–50% of all cases of congenital rubella. Our purpose was to assess missed opportunities for postpartum rubella vaccination. Methods: A retrospective prenatal record review of 304 women attending a high risk obstetrics clinic was done. The rubella status on the first prenatal visit was recorded. Rubella status was determined by immunoassay (ELISA) and reported as immune, uncertain, or nonimmune. For rubella nonimmune women their ethnicity, age, parity, and place of delivery were recorded. Results: Fifteen (4.9%) of the 304 women were nonimmune to rubella. Of the 15 women, 6 were white, 4 were Afro-American, and 5 were Hispanic. The mean age was 30.1 ± 6.2 y (range 20–42 y). Thirteen had given birth at least once (range 1–4), while two were nulliparous. Eleven of the 13 women gave birth in the USA, while two gave birth in South America. These eleven women gave birth 20 times without receiving rubella counseling or vaccination. Conclusion: Recommendation for postpartum rubella vaccination of nonimmune women should be adhered to in order to decrease the risk of congenital rubella syndrome.

Risk of Chronic Arthropathy Among Women After Rubella Vaccination

A review by the Institute of Medicine found a possible relationship between rubella vaccination and chronic arthritis among women. To evaluate the risk of persistent joint and neurologic symptoms in rubella seronegative women subsequently vaccinated with RA 27/3 rubella vaccine. Retrospective cohort study based on computerized laboratory data and medical record review. Records were reviewed for symptoms occurring within 2 years before and after the date of serological testing and to identify vaccinees. Possible cases were evaluated by a rheumatologist blinded to serological findings and vaccination status. Large health maintenance organization in northern California. Women aged 15 to 59 years serotested for rubella during 1990 with continuous health plan membership for 2 years before and after the date of their serological test. Seronegative women immunized within 1 year of serotesting (n=971) were defined as exposed. Primary comparison groups included all unvaccinated, seronegative women (n=924) and randomly selected seropositive, unvaccinated women (n=2421) matched to exposed subjects on serological test date and age (+/-3 years). Prevalence and incidence of chronic joint and neurologic symptoms during 1-year follow-up period stratified by age and serological findings, immunization, and postpartum status. No significantly increased risk was associated with receipt of rubella vaccine for any outcome except for prevalence of carpal tunnel syndrome in vaccinated women at least 30 years old compared with seropositive, unvaccinated women (2.9% vs 1.4%; P=.03). A total of 34 women had onset of conditions within the 1-year follow-up period; 9 of these were in the group of seronegative, immunized women, of whom 6 had onset of symptoms within 6 weeks of vaccination. Among these 6 women, symptoms included transient arthritis or arthralgias (<6 weeks duration) in 4 women, arthralgia of indeterminate chronicity in 1 woman, and carpal tunnel syndrome in 1 woman. Postpartum women across all groups were less likely to be seen for nontraumatic arthropathies than nonpostpartum women (4.5% vs 7.2%, P=.08 in vaccinated women; 4.8% vs 8.1%, P=.09 in seronegative controls; and 4.8% vs 10.0%, P=.01 in seropositive controls). In this large retrospective cohort analysis there was no evidence of any increased risk of new onset chronic arthropathies or neurologic conditions in women receiving the RA 27/3 rubella vaccine. These data support the continued vaccination of rubella-susceptible women to reduce the risk of congenital rubella syndrome.

Congenital Rubella Syndrome Among the Amish—Pennsylvania, 1991-1992

From February through May 1991, an outbreak of rubella occurred among the Amish in Pennsylvania that was part of a widespread rubella outbreak reported among the Amish in at least six states during 1991 (1). The Pennsylvania Department of Health (PDH), in cooperation with CDC, conducted an investigation to document cases of rubella among pregnant Amish women in Lancaster County and a cohort study to estimate the risk for congenital rubella syndrome (CRS) among infants born to Amish mothers from November 1, 1991, through January 31, 1992. This report summarizes investigation and study findings.

Rubella Antibody Titers in Vaccinated and Nonvaccinated Women and Results of Vaccination during Pregnancy

In the Federal Republic of Germany (FRG), the selective rubella vaccination strategy used in the United Kingdom was followed until 1980, when vaccination of children was introduced. According to surveys in the Stuttgart area, so far no significant reduction in the rate of seronegativity (10%) among postpubertal women has occurred. However, among women with a history of vaccination, the rate of seronegativity has decreased to 2.4%o. For the vaccinated group the percentage of women with low levels of rubella antibody (23%) is significantly higher than for women without a history of vaccination (9.5%). In the study of the outcome of accidental vaccination during pregnancy or shortly before conception, which has followed up 365 women so far, 194 infants have been born without signs of congenital rubella syndrome (CRS). Also no cases of CRS were noted in 98 infants born to women known to be susceptible to rubella at the time of vaccination. When the data obtained in the United States and Stuttgart on the outcome of accidental vaccination are combined, the theoretical maximum risk of CRS calculated is as low as 1.2%. In the Federal Republic of Germany (FRG), rubella vaccination commenced in 1969 with use of the Cendehill vaccine. The vaccine was administered on an individual basis among seronegative, postpubertal women. In 1971 prenatal screening for rubella antibody and postpartum vaccination were introduced. In 1974-1975 the FRG, following the strategy of the United Kingdom, introduced in most states the vaccination of 10-14-year-old schoolgirls with Cendehill or HPV-77 DE-5 vaccine without assessing immune status before or after vaccination. The upper age limit of 14 years was chosen to avoid vaccinating girls who might be pregnant. Mostly schoolgirls ages 12-13 years were vaccinated. When the trivalent (measles, mumps,

Rubella antibody titers in vaccinated and nonvaccinated women and results of vaccination during pregnancy.

In the Federal Republic of Germany (FRG), the selective rubella vaccination strategy used in the United Kingdom was followed until 1980, when vaccination of children was introduced. According to surveys in the Stuttgart area, so far no significant reduction in the rate of seronegativity (10%) among postpubertal women has occurred. However, among women with a history of vaccination, the rate of seronegativity has decreased to 2.4%. For the vaccinated group the percentage of women with low levels of rubella antibody (23%) is significantly higher than for women without a history of vaccination (9.5%). In the study of the outcome of accidental vaccination during pregnancy or shortly before conception, which has followed up 365 women so far, 194 infants have been born without signs of congenital rubella syndrome (CRS). Also no cases of CRS were noted in 98 infants born to women known to be susceptible to rubella at the time of vaccination. When the data obtained in the United States and Stuttgart on the outcome of accidental vaccination are combined, the theoretical maximum risk of CRS calculated is as low as 1.2%.

Fetal risk associated with rubella vaccine: an update.

One hundred nineteen women susceptible to rubella received RA27/3 vaccine, 94 received either Cendehill or HPV-77 vaccine, and one received a vaccine of unknown strain in the three months before or after their estimated date of conception. They gave birth to 216 living infants free of abnormalities compatible with the congenital rubella syndrome (CRS). The maximum theoretical risk for CRS for these infants was 1.7%. Four of these infants born to susceptible women had laboratory evidence of subclinical infection (three after receiving Cendehill or HPV-77 vaccines and one after receiving RA27/3 vaccine) but were normal at birth and at subsequent follow-up examinations. Rubella virus was isolated from the products of conception for only 3% (1 of 32) of cases involving susceptible women who received RA27/3 vaccine; the reported rate of virus isolation for Cendehill and HPV-77 vaccine is 20%. The available data indicate that if vaccination occurs within three months of conception, the risk is negligible. However, since the actual risk may not be zero, women known to be pregnant should not be vaccinated, and conception should be avoided for three months after vaccination.