Rubella-specific IgM Antibodies Research Articles

Difficulty in Serologic Screening for Subclinical Rubella during Pregnancy.

In Japan, rubella antibodies are tested in all pregnant women to detect subclinical infections. This study aimed to assess the validity of measuring rubella antibodies for detecting subclinical rubella among pregnant women in Japan. This single-center retrospective study measured rubella hemagglutination inhibition (HI) titers and rubella-specific IgM antibody index (IgM) values. IgM values were measured by conducting enzyme immunoassay, and IgM-values >1.2 were considered positive. Of 14,965 included pregnant women, 186 (1.2%) were IgM-positive. Only one patient was clinically diagnosed with rubella (HI titer, 1:2,048; IgM value, 10) and developed fever and skin rash. She decided to terminate her pregnancy without undergoing repeated blood tests. Of the IgM-positive patients, 136 (73.1%) had rubella HI titers of < 1:256. The correlation coefficient between rubella HI and IgM titers was weakly positive (0.2527; P < 0.0001). This study showed that a single combination of rubella HI and rubella-specific IgM measurements alone could not detect subclinical rubella. Creating awareness among pregnant women by informing them that almost all rubella-specific IgM-positive individuals without symptoms are not acutely infected could decrease their anxiety and prevent unnecessary pregnancy termination.

Seroepidemiology study of rubella virus antibodies among neonates and pregnant women at hospitals in Henan province, China.

Rubella virus infection can cause vertical transmission to the fetus during pregnancy. In China's Henan province, rubella surveillance needs to be well-established. In this research, a total of 1933 neonates and 2502 pregnant women were enrolled, and their sera for IgG and IgM antibodies against rubella were tested by chemiluminescence assay. Of 1933 neonates' sera tested, the seropositive of rubella IgG was 68.7%. The seroprevalence of rubella IgM in neonates was 0.4%. 30.9% of neonates had negative results for IgG and IgM antibodies. Two thousand five hundred and two pregnant women participated in the serosurvey, and 79.3% were rubella IgG positive. Rubella IgG seropositivity in pregnant women differed by age and number of births. 0.8% of the pregnant women had positive results for IgM against the rubella virus. The seronegative of rubella IgG and IgM antibodies in pregnant women was 19.8%. Due to the negative rubella-specific IgG antibody, many neonates remain at risk of rubella virus infection. Rubella virus continues to spread since some neonates and pregnant women with rubella-specific IgM antibody positive have been detected. Rubella vaccination may be introduced for childbearing-age women to increase immunity levels against rubella with periodic sero-surveillance.

Measles and Rubella Incidence and Molecular Epidemiology in Senegal: Temporal and Regional Trends during Twelve Years of National Surveillance, 2010-2021.

We investigated the epidemiology of measles and rubella infections in Senegal based on data from twelve consecutive years of laboratory-based surveillance (2010–2021) and conducted phylogenetic analyses of circulating measles viruses. Sera from measles-suspected cases were collected and tested for measles and rubella-specific IgM antibodies using enzyme-linked immunosorbent assays (ELISA). Throat swabs were collected from patients with clinically diagnosed measles for confirmation by reverse-transcription polymerase chain reaction (RT-PCR) and viral genotyping. Among 8082 laboratory-tested specimens from measles-suspected cases, serological evidence of measles and rubella infection was confirmed in 1303/8082 (16.1%) and 465/6714 (6.9%), respectively. The incidence of rubella is now low—0.8 (95% CI 0.4–1.3) cases per million people in 2021—whereas progress towards measles pre-elimination targets (<1.0 case per million people per year) appears to have stalled; there were 10.8 (95% CI 9.3–12.5) cases per million people in 2021. Phylogenetic analyses revealed that all Senegalese measles strains belonged to genotype B3. The rubella virus sequence obtained in this study was consistent with genotype 1C. Our national surveillance data suggest that despite their low incidence both measles and rubella remain endemic in Senegal with a concerning stagnation in the decline of measles infections that represents a significant challenge to the goal of regional elimination.

Rubella-specific IgM antibodies in non-pregnant women in Rivers State, Nigeria

Rubella can cause arthritis in some women's fingers, wrists, and knees, especially if the infection is complicated. Scarcity of information about the disease in Nigeria, and rubella vaccination is not widely available. This study aimed to look for rubella virus IgM antibodies in non-pregnant women in Rivers State. Method: Ninety-two (92) consenting non-pregnant women attending Rivers State University Teaching Hospital, Rivers State, were randomly assessed for the study. The sera were analyzed for detectable anti-rubella IgM antibodies following the manufacturer’s description using ELISA kits. Results: Of the 92 samples evaluated for rubella Immunoglobulin M antibody, 14 (15.2%) were positive, and 78 (84.8%) were negative. None of the socio-demographic factors had significant relation with Rubella anti-IgM seroprevalence (p&lt;0.05). Conclusion: The substantial frequency of IgM antibodies demonstrated the existence of the virus and the possibility of new infections of Rubella in non-pregnant women. To determine the predominance of the rubella infection and subsequently design control tactics against it, a surveillance strategy and education of women regarding the implications of the existence of IgM antibodies would be helpful.

RUBELLA OUTBREAK AMONG TRAINEES OF NATIONAL SERVICE PROGRAM IN PASIR MAS, KELANTAN, MALAYSIA

&#x0D; &#x0D; &#x0D; An outbreak occurred at the National Service Training Camp Cancun Park in Pasir Mas, Kelantan and a subsequent outbreak investigation was carried out to verify the agent of the outbreak and to recommend a control measure. Descriptive (cases series) study was carried from 13th April 2008 to 16th May 2008 at the training camp. The case definition for the outbreak was a person presenting with a maculopapular rash with or without fever from 1st April 2008 and stayed in the training camp. Confirmed cases were clinical cases positive for rubella IgM. Case findings were carried out by the medical team in the camp and from the nearest health centre where the affected person who fit in the clinical case definition was interviewed, clinically examined, and had blood investigations done. A total of 337 persons (280 trainees and 57 camp trainers) who occupied the training centre at the point of the outbreak were purposively included in this study. Out of 337 occupants of the training camp, 22 (6.5% attack rate) fulfilled the case definition and all of them were among trainees. 95% of cases were male and 86% were Malays. 100% had a maculopapular rash, 77% presented with fever, 41% presented with cough and 50% presented with conjunctivitis. Rubella-specific IgM antibody was positive in 59% (n = 13) of the cases. There was no history of vaccination for all the confirmed cases. Control measures taken were strict isolation of the affected trainees, daily surveillance of rash and fever, and health education to promote awareness on symptoms and signs, nature of transmission, prevention, and control of rubella infection to trainees. Rubella is confirmed as the cause of the outbreak based on the clinical and serological analysis. The probable source of the outbreak is the possibility of exposure during a family day at the training camp.&#x0D; &#x0D; &#x0D;

Rubella Specific IgG and IgM Antibodies among Infants before Rubella Vaccination in Dar es Salaam, Tanzania: A Cross-Sectional Study

Prevention of Rubella virus infection using rubella vaccine has been widely used in high-income countries contributing to the declining of congenital rubella syndrome. Before introduction of rubella vaccine in Tanzania October 2014, status of rubella specific antibodies in the infant was limited. This study was conducted to assess the rubella specific IgG and IgM antibodies among infants before receiving the vaccine.

Seroprevalence of Rubella Virus-specific Antibodies in Women and the Diagnostic Efficacy of Enzyme-linked Immunoassay and Rapid Immunochromatographic Tests.

IntroductionRubella is an infectious disease caused by the Rubella virus. The disease was previously called German measles and is transmitted through respiratory aerosols. Rubella causes both clinical and subclinical infections in children and young adults. Rubella virus has teratogenic capabilities and may cause severe complications in the fetuses of women who acquire Rubella viral infection during their pregnancy. The present study aims to evaluate the seroprevalence of anti-Rubella virus immunoglobulin (Ig) G and IgM antibodies in both pregnant and non-pregnant women and assess the diagnostic efficacy of enzyme-linked immunosorbent assay (ELISA) and rapid immunochromatographic tests.MethodsThe study included 240 females in the age range of 16-45 years. The study subjects included both pregnant women and non-pregnant women. After informed consent, 5 milliliters of blood was collected from each participant, and serum was separated and tested for the presence of antibodies (IgG and IgM) against the Rubella virus using both the traditional ELISA (Delta Biologicals, Pvt. Ltd., China) and a rapid ELISA-immunochromatographic test (ICT) (Span Biotech. Ltd., China). The data collected were systematically entered into Microsoft Excel sheets (Microsoft Corporation, Redmond, Washington) and were analyzed using SPSS Statistics for Windows, Version 17.0, 2008 (SPSS Inc., Chicago, Illinois).ResultsThe study revealed an overall seroprevalence of 31.66% for Rubella-specific IgG and IgM antibodies. Out of the 125 pregnant women included in the study, 49 (39.20%) were seropositive for Rubella IgG antibodies, and among the 115 non-pregnant women tested, 24 (20.86%) were positive for Rubella IgG antibodies. Four (5.26%) of the 76 seropositive women revealed IgM antibodies. The sensitivities of both the ELISA (40.61%) and rapid immunochromatographic (39.20%) tests were observed to be low and the specificities of both methods were similar (79.13%).ConclusionThe seroprevalence of Rubella-specific IgG antibodies was observed to be low as compared to the other regions of India. The low seroprevalence may predispose pregnant women to Rubella viral infection and may lead to increased incidences of congenital Rubella syndrome (CRS). Both the ELISA and immunochromatographic tests showed low sensitivity and similar specificities.

Rubella virus infections and immune status among pregnant women before the introduction of rubella vaccine in Amhara Regional State, Ethiopia

BackgroundRubella and its associated congenital anomalies have been greatly reduced in most developed countries through use of the rubella vaccine. However, the magnitude of the problem is underestimated and there are no well-established rubella/congenital rubella syndrome prevention and control strategies in many developing countries, including Ethiopia. The aim of this study was to determine the prevalence of rubella virus infections among pregnant women and their immune status before the introduction of rubella vaccine in Amhara Regional State, Ethiopia. MethodsA prospective cross-sectional study was conducted among pregnant women in Dessie, Felege-Hiwot, and University of Gondar referral hospitals, from December 2015 to February 2017. After obtaining written informed consent, socio-demographic data, reproductive history, clinical manifestations, and the possible risk factors for rubella virus infections were collected using a structured questionnaire. The laboratory analysis of rubella-specific antibodies was done using an enzyme-linked immunoassay method on venous blood samples. Data were entered and analyzed using IBM SPSS Statistics version 20. Binary logistic regression was used to determine the strength of association between the dependent variables and covariates. ResultsA total of 600 pregnant women were included in the study. Their mean age was 26.4±5years (range 16–40 years). The overall seroprevalence of rubella infection was 89%. Of the total study participants, 9.5% were positive for rubella-specific IgM antibody, which indicates acute/recent rubella virus infection. In contrast, 79.5% of them had protective levels of rubella-specific IgG antibody and were immune as a result of previous wild-type rubella infection. However, 11% of the pregnant women were negative for both rubella-specific antibodies; these women represent the susceptible group. ConclusionsA large number of pregnant women had acute/recent rubella virus infections at the time of data collection, indicating that the virus is endemic in the study area. More than a tenth of pregnant women were found to be susceptible to acquiring the infection in future pregnancies, with the possible risk of rubella-associated congenital anomalies. Hence screening of all women of child-bearing age before conception and during pregnancy might reduce the devastating effects of the virus on the developing fetus.

Acute Rubella Virus Infection among Women with Spontaneous Abortion in Mwanza City, Tanzania.

Acute rubella virus infection in early pregnancy has been associated with poor pregnancy outcome ranging from spontaneous abortion, stillbirth and multiple birth defects known as Congenital Rubella Syndrome (CRS). Despite its importance the prevalence of acute rubella virus infections is not known among women with spontaneous abortion in most centres in developing countries. The present study was aimed to determine the seroprevalence of acute rubella infection among women with spontaneous abortion in Mwanza city. A total of 268 women with spontaneous abortion were enrolled from four different hospitals in Mwanza city between November 2015 and April 2016. Blood samples were collected; sera were extracted and stored at -80°C until processing. Acute rubella virus infection was diagnosed by the detection of rubella specific IgM antibodies using indirect Enzyme Linked Immunosorbent Assay (ELISA) as per manufacturer's instructions. Data were analysed by using STATA version 11. The mean age of enrolled women was 26.3±5.6 years. The prevalence of acute rubella virus infection was found to be 9/268 (3.7%, 95% CI: 1-5). Only women residing in urban areas (AOR: 5.65, 95% CI: 1.15-27.77, p=0.035) were found to predict acute rubella virus infection among cases with spontaneous abortion in Mwanza city. About four out of hundred women residing in urban areas with spontaneous abortion in Mwanza are acutely infected with rubella virus highlighting the potential of this virus in contributing to poor pregnancy outcome in this setting.

Rubella and CMV Antibodies Screening During Pregnancy - A Retrospective Study in a Tertiary Hospital

Background: In India, RUBELLA & CMV Antibodies screening is routinely carried out, but due to absence of clear intervention, its value is questionable. This retrospective study evaluated the usefulness of rubella & cmv antibody screening during pregnancy. Methods: Blood is collected from pregnant women & children, tested for rubella and CMV specific IgM Antibody by capture ELISA. The data were analysed to determine the incidence of rubella &CMV infection during pregnancy & in congenital infections. Results: In asymptomatic pregnancy females (n=252) rubella positivity was 1.58% and in woman with BOH (n=110) it was 3.66%, while CMV passivity was 2.9% in both asymptomatic and BOH women. In children (n=100) the overall positivity for rubella and CMV specific IgM antibodies was 7.5% and 12.5% respectively. The incidence of rubella and CMV infections in pregnant women & women with BOH has declined. In children, also the congenital rubella syndrome has declined but for the past 5 years the incidence of CMV infection remained same without any change. Conclusions: The incidence of rubella over the past 5 years can be reduced after giving the rubella vaccine to school going girls & women with reproductive age apart from routine vaccine. But CMV infection is a big problem due to unavailability of vaccine & safe treatment against CMV infection, so routine screening for rubella and CMV should be reserved for women with obstetric complications only.

Cytomegalovirus, Parvovirus B19 and Rubella Co-Infection among Pregnant Women Attending Antenatal Clinics in Mwanza City: The Need to be considered in Tanzanian Antenatal Care Package

Background: Viral infections are common in pregnancy and have been associated with poor pregnancy outcome. In many developing countries including Tanzania, the magnitude of these infections and their impact to pregnancy outcome is not clearly understood. The aim of this study was to determine the magnitude of these infections. The information from this study may influence policy makers to consider routine screening of these infections during antenatal visits. Methods: A cross sectional hospital based study involving 214 pregnant women was conducted between December 2014 to and August 2015 in two antenatal clinics in Mwanza city. Rubella, cytomegalovirus and parvovirus B19 (B19) specific IgG and IgM antibodies were detected by using commercial indirect enzyme linked immunosorbent assay. Data were analyzed using STATA version 11. Results: The median age of enrolled pregnant women was 21 (Interquartile range: 20-26) years. Previous co-infections of rubella, cytomegalovirus and B19 was detected in 78 (36.5%) of pregnant women tested. A total of 20 (9.4%) pregnant women had acute co-infection of rubella and parvovirus B19 while 1(0.5%) had acute co-infection of cytomegalovirus and parvovirus B19. The odds of having previous co-infection (IgG sero-positivity) increase significantly as the age increases (odd ratio: 1.056, 95% CI: 1.00-1.11, P=0.03). Moreover, as the gestation age increases the odds of having co-infection decreases significantly (odd ratio: 0.923, 95% CI: 0.88-0.96, P=0.001). Conclusion: Considerable proportion of pregnant women in Mwanza is co-infected with rubella, Cytomegalovirus and parvovirus B19. We recommend routine screening for these infections during antenatal visits so as to reduce the possibility of congenital infection.

The study of congenital cytomegalovirus, Rubella and Herpes Simplex Virus-2 infections in infants

AimsThe study was conducted to analyze the role of Cytomegalovirus (CMV), Rubella and Herpes Simplex Virus (HSV-2) as an etiological agent in congenital infections in infants. Material and methodsThe study was carried out at National Reference Centre i.e. NCDC, Delhi where samples are referred from various government hospitals of Delhi from the period of January 2013–December 2013. The samples were tested for CMV, Rubella and HSV specific IgM antibodies by μ capture ELISA (Enzyme linked Immunoassay). ResultsIn children the overall positivity of CMV, Rubella and HSV-specific IgM antibodies was 20.7%, 5.4%, and 2.3% respectively. ConclusionThe study indicated that maternal infection with CMV, Rubella and HSV-2 is a major contributory factor for congenital infections in neonates and infants and therefore screening for these viruses in early pregnancy should be made mandatory.

Detection of Human parvovirus B19 (HPVB19) in serum samples from fever-rash ill individuals during the rubella outbreak (2005) in Bulgaria

The present study aimed to determine the involvement of the parvovirus B19 (HPVB19) as an etiological agent in individuals with fever-rash infections but not infected with rubella during the rubella outbreak (2005) in Bulgaria. A total of 194 serum samples with negative results for measles and rubella-specific IgM antibodies were tested in the National Reference Laboratory. The individuals aged 5–52 years (mean age 17.2 ± 10.15) were divided into four age groups: 5–14; 15–24; 25–34; and 35+ years old. Serological (indirect enzyme immunoassay – EIA) and molecular (extraction and detection of HPVB19-DNA) methods were used. A genotyping assay of the NS1-PCR product was proceeded with the MfeI restriction enzyme. Out of the total number of samples, 95 samples (48.97%) tested positive for HPVB19-IgM and 109 (56.18%) for HPVB19-DNA. The results from the genotyping assay revealed that genotype 1 (prototype B19) was dominant in 106 from 109 samples (97.25%), while genotype 3 (prototype V9) was detected in only 3 (2.75%). Subjects whose sera tested positive for IgM and had a positive PCR result formed a group that was most frequently linked (in 40% of cases) to acute infection. The highest prevalence was established in the group of the school-age children (5–14 years). The combined application of serological and molecular methods confirms the etiological role of HPVB19, and including virus genotyping, confirms the involvement of HPVB19 in the etiological palette of febrile rash diseases and provides a correct differential diagnostic approach.

English

Rubella is a mild illness that presents with fever and rash with the infection occurring sub clinically. Its public health importance is due to its teratogenic effects on the growing foetus in the first trimester of pregnancy. There is insufficient data in India with regard to rubella virus immunity in the community. Occupational exposure of health care personnel to rubella infection disease requires special attention. Hence this study was taken up to analyse the rubella seroprevalence rate according to age, geographical distribution, socio-economic class among health care personnel. Study design: Cross-sectional study. Methodology: 161 subjects aged between 15 to 30 years were given background information about the study and those who provided voluntary and written consent were enrolled. Study was conducted in the month of August 2010. Analysis of rubella specific IgG and IgM antibodies was done by ELISA. Results: Among 161 subjects, 88 subjects were from South India, 42 from North India, 19 from Eastern region and 12 were from the western region of India. Serum IgG positivity was the highest 100% in subjects hailing from Western India, followed by 84.2% from Eastern India and 83.3% in subjects from north India. Subjects from South India showed the lowest seropositivity of 68.18%. Conclusion: Immunisation of health care personnel against rubella and whole population of India for rubella immunity is necessary.

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.

Seroprevalence of rubella in antenatal women in and around Kirumampakkam, Puducherry

Rubella is a mild self limiting vaccine preventable viral disease. Maternal Rubella infection during first trimester of pregnancy leads to abortion, still birth and Congenital Rubella Syndrome. Seroepidemiological studies conducted in different countries have shown that Rubella is a worldwide infection. The present study was conducted to assess the immunity status to Rubella among pregnant women in and around Kirumampakkam, Puducherry for a period of one year. A detailed history with special reference for previous bad obstetric history was collected after an informed consent. They were tested for Rubella IgG and IgM antibodies using commercially available kits. Overall seropositivity was 87.9% and 12% were susceptible to Rubella infection. 6.5% were positive to Rubella specific IgM antibodies. Percentage of seropositivity was seen to be increasing with age. The percentage of IgG negatives was higher among the cases with bad obstetric history. Cases from lower socioeconomic status had good immunity against Rubella. All the cases that had previous immunization record were positive for Rubella specific IgG antibodies. In conclusion, an action revamping the national immunization policy should be considered along with sero-surveillance of Rubella among adolescent girls and women of childbearing age before conception for the assessment and analysis of the situation, and take appropriate action to eradicate Rubella.

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.

Susceptibility to rubella among pregnant women and the serological evidence of congential rubella in newborn babies at Colombo South Teaching Hospital

To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.

Evaluation of the World Health Organization Global Measles and Rubella Quality Assurance Program, 2001–2008

During 2001-2008, the Victorian Infectious Diseases Reference Laboratory (VIDRL) prepared and provided a measles and rubella proficiency test panel for distribution to the World Health Organization (WHO) measles and rubella network laboratories as part of their annual laboratory accreditation assessment. Panel test results were forwarded to VIDRL, and results from 8 consecutive years were analyzed. We assessed the type of assays used and results achieved on the basis of the positive and negative interpretation of submitted results, by year and WHO region, for measles and rubella. Over time, there has been a noticeable increase in laboratory and WHO regional participation. For all panels, the proportion of laboratories in all WHO regions using the WHO-validated Dade Behring assay for measles and rubella-specific IgM antibodies ranged from 35% to 100% and 59% to 100%, respectively. For all regions and years, the proportion of laboratories obtaining a pass score ranged from 87% to 100% for measles and 93% to 100% for rubella. During 2001-2008, a large proportion of laboratories worldwide achieved and maintained a pass score for both measles and rubella. Measles and rubella proficiency testing is regarded as a major achievement for the WHO measles and rubella laboratory program.

An outbreak of rubella in the Federation of Bosnia and Herzegovina between December 2009 and May 2010 indicates failure to vaccinate during wartime (1992–1995)

A rubella outbreak involving 1900 cases was recorded in the Federation of Bosnia and Herzegovina between mid-December 2009 and the end of May 2010. Sera from 389 suspected rubella cases were examined for the presence of rubella-specific IgM and IgG antibodies. A total of 32 throat swabs from suspected rubella cases were tested by RT-PCR and were used to attempt virus isolation. Most patients (945/1900, 49·73%) had never received rubella vaccination or had an unknown vaccination status (563/1900, 29·63%). About 45% (178/389) of suspected rubella patients were IgM positive. From 13 of the throat swabs a virus isolate and E1 gene sequences attributed to genotype 2B were obtained. The rubella outbreak was due to failure to vaccinate during the war period (1992-1995) and emphasizes the need for additional vaccination opportunities.