Rubella Susceptibility Research Articles

Seroprevalence of rubella antibodies among antenatal patients in the Western Cape.

To determine the seroprevalence of rubella virus infection among antenatal patients aged between 15 and 45 years in the Western Cape province of South Africa, in order to provide data to determine the need for vaccination to protect women of childbearing age. A cross-sectional study. Setting. Virology laboratory, Groote Schuur Hospital, National Health Laboratory Service (NHLS), South Africa. One thousand two hundred provincial serum specimens from participants in the 2003 Department of Health antenatal HIV/syphilis serosurvey were selected from the 4 districts of the Western Cape. The specimens were age-stratified and screened qualitatively for rubella immunoglobulin G (IgG) antibodies by means of a commercial immunoassay during October 2004. Within the Western Cape a total of 95.3% of women in the 15-24-year age group, 97.5% in the 25-34-year group and 98% in the 35-45-year age group were immune to rubella. There was no statistically significant difference in the rate of rubella susceptibility between the 4 districts tested. The study is an important step in addressing the seroprevalence of rubella infection in women of childbearing age in South Africa. Further information is needed on rubella seroprevalence from the other provinces in South Africa as well as formal implementation of rubella and congenital rubella syndrome surveillance to determine the feasibility of routine rubella immunisation.

Rubella and measles seroprevalence among women of childbearing age, Argentina, 2002

To assess rubella and measles susceptibility among women of childbearing age we conducted a cross-sectional seroprevalence study in four cities and one rural area in Argentina. A convenience sample of women aged 15-49 years seeking care in public health-care institutions was selected (n=2804). Serum specimens were tested for rubella and measles IgG antibody titres. The overall susceptibility to rubella and measles was 8.8 and 12.5% respectively. Seroprevalence differences were found for both rubella (P<0.001) and measles (P=0.002) across sites. Rubella seroprevalence was higher in women aged >or=40 years than in younger women (P=0.04). Measles seroprevalence tended to increase with age (P<0.001). Approximately 15% of women aged 15-29 years were not immune to measles. No risk factors were associated with rubella seronegativity; however, age (P<0.001) and having less than four pregnancies (P<0.001) were factors associated with measles seronegativity. Our findings support the introduction of supplemental immunization activities targeting adolescents and young adults to prevent congenital rubella syndrome and measles outbreaks over time.

New features of rubella in Spain: the evidence of an outbreak.

In most of western Europe the rubella vaccine coverage is high. However, prior to the introduction of the vaccine in Latin America, rubella susceptibility in women of childbearing age was 10-25%. Forty one (93%) countries in Latin America have adopted the rubella vaccine since 2002. The adult immigrant population in Spain constitutes a group of susceptibles. In February 2003, the Madrid Community Measles Elimination Plan detected an increase in rubella notifications in women who had been born in Latin America. A descriptive study was undertaken to characterise the outbreak. A confirmed case was a person with fever or rash and a positive IgM serology, and living in Madrid, between 1 December 2002 and 31 March 2003. The secondary attack rate (SAR) per household was calculated. A total of 19 cases of rubella were identified, 15 were confirmed and 4 were probable cases. Fourteen (73.7%) cases were women at childbearing age. The mean age was 25.1 years. One pregnancy was diagnosed with a voluntary termination. Eleven (57.9%) cases were from Ecuador. The mean time of residence in Spain was 41 months. None of the cases or the 54 (78.3%) household contacts had been vaccinated against rubella. The SAR was 9.1%. This study showed the spread of rubella in the susceptible Latin American Community that is resident in Madrid. The interventions proposed were a vaccination programme towards immigrants, a health education campaign to prevent congenital rubella, and a health professional training programme case management.

Rubella in England, Scotland and Wales.

Rubella vaccine was offered to schoolgirls in the United Kingdom (UK) from 1970, with antenatal testing and postpartum vaccination for susceptible women introduced during the 1970s. Mass vaccination with MMR of children aged 12-15 months was introduced in 1988; schoolgirl vaccination was discontinued in 1996 and replaced by a second dose of MMR for pre-school children; postpartum vaccination of susceptible women identified through antenatal testing continues. Rubella was made a notifiable disease in 1988, and is monitored through clinical and laboratory reports; data are available on rubella associated terminations and congenital rubella syndrome(CRS) births, rubella susceptibility in population subgroups, and vaccine uptake. Reported cases of CRS declined from about 50 a year 1971-75 to just over 20 a year 1986-90, and rubella associated terminations from an average of 750 to 50 a year. About 40 infants with CRS have been reported since 1991; about a third of their mothers were infected abroad, most in their country of origin (imported infections), a third were born abroad but acquired infection in the UK, and a third were UK-born. Women living in the UK who were born abroad have much higher rubella susceptibility rates than UK-born women. Although there is currently very little rubella infection circulating, uptake of MMR has dropped by over 10% since 1995. If rubella starts to circulate again, immigrant women will be at increased risk of acquiring infection in pregnancy.

Rubella serosurveys at three Aravind Eye Hospitals in Tamil Nadu, India.

To determine the susceptibility of female eye hospital staff to rubella infection and the potential risk for hospital-based rubella outbreaks. A prospective cohort study on the seroprevalence of rubella IgG antibodies was conducted at three large eye hospitals in Coimbatore, Madurai and Tirunelveli, Tamil Nadu, India, where young children with eye abnormalities attributable to congenital rubella are treated. A total of 1000 female hospital employees aged 18-40 years agreed to participate and gave written informed consent. The proportions of rubella-seronegative women were: 11.7% at Coimbatore, with a 95% confidence interval (CI) of 8.1-16.5; 15% at Madurai (95% CI = 12.3-18.1), and 20.8 at Tirunelveli (95% CI = 14.7-28.6). For the entire cohort the proportion seronegative was significantly higher among married women (21.5%) than among single women (14.0%) (P = 0.02). Rates of seronegativity were highest among physicians and lowest among housekeepers. All 150 seronegative women in the study sample accepted a dose of rubella vaccine. These are the first rubella serosurveys to have been reported from eye hospitals in any country. The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and this was reduced by vaccinating all seronegative women. A policy has been established at all three hospitals for the provision of rubella vaccine to new employees. Other hospitals, especially eye hospitals and hospitals in countries without routine rubella immunization, should consider the rubella susceptibility of staff and the risk of hospital-based rubella outbreaks.

The impact of rubella immunization on the serological status of women of childbearing age: a retrospective longitudinal study in Melbourne, Australia.

This study assessed the impact of rubella immunization, which commenced in Australia in 1971, on the serological status of women of childbearing age over a 25-year time period and identified the risk factors for ongoing rubella susceptibility.

Identifying risk factors for rubella susceptibility in a population at risk in the United States.

Since the early 1990s, rubella disproportionately affected non-US-born Hispanic persons in the United States. In 2000, 149 (78%) of the 192 rubella cases were among Hispanics, and 23 (77%) of the 30 infants with congenital rubella syndrome reported between 1997 and 2000 were born to non-US-born Hispanic mothers.1–5 The US childhood rubella vaccination program was started in 19691; however, many other countries do not have, or have recently implemented, rubella vaccination programs.6 Foreign-born workers in certain US industries (e.g., meat- and poultry-processing plants) appear to be at increased risk for rubella, suggesting higher susceptibility rates.7–9 In 2000, a varicella outbreak occurring among Mexican-born adults, most of whom worked in a poultry-processing plant in southern Alabama, provided an opportunity to test for rubella susceptibility.10 Vaccine was offered to susceptible persons. We describe risk factors for susceptibility among these workers.

Rubella Seroprevalence in Korean Children

The aim of this study was to determine the age-specific rubella seroprevalence and the related factors in Korean children. Subjects of the study were 5393 students from 8 elementary schools in Gyeonggi Province, Korea. Questionnaire surveys with blood sampling were conducted in 1993, 1996, and 1999. ELISA tests, used to detect rubella specific IgG antibody, were Imx (R) (Abbott, U.S.A.) in 1993 and 1999, and Enzygnost (Behring, Germany) in 1996. The age-adjusted rubella susceptibility rate was 22.9% (95% CI: 22.8-23.0%) and it increased with age from 14% to 28%. The susceptibility rates of vaccinees, nonvaccinees, and the unknown group were 21%, 35%, and 27%, respectively (p=0.000). The rates by parental education levels for elementary and below, middle school, high school, and college and over were 37%, 26%, 24%, and 20%, respectively. The geometric mean titers (GMTs) of nonvaccinees, the unknown group, and vaccinees were 47 IU/mL, 42 IU/mL, and 37 IU/mL, respectively (p=0.000). The susceptibility level was too high to prevent the rubella epidemic in Korea, which necessitates a programme that will enhance the coverage for 1st and 2nd MMR vaccination among school children. In particular, more attention should be paid to the vaccination of the children whose parental education level is relatively low.

Time-resolved fluorometric immunoassay for rubella antibody—a useful method for serosurveillance studies

Rubella antibody (IgG) has been measured in females reporting for antenatal screening using single radial haemolysis (SRH) and time-resolved fluorescence immunoassay (TRFIA). We have shown TRFIA to be a simple, specific, highly sensitive, quantitative assay for rubella IgG with a lower limit of detection of 0.2 IU/ml. Out of 506 sera tested by SRH, 18 (3.6%) had low levels of antibody (<15 IU/ml) compared to 83 (16.4%) tested by TRFIA and, of these, 32 (6.3%) had rubella antibody concentrations <10 IU/ml. The lowest level (3.1%) of rubella susceptibility (antibody levels <10 IU/ml) was found in females aged 25–29 and the highest level of susceptibility (23.5%) occurred in females aged 40 years, and over. Geometric mean rubella antibody concentrations (IU/ml) were 26.8, 34.4, 34.8, 29.7, 27.5 and 20.0 for age groups <20, 20–24, 25–29, 30–34, 35–39 and ≥40 years, respectively. Our rubella vaccination policies have built up good levels of rubella immunity in women of childbearing age in our locality, and using TRFIA technology we can accurately monitor changes over time.

Preventing congenital rubella syndrome (CRS) through vaccination of susceptible women of childbearing age.

Journal of Women's Health & Gender-Based MedicineVol. 10, No. 7 Observations from the CDCPreventing Congenital Rubella Syndrome (CRS) through Vaccination of Susceptible Women of Childbearing AgeM. Carolina Danovaro-Holliday, Laura Zimmerman, and Susan E. ReefM. Carolina Danovaro-HollidaySearch for more papers by this author, Laura ZimmermanSearch for more papers by this author, and Susan E. ReefSearch for more papers by this authorPublished Online:7 Jul 2004https://doi.org/10.1089/15246090152563489AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byViral Infections of the Fetus and NewbornCongenital Rubella SyndromeInfectious Diseases in Clinical Practice, Vol. 20, No. 3Viral Infections of the Fetus and Newborn and Human Immunodeficiency Virus Infection during PregnancyCommonly Encountered Medical Problems in PregnancyViral Infections of the Fetus and NewbornIdentifying Risk Factors for Rubella Susceptibility in a Population at Risk in the United StatesAmerican Journal of Public Health, Vol. 93, No. 2 Volume 10Issue 7Sep 2001 To cite this article:M. Carolina Danovaro-Holliday, Laura Zimmerman, and Susan E. Reef.Preventing Congenital Rubella Syndrome (CRS) through Vaccination of Susceptible Women of Childbearing Age.Journal of Women's Health & Gender-Based Medicine.Sep 2001.617-619.http://doi.org/10.1089/15246090152563489Published in Volume: 10 Issue 7: July 7, 2004PDF download

Rubella susceptibility predicts measles susceptibility: implications for postpartum immunization.

Measles and mumps antibody titers were measured in 262 pregnant women who were either positive (n=128) or negative (n=134) for rubella antibodies. Susceptibility to measles and mumps was detected in 4.6% (12/262) and 7.6% (14/184) of the women, respectively. Of the rubella-susceptible group, 8.2% were also measles susceptible, whereas only 0.8% of the rubella-immune women were measles susceptible. Susceptibility to mumps was evenly divided between rubella-susceptible (7.8%) and rubella-immune (7.4%) groups.

RUBELLA IMMUNITY IN YOUNG WOMEN

To The Editors: The articles on rubella in the July issue of the Pediatric Infectious Disease Journal® by Plotkin1 and Aksit et al.2 were of considerable interest to us. Last year we carried out a retrospective study of the prevalence of rubella IgG antibody in our patient population as measured by an enzyme-linked immunosorbent assay (Sigma). Overall 7848 specimens (7636 female and 210 male) were evaluable, and 1033 specimens (13.1%) lacked detectable antibody. A substantial portion of women in their childbearing years, 14.2% of those between 15 and 35 years of age, did not have rubella antibodies. These percentages are much higher than the estimate of 8% for rubella susceptibility in the United States cited by Aksit et al. The lack of detectable antibody suggests to us that many opportunities for immunization have been missed and that the potential for cases of congenital rubella syndrome will remain until the percentage of seronegative individuals is reduced. William T. Walsh Ph.D. Loma Payton M.P.A., M.T. (ASCP) Hurley Medical Center Flint, MI Accepted for publication Nov. 19, 1999.

An approach to the diagnosis of congenital infections

An approach to the diagnosis of congenital infections

Serologic survey of rubella in the pre-vaccine era in child-care centers, schools and maternity units of Fortaleza

OBJECTIVES: To identify rubella prevalence in different ages and population groups and rubella susceptibility of pregnant and postpartum women according to age, number of children and spontaneous abortion. METHODS: Cross-sectional study of sero-survey type. Children and students were selected in day-care centers and schools distributed by health districts of Fortaleza. Pregnant and postpartum healthy women were recruited in two large maternity units and three antenatal clinics; individuals previously vaccinated and presenting chronic or acute diseases where excluded. Written consent was obtained from participants or their caretakers. Anti-rubella IgG qualitative detection was performed with an Elisa-sandwich assay. RESULTS: Mean age-specific sero-prevalence rates of 999 samples were: 2 to 5 years= 59% (136/231); 6 to 9 years= 47% (95/204); 10 to 19 years= 56% (243/432) and 20 to 39 years= 80% (106/132). The mean age of 187 pregnant and postpartum women was 23 years (10-39) with a sero-prevalence of 76% (142/187), where 62% sero-positives aged 15 to 19 and 83% aged 26 to 39 years. A higher sero-prevalence was related to womeńs age (p<0.001), history of spontaneous abortion (p= 0.03), and two or more children (p=0.01). CONCLUSIONS: The high sero-prevalence of rubella in preschool age children reflects the intense viral transmission in child-care centers. The high susceptibility in adolescents (45%), among whom pregnancy is common, emphasizes the need to introduce rubella vaccine early and keep high immunization coverages in youngsters in order to eradicate congenital rubella syndrome. Also, postpartum routine immunization against rubella in this age group is of particular benefit.

Reasons for Rubella Susceptibility among Pregnant Women in West Lambeth

One hundred and thirty-three pregnant women who delivered at St Thomas' Hospital, in 1990 were noted to require rubella vaccination post partum. Fifty-three (39%) had completed a telephone questionnaire in order to determine reasons for susceptibility to rubella. Laboratory reports confirmed that 92 women were rubella seronegative and 27 had low levels of antibody. Of the 53 women interviewed, 25 gave a history of one or more rubella immunizations, 20 had no history of immunization and vaccination history was unknown for eight. Eleven of the 20 unvaccinated women had not been at school in the UK between 11 and 14 years of age. Eighty-seven per cent of the patients' general practitioners had no knowledge of their patients' rubella antibody status. Ninety-four per cent of the 133 women received rubella vaccine post partum. The Department of Health guidelines should be more vigorously implemented in order to identify and immunize remaining rubella susceptible women of child-bearing age. Susceptibility among women with a history of rubella immunization suggests that the seroconversion rate following rubella immunization in clinical practice may be lower than in vaccine trials.

Rubella Susceptibility in Women of Childbearing Age

The major purpose of the study was to determine the number of rubella-susceptible women attending an urban family-planning clinic. A retrospective, descriptive survey was conducted of all new clients attending the clinic over a 3-month period. A family-planning clinic located in a small city in the mid-Atlantic region of the United States. The clinic offers primary health care to women of childbearing age. The 325 clients involved in the study were young women (mean age = 20 years) from racially diverse backgrounds. Educational programs for both the health-care provider and the consumer regarding rubella susceptibility are necessary. Rubella screening and re-immunization also must be a major focus of nursing care. Hematologic screening for rubella immunity. Of the 325 clients surveyed, 35, or 10.7%, were found to be susceptible to rubella. Although rubella is usually a mild disease for the women it infects, it can have devastating consequences for their offspring if women are infected during their 1st trimester of pregnancy. The study found a sufficient number of women susceptible to rubella to warrant screening for all women of childbearing age.

Prevalence of HIV antibody and pregnancy in Tayside, 1984-9: background to screening.

To determine age specific prevalence of HIV antibody, incidence of pregnancy, and likelihood of detection and correct assignment to risk category by antenatal screening of women known to be positive for HIV antibody, from 1984 to 1989. Retrospective analysis of reproductive history and risk behaviour of women positive for HIV antibody and prediction of detection by screening on the basis of blood group samples, Guthrie tests, and rubella tests. City of Dundee, where the prevalence of HIV is high, since the appearance of HIV in 1984, predominantly among heterosexual intravenous drug users. All (61) women known to be positive for HIV antibody who had had clinically indicated tests, for whom case notes were available for 60. Risk assessment according to case notes and reported to the laboratory, incidence of infection, geographical location, age, date of positive test result, and reproductive history. With 61 infected women the overall minimum prevalence among women within the city of Dundee was 0.67/1000 and 2.9/1000 among women in their third decade. Of the 60 women whose reproductive history was available, 35 had 57 pregnancies, 36 of which occurred after seroconversion was known to have taken place, representing 8.7% of the total number of affected pregnancies reported for the United Kingdom. If antenatal screening for HIV had been performed between 1984 and 1989 it could not have detected positivity for HIV antibody in 25 (42%) women who had no pregnancies during this time. Among the remaining 35 women, screening samples taken for blood grouping could have identified a maximum of 34 (57%), samples taken to check rubella susceptibility a maximum of 22 (37%), and blood spots on Guthrie cards a maximum of 19 (32%). Retesting would have occurred in 14 women 33 times with samples taken for blood grouping, but three and four women would have been tested twice using samples taken for rubella testing and Guthrie cards respectively. Anonymous screening would have been unable to determine risk category as a history of intravenous drug use was known in 47 (79%) women before testing but this was increased by a further 5 (8%) who admitted to it after the test result was known. Interpreting the results of antenatal screening programmes will be complex and will underestimate overall prevalence of HIV antibody among women; this will be exaggerated by strategies based on anonymous testing with Guthrie cards or on samples taken for rubella testing, which do not include women who have had an earlier loss of pregnancy. Only open testing with consent will permit satisfactory attribution to

Increasing rubella seronegativity despite a compulsory school law.

To determine if lower rubella susceptibility persisted five to seven years after immunization legislation, we retrospectively reviewed the serologic status of 341 outpatients from 1985 to 1987 in an inner-city school age population. Seronegative rates increased significantly during the two-year study period from 4.2 to 24.5 percent (17 percent overall). (Beta = 6.8%, 95% CI = 3.3, 10.3). Charts were reviewed for 57 of 58 seronegative and 114 seropositive controls. Estimates were then made to the population of 341 subjects. Those with documented rubella immunization had a seronegative rate of 13 percent compared to 19 percent if the immunization status was unknown. For patients who received care in our clinic for less than two years, 32 percent were seronegative compared to 10 percent for those treated greater than or equal to 2 years (odds ratio = 0.31, 95% CI = 0.16, 0.60). Among patients immunized in 1977 or 1978, 33 percent were seronegative compared to 7 percent immunized at other times (OR = 0.21, 95% CI = 0.07, 0.63). Factors associated with increased rubella seronegativity include immunization in 1977 or 1978 and lack of continuity of care in our clinic. Much of the increase remains unexplained.

Rubella Susceptibility and the Continuing Risk of Infection in Pregnancy

Rubella Susceptibility and the Continuing Risk of Infection in Pregnancy

Rubella Susceptibility and the Continuing Risk of Infection in Pregnancy

Rubella Susceptibility and the Continuing Risk of Infection in Pregnancy