Rubella Immunization Research Articles

ANALISIS DETERMINAN YANG MEMPENGARUHI KEPATUHAN IBU TENTANG PEMBERIAN IMUNISASI MEASLES RUBELA PADA BALITA DI PUSKESMAS DELI TUA KABUPATEN DELI SERDANG

The purpose of this study was to analyze what determinants influence maternal adherence regarding Measles Rubella immunization in infants. This type of research is quantitative research with cross sectional study design. The population in this study were all mothers who have children under five in the Delitua Health Center with asample size of 36 people. Data collection methods obtained directly from respondents through interviews using interview guidelines (questionnaire). Secondary data were obtained from Obstetric Gynecology records in the midwifery room and the medical records of the Deli Tua Health Center. Data retrieval of information will be done by interviewing Delitua Health Center with a questionnaire that has fulfilled the elements of validity and reliability. The results of this study are factors that greatly affect mothers not giving MR immunization in infants is a factor of family support with a value of 1.397 and information source factors. It is expected that health workers will provide more health information to the public that MR immunization is very important for toddlers to prevent Measles Rubella disease.

Risk Factors for Rubella Transmission in Kuyu District, Ethiopia, 2018: A Case-Control Study.

Background Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus. Despite increased episodes of rubella epidemics (127 outbreaks in 2009–2015), rubella national vaccination is not yet introduced in Ethiopia. In January 2018, an increase of fever and rash cases was reported in Kuyu District of Oromia. We investigated the outbreak to confirm rubella, determine risk factors, and guide interventions. Methods We identified rubella cases from health centers and conducted a case-control study (1 case : 2 controls) with 150 participants, from March 12 to 15, 2018. Cases were people who presented with fever and rash or laboratory-confirmed cases. Controls were age matched (<15 yrs) with neighbors selected purposively. We interviewed parents by a structured questionnaire and observed the housing condition. Variables include sex, age, vaccination status, family size, contact history, housing condition, and travel history. Simple logistic regression was used to select the candidate variable at a P value <0.25. We identified risk factors at P < 0.05 with AOR and 95% CI by multivariate logistic regression. Results We identified 50 cases (with no death), and out of them, seven (14%) were confirmed cases (rubella IgM positive). The mean age of the cases was 6 ± 3 years and of the controls was 8 ± 4 years. Family size >5 (AOR = 2.4; 95% CI: 1.5–4.11), not well-ventilated living room (AOR = 4.7; 95% CI: 3.43–8.12), history of contact with rash people (AOR = 2.2; 95% CI: 1.6 3.5), no history of diarrhea in the last 14 days (AOR = 0.8; 95% CI: 0.6–0.9), and no history of vitamin A supplementation (AOR = 2.9; 95% CI: 1.7–2.6) were significant factors for rubella infection. Conclusions We identified rubella outbreak in the rural area. Crowded living condition, large family size, not receiving vitamin A in the last 6 months, and contact with people with symptoms of rubella were factors that drove the outbreak, while not having diarrhea in the last 14 days was the protective factor. We recommended the introduction of rubella immunization national programs and advocated the policy on rubella vaccine and strengthening surveillance for congenital rubella syndrome and rubella.

Measles and rubella immunity in the population of Bhutan, 2017

BackgroundIn 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps existed that could threaten Bhutan’s elimination status. MethodsA nationwide, three-stage, cluster seroprevalence survey was conducted among individuals aged 1–4, 5–17, and >20 years in 2017. Demographic information and children’s vaccination history were collected, and a blood specimen was drawn. Serum was tested for measles and rubella immunoglobulin G (IgG). Frequencies, weighted proportions, and prevalence ratios for measles and rubella seropositivity were calculated by demographic and vaccination history, taking into account the study design. ResultsOf the 1325 individuals tested, 1045 (81%, 95% CI 78%–85%) were measles IgG seropositive, and 1290 (97%, 95% CI 95%–99%) were rubella IgG seropositive. Rubella IgG seropositivity was high in all three age strata, but only 47% of those aged 5–17 years were measles IgG seropositive. Additionally, only 41% of those aged 5–17 years who had documented receipt of two doses of measles– or measles-rubella–containing vaccine were seropositive for measles IgG, but almost all these children were rubella IgG seropositive. ConclusionsAn unexpected measles immunity gap was identified among children 5–17 years of age. It is unclear why this immunity gap exists; however, it could have led to a large outbreak and threatened sustaining of measles elimination in Bhutan. Based on this finding, a mass vaccination campaign was conducted to close the immunity gap.

High rate of rubella seronegativity in perinatally-infected HIV women of childbearing age: A case-control study

Rubella infection is a vaccine preventable disease. Maternal infection during pregnancy may lead to congenital infection and severe foetal malformations. Thanks to antiretroviral therapy, perinatally HIV-infected women have better prognosis and are now experiencing pregnancy. We evaluated the rate of rubella seronegativity in a cohort of HIV perinatally-infected women of childbearing age. A high rate of seronegativity was found in this group as compared to age-matched non-perinatally infected HIV-infected women (34.5% vs 6.90%, p < 0.01). MMR administration before rubella testing was identified in 75.8% of perinatally-infected women (22/29) with a mean of 2 doses (range: 1–3 doses). HIV perinatally-infected women of childbearing age should be screened repeatedly for rubella immunity.

Serologic Confirmation of Rubella Immunity During Index Pregnancy Can Eliminate Re-testing in Later Pregnancies [11F

INTRODUCTION: Vaccination ended endemic rubella transmission in America with the last documented case of congenital rubella syndrome in 2004. The American College of Obstetrics and Gynecology recommends rubella susceptibility screening as a prenatal lab for all pregnancies. As no studies in the United States support or contest this, we explored whether women with documented immunity during their index pregnancy demonstrated serologic evidence of Rubella immunity during subsequent gestations. METHODS: A retrospective cohort study of Medicaid insured pregnant women receiving prenatal care at an urban clinic from 2012-2017 was undertaken. Only those with documented immunity during their initial antenatal visit and repeat serologies during subsequent pregnancies were included. Immunity was defined as rubella IgG antibodies titers greater than 10 IU/mL. All patient protected health information has been de-identified and patient faces are entirely covered. RESULTS: Five hundred women were screened for study eligibility with rubella serologies obtained in 318 during both index and subsequent pregnancies. In this cohort, 94.3% (n=300) were noted to be immune during their index pregnancy. Among this immunized population, 98.3% continued to demonstrate serologic immunity during subsequent pregnancies. There was no relationship between the time interval between pregnancies and rubella sero-conversion rates. CONCLUSION: Our data indicates 98% of women with rubella immunity during their first pregnancy maintain immunity during subsequent pregnancies. Given rates of retained immunity and low disease prevalence with routine vaccination, this study suggests reconfirmation of rubella immunity during subsequent pregnancies is unnecessary. Given the small sample size and retrospective nature of data, large, prospective studies evaluating the sero-conversion rate between pregnancies and the cost-effectiveness of screening prior to every pregnancy are warranted.

Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey

BackgroundSerological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. MethodsDried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). ResultsOverall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). ConclusionSeroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.

The seroprevalence of Rubella in pregnant women in Turkey: a meta-analysis research of 90988 Rubella IgM, 84398 Rubella IgG, and 522 avidity results.

Objective:Rubella infection prevalence in pregnant women can vary from country to country, or even across regions in the same country. In this metaanalysis, the seroprevalence Rubella among pregnant women in Turkey in the last decade was evaluated.Materials and Methods:Studies conducted in Turkey between 2007 and 2017 were analyzed, and differences in seroprevalence between provinces were compared by evaluating Rubella immunoglobulin (Ig)-G, IgM, and IgG avidity results in pregnancy in this period. A data search was performed using the search terms Rubella, kızamıkçık, gebe, hamile, pregnancy, Türkiye, Turkey in Google Scholar, PubMed, Web of Science, Türk Medline, and the YÖK thesis database center.Results:A total of 26 articles associated with the seroprevalence of Rubella among pregnant women in Turkey were enrolled in the meta-analysis. As a result of an analysis of 84398 Rubella IgG, and 90988 Rubella IgM serology tests among pregnant women in 26 studies; Rubella IgG and IgM seroprevalence rates in pregnant woman in Turkey were found as 93.47% (95% CI: 91.72 to 95.03) and 0.783% (95% CI: 0.505 to 1.120), respectively. Rubella IgG low, intermediate, and high avidity rates were 4.66% (95% CI: 0.969 to 10.906), 7.51% (95% CI: 5.101 to 10.345), and 93.55% (95% CI: 82.584 to 99.311), respectively.Conclusion:The Rubella IgG seropositivity rate in Turkey among pregnant woman is high, whereas it is low for IgM. These rates may be considered as the result of successful immunization policies and practices. In a few provinces, it is necessary to revise the Rubella immunization procedures and adult vaccination strategies should be developed in order to control Rubella infections in adults, including pregnant women.

Assessment of immune susceptibility to rubella among pregnant women in Hilla City

Background: Rubella (German measles) is a viral infection, which is contagious disease and self-limiting. Nonimmune adult women may be infected during pregnancy; the 1st-trimester rubella infection is very dangerous and may lead to miscarriage or severe fetal malformation (congenital rubella syndrome). That is why basic epidemiological data concerning rubella (immunity and seropositivity) is necessary for health planners and health-care providers in preventive medicine. Objective: The main objective of the study was to assess the immune susceptibility to rubella among pregnant women by checking serum immunoglobulin (Rubella IgG) using enzyme-linked immunosorbent assay (ELISA) test. Materials and Methods: The study protocol was approved by the Ethical Committee of Babylon University, College of Medicine. A cross-sectional study was to investigate the seroprevalence of rubella infection and associated possible risk factors among pregnant women. A total of 100 pregnant women in their first trimester of pregnancy were enrolled from four different primary health-care centers in Al-Hilla city. Filling a prepared structured questionnaire followed by ELISA test to detect IgG against rubella in the blood samples was collected. Results: A total of 100 pregnant women with a mean age of 24.78 ± 5.74 years who are in their first trimester of pregnancy, the study shows that 58 (58%) of the pregnant women have negative IgG against rubella (none immune), whereas the remaining 42 (42%) have positive IgG (either by previous infection with rubella or through vaccination). Living in rural area was highly significant among the seronegative pregnant women, 32 out of 58 seronegative women (55.2%), 41 (97%) of the seropositive group had regular vaccination program, whereas 36 (62%) of the seronegative group had irregular or unknown vaccination history, and 18 (31%) have no vaccination at all with a P < 0.001. The primary level of education was dominant among all the studied women with a P = 0.017. Conclusion: A high percentage of women of reproductive age group, mainly those living in the rural area are considered (at risk) population which necessitates an action by the health services provider.

Seroprevalence of Rubella Immunity (IgG Antibody) among Female Health Care Workers in a Hospital in Southern India

Seroprevalence of Rubella Immunity (IgG Antibody) among Female Health Care Workers in a Hospital in Southern India

Enhancing Preparedness against Rubella at the Workplace: Proactive Prevention Efforts by the Tokyo Metropolitan Government.

In the 2012-2013 rubella epidemic in Japan, most transmissions in Tokyo occurred at workplaces, especially among men aged 20-49 years. This tendency was likely related to previous rubella immunization policies that prioritized female adolescents. Since 2015, the Tokyo Metropolitan Government has been promoting a project to prevent rubella and other infectious diseases in workplaces. Companies participate by choosing one or more of three options: (i) acquire fundamental understanding of infectious diseases, (ii) develop a Business Continuity Plan (BCP) for infectious diseases in the workplace, and (iii) increase rubella antibody prevalence in employees.Criteria for accomplishment are (i) at least 80% of employees complete the infectious disease training modules or (ii) produce a BCP and (iii) at least 90% of employees demonstrate the presence of antibodies at levels sufficient for preventing rubella. As of July 2018, 39.8% (n ＝ 90) of the 226 companies that began participating in 2015-2017 had met at least one accomplishment criteria (Option I, 42.7% of 192 companies; Option II, 19.3% of 140; and Option III, 17.0% of 53). The main project challenges were recruiting companies and following participating companies. Although early in its implementation, this project has made considerable contributions toward rubella elimination in Japan.

Rubella immunity and serum perfluoroalkyl substances: Sex and analytic strategy.

BackgroundPerfluoroalkyl substances (PFASs) have been associated with decreased immunity to childhood tetanus and diphtheria immunizations. If these vaccinations are vulnerable to influence from PFASs, questions arise about associations with other common inoculations.ObjectiveTo examine whether serum PFASs were associated with reduced immunity to rubella immunization, and whether interactions with sex or ethnicity warranted analytic stratification. Usually, toxicology analyses are calculated controlling for race and sex. However, sex differences in immune function have been reported and a reduction of immunity to rubella in women could pose risks such miscarriage.MethodsWe analyzed a nationally representative sample of individuals ≥ 12 years from the National Health and Nutrition Examination Survey (NHANES) for years 1999–2000 and 2003–2004 for whom PFAS measures were available. Our analytic strategy was to start with separate analyses for youth and adults controlling for several covariates including ethnicity and sex, as well as the interaction of these terms with PFASs. If there was a main effect of PFASs and an interaction term, we would stratify analyses of effect size. The outcome variable was Rubella IgG titers by quartile of perfluoroalkyl substances.ResultsAfter exclusion for missing data, the analyzed sample contained 581 adult women, 621 adult men, and 1012 youth. There was no significant effect of PFASs on immunity in youths but a significant effect of both PFOA and PFOS in adults, as well as a significant interaction of PFOA x sex and a borderline significant interaction of PFOS x sex. When effect size analyses were stratified by sex, a significant association between rubella titres and PFOA was found in men but not women and PFOS was not significant in either sex.ConclusionsThese results support our earlier studies showing sex specific responses to PFASs and indicate the importance of thinking carefully about analytic strategies in population based toxicology research.

Rubella immunity in infertility patients

Rubella immunity in infertility patients

High BMI: A New Determinant of Impaired Rubella Immunity During Pregnancy?

See accompanying article, pg. 1392.

Impact of Maternal BMI on Rubella Nonimmunity at Antenatal Screening.

The aim of this study was to examine the relationship between BMI and the incidence of rubella nonimmunity among pregnant women with regard to the World Health Organization categories. This was a retrospective cohort study of 117,063 eligible gravidas, managed between 1998 and 2015 in a university hospital of Hong Kong, China. BMI at antenatal booking was banded using the following World Health Organization definitions: < 18.5 kg/m2 , 18.5 to 24.9 kg/m2 , 25.0 to 29.9 kg/m2 , and ≥30.0 kg/m2 . Maternal rubella nonimmunity status by BMI was assessed. Incidence rates were also assessed after adjusting for maternal advanced age, short stature < 151 cm, mothers' birthplace, and postobstetric history covariates. Rubella nonimmunity incidence increased as the BMI increased (P < 0.001). Gravidas with high BMI were more likely to be nonimmune if born in Hong Kong (odds ratio [OR], 1.234; 95% CI: 1.159-1.315; P < 0.001) compared with those born outside of Hong Kong (OR, 1.066; 95% CI: 0.997-1.141; P = 0.063). After adjusting for covariates, women with BMI ≥ 25 kg/m2 had 1.127 (P < 0.001; 95% CI: 1.074-1.182) greater odds of being nonimmune. High maternal BMI (≥ 25.0 kg/m2 ) is associated with reduced rubella immunity, an effect confined to gravidas with almost complete vaccine coverage in childhood.

Rubella infection in pregnancy and congenital rubella in United Kingdom, 2003 to 2016.

Rubella vaccination has been included in the United Kingdom’s (UK) routine childhood schedule for nearly 30 years. The UK achieved World Health Organization (WHO) elimination status in 2016 and acute rubella infections are rare. In the period 2003–16, 31 rubella infections in pregnancy (0.23 per 100,000 pregnancies) were identified through routine surveillance, of which 26 were in women who were born abroad. Five of the 31 rubella infections led to congenital rubella syndrome in the infant and three had confirmed congenital rubella infection without congenital rubella syndrome. An additional seven babies were identified with congenital rubella syndrome, although rubella infection in pregnancy had not been reported. Place of birth was known for six of these seven mothers, all of whom were born outside the UK, and in five cases maternal infection was acquired abroad. WHO Europe has set targets for measles and rubella elimination and prevention of congenital rubella syndrome by 2015. Vaccination uptake and rubella immunity is high in the UK population and most infections in pregnancy since 2003 were acquired abroad and in unvaccinated women. Every contact with a health professional should be used to check that women are fully immunised according to UK schedule.

Topical issues of vaccination and epidemiological surveillance over measles and rubella in Ukraine.

The analysis of measles and rubella morbidity, the state of their vaccination in Ukraine was carried out. Despite decades of preventive vaccination, there is a 5-6 years’ cyclicity of measles epidemic process at present time. Measles morbidity increased 46.8 times in 2017 in comparison with 2016. Elevated rates of rubella epidemic morbidity were registered in 2004 and 2011. There was decrease of routine measles and rubella immunization coverage in the period from 2009 to 2016. Critically low rates were noted in 2016 – 45.5% (vaccination) and 30.2% (revaccination). In spite of progress in the measles and rubella vaccination in 2017 (93.3% – vaccination and 90.7% – revaccination), Ukraine has not achieved the immunization coverage (≥95.0%) necessary to interrupt these pathogens circulation. The national laboratory and a network of regional ones, in-system of the Global Measles and Rubella Laboratory Network, were established in Ukraine to ensure high-quality performance of epidemiological surveillance. Genotyping of the clinical samples from Ukrainian measles and rubella patients is carried out in the WHO Regional Reference Laboratory (Luxembourg). Different genetic lines of the measles virus with prevalence of D8 genotype were indicated to circulate in Ukraine. The genotype B3 was also identified and the genotype D9 was isolated for the first time. In the furtherance of the goal of rubella and measles elimination in Ukraine, standard international approaches to clinical, laboratory and epide­miological diagnosis of cases, investigation of viruses transmission chains and detection of endemicity cases are in the course of implementation. Quality of the executing activities is assessed according to relevant standard indicators.

Australian rubella serosurvey 2012–2013: On track for elimination?

BackgroundThe World Health Organization has targeted rubella virus for elimination regionally. Australia was one of the first countries to implement a nationally funded rubella immunisation program, in 1971, and conducts regular national rubella serosurveillance studies. We aimed to estimate the seroprevalence of rubella-specific IgG antibody in the Australian population by age and sex in 2012–2013, to compare the results with three previous serosurveys conducted in 1996–1999, 2002 and 2007 and to estimate the effective reproduction numbers (Rn). MethodsThis study used 2729 serum and plasma specimens, randomly selected from a specimen bank collected in 2012–2013 across Australia. Age groups included in the sample ranged from 1 to 49 years. Sera were tested for rubella-specific IgG-antibody using the Enzygnost anti-rubella IgG enzyme immunoassay and classified as positive, negative or equivocal according to rubella-specific IgG concentrations of >7 IU/ml, <3 IU/ml and 3–7 IU/ml, respectively. ResultsThe overall proportions seropositive, seronegative and equivocal for rubella-specific IgG were 92.1% (95% CI, 91.0–93.2), 6.7% (95% CI, 5.7–7.7) and 1.2% (95% CI, 0.8–1.6), respectively. The proportion of males seropositive was significantly lower than females in the 30–34 (83.1% vs. 96.8%, p = 0.003), 35–39 (86.1% vs. 96.3%, p = 0.02) and 40–44 (86.1% vs. 95.7%, p = 0.03) year age groups. Rn for rubella in 2012–2013 was estimated to be 0.33 (95% CI 0.28–0.39). DiscussionThe 2012–2013 national serosurvey showed levels of rubella-specific IgG seropositivity in the Australian population are relatively high with no evidence of decrease compared to previous serosurveys conducted in 1996–1999, 2002 and 2007. The lower proportion of seropositive males aged 30–44 years likely reflects the initial immunisation program targeting females only. To our knowledge this study represents the longest period of serosurveillance following introduction of a nationally funded rubella immunisation program. The lack of evidence of decreasing rubella-specific IgG seropositivity is therefore reassuring for Australia and other countries with longstanding high vaccine coverage.

Rubella seroprevalence among pregnant women in Beijing, China

BackgroundRubella infection in pregnant women can result in serious effects, such as miscarriages, stillbirths, and congenital rubella syndrome (CRS). However, very little is known about the rubella seroprevalence among pregnant women in China.MethodsThis is a cross-sectional and hospital-based study. From June 2016 through March 2017, a total of 324 serum samples from healthy pregnant women were collected in the Shunyi Women and Children’s Hospital of Beijing Children’s Hospital. Rubella-specific IgG antibody was determined by ELISA (Euroimmun, Lübeck, Germany) kits. International assigned cut-off values of ≥10 IU/ml were used to assess the percentage of pregnant women with protective IgG concentrations.ResultsThe total rate of protected individuals was 83.3% (95% CI: 78.9%–87.0%). The protective rates of pregnant women in 17–26 years group, 27–36 years group and 37–46 years group were 84.0% (95% CI: 75.3%–90.1%), 81.9% (95% CI: 74.9%–87.4%) and 84.9% (95% CI: 75.8%–90.9%) respectively. No significant difference in protective rates among the three age groups was found (P = 0.83). There were also no statistically significant correlations between protective rates and gravidity (P = 0.84), parity (P = 0.84), birth place (P = 0.16), residence area (P = 0.58), education (P = 0.40) or occupation (P = 0.65).ConclusionsDespite the generally low vaccination coverage for rubella, most of Chinese pregnant women had potent rubella immunity. However, at least 16.7% of pregnant women were susceptible to rubella, which suggested rubella immunization in Chinese women at or before child-bearing age.

Measles Rubella Immunization Campaign: Challenges Faced in an Urban Area of Chennai

Measles Rubella Immunization Campaign: Challenges Faced in an Urban Area of Chennai

Epidemiological changes in rubella IgG antibody levels detected in antenatal women from a retrospective rubella seroprevalence study.

Rubella is caused by the rubella virus, a single-stranded RNA virus of the Togaviridae family. The most severe complications of rubella in adult women occur during pregnancy when infection can lead to miscarriage, stillbirth or congenital rubella syndrome. Antenatal rubella susceptibility screening is no longer performed in England, Scotland or Wales but continues in Northern Ireland. The aims of this seroprevalence study were to (1) determine amongst women presenting for antenatal care the percentage of women who are rubella susceptible, rubella immune and those with equivocal rubella antibody levels by year of birth and (2) to consider how rubella vaccination resources can best be utilised. A retrospective study was performed analysing all antenatal rubella IgG antibody tests performed between January 2015 and June 2017 inclusive (n = 19,000; excluding duplicate tests). All antenatal women were included regardless of the country of origin and age. From our analysis, 88.7% (n = 16,868) women had plasma concentrations of anti-rubella IgG > 10IU/ml. 7.3% of women (n = 1403) had rubella IgG levels between 5 and 9.99IU/ml, and 2.8% (n = 729) had IgG levels < 5IU/ml. A decline in rubella immunity in younger women was evident. This study has identified an increase in women who are rubella susceptible and women with equivocal rubella antibody levels. International evidence suggests that rubella serology is unreliable and antenatal screening does not confer any benefit to women during their current pregnancy. Consideration should be given to re-direct resources currently utilised for antenatal screening to facilitate the vaccination of pre-pregnancy and postpartum women and also to opportunistically offer vaccination to all women of childbearing age.