The immunoglobulin M response to rubella vaccine in young adult women.

Rubella vaccination histories were taken from 333 young women working in the head office of a retail organization: 29% said they had had vaccine and 47% said they had not. The remainder did not know. Forty-six per cent of those less than or equal to 25 years old (who should have been offered vaccine at school), and 6% of those greater than 25 years old, said they had been vaccinated. When screened for immunity to rubella by radial haemolysis (RH) 3% had a low level of antibody (less than 15 i.u./ml) and 11% had no antibody. After immunization with Cendevax the specific rubella IgM response was measured by an IgM antibody capture radioimmunassay (MACRIA). It was only detectable in the group without RH antibody, and was present in 26/31 of them. The IgM response to Cendevax was strongest in specimens taken 20-39 days after immunization, but in 10 out of 11 cases tested was still present at around 71 days. The specific IgM responses to Cendevax were very similar to those in women given Almevax in an earlier study, when measured in parallel tests. Taking both vaccines together, specific IgM was present in 35 out of 36 vaccinees without pre-existing antibody tested between 40 and 77 days post-immunization. Detection of specific IgM by MACRIA would therefore be an effective means of determining susceptibility retrospectively in rubella vaccinees found to be pregnant.     

Are many women immunized against rubella unnecessarily?

Radial haemolysis (RH) was used to test sera for immunity to rubella from 1317 patients attending a general practice. One hundred and forty-one (10.7%) were treated as susceptible and offered an attenuated virus vaccine (RA 27/3). Pre-immunization sera from 43% of these patients were reactive at low levels in RH (less than 15 international units rubella antibody per ml). Pre- (S1) and post- (S2) immunization sera from 66 vaccinees were studied in detail. Antibody was detected by RH, haemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA), and the specific IgM response was measured by a solid-phase M-antibody capture radioimmunoassay (MACRIA). The vaccine-induced IgM response was only detected if the S1 serum was non-reactive by all tests for rubella antibody. It was weaker than that seen following wild virus infection. It could be detected reliably for six weeks, and in most cases for nine weeks, after immunization. In contrast, patients with S1 specimens reactive by RH, HI or ELISA never showed an IgM response in the S2 specimen despite "significant'' antibody rises often being present. It was considered that an IgM response to RA 27/3 was the best indicator of pre-immunization susceptibility to rubella. The failure of many vaccinees to make an IgM response implied that a significant proportion were already immune. It is suggested that the threshold for a report of immunity to rubella could be lowered from 15 i.u. antibody per ml and so fewer women immunized without vaccine being withheld from those who need it.     

Antibody capture radioimmunoassay for anti-rubella IgM.

An M-antibody capture radioimmunoassay (MACRIA) for anti-rubella IgM was developed. Under optimum conditions positive serum specimens bound up to 20 times as much radioactivity as negative specimens. Positive reactions were expressed in arbitrary units/ml by comparison with a calibration curve derived from results obtained with dilutions of a standard serum. The specificity of the assay was confirmed by testing IgM and IgG rich fractions of positive sera. One hundred and forty specimens from blood donors, patients whose sera contained rheumatoid factor and patients with acute, non-rubella, virus infections were tested by MACRIA. No significant non-specific reactions were detected. Paired sera from acute rubella (25 patients) and individual sera from suspected rubella (69 patients) were tested for anti-rubella IgM by MACRIA and by haemagglutination inhibition following sucrose-density-gradient fractionation. There was close agreement between the two methods. The capture assay was more sensitive and could be used to detect the weak IgM response in women given RA 27/3 vaccine. After the natural infection, the MACRIA was strongly positive for two months and remained weakly so for a further two months. Repeat testing of sera demonstrated good reproducibility of the assay. MACRIA proved a simple, sensitive and specific test for anti-rubella IgM and compared favourably with currently used techniques.     

Specific antibody patterns over a two-year period after rubella immunization with RA 27/3 live attenuated vaccine

Screening for rubella antibodies was carried out on 1557 schoolgirls aged 9–20. Of seronegative subjects 70% (442/631) were immunized with RA 27/3 rubella vaccine and some of the vaccinees underwent a serological and clinical follow-up over a two year period. Adverse reactions occurred in 27% of vaccinees, usually 1–2 weeks after immunization; late reactions were never observed. The vaccine-induced seroconversion rate evaluated at 4–5 weeks after immunization was 99.7%. Both one and two years after immunization the seropositivity rate of vaccinees was 100%. The maximum geometric mean antibody titre (GMT) was observed at 4–5 weeks after vaccination and a significant GMT decrease was evident on both the following annual controls. Specific antibody patterns in vaccinees were highly variable and in a small number of subjects a remarkable antibody titre decrease was noticed.     

兰山区麻疹疫苗强化免疫效果分析

目的：进一步控制兰山区的麻疹疫情。方法：1999年度对该区149 016名8月龄—14岁儿童实施了麻疹疫苗(MV)强化免疫，接种率为97．38％。随后开展了麻疹免疫监测，应用酶联免疫吸附法(EHSA)检测麻疹和风疹IgM抗体，微量血凝抑制试验检测麻疹IgG抗体。结果：强化免疫后麻疹抗体阳转率达100％，GMT从1：5．56上升到1：52．68；经过流行病学观察，强化免疫后麻疹疫情被控制，2a后发病率下降到0．75／10万，麻疹发病数与1999年相比，下降了97．53％。检测79例麻疹疑似病例血清，其中麻疹IgM阳性16例，占20．25％；风疹IgM阳性12例，占15．19％。结论：开展麻疹强化免疫对控制麻疹效果非常显著。     

山东省实施儿童风疹疫苗免疫后风疹发病年龄变化趋势的分析

目的分析山东省自1995年开始实施儿童风疹疫苗免疫后风疹发病年龄的变化趋势。方法对1999—2004年通过麻疹疫情专报系统得到的风疹疫情资料以及风疹疫苗接种情况进行分析。结果1999—2004年山东省风疹年平均报告发病率为0．59／10万，多为暴发（占总病例数的81．17％）；发病主要集中在7～15岁学龄儿童（77．77％），7岁以下发病较少（占7．93％），发病年龄中位数分别为10．37岁、11．66岁、11．41岁、12．81岁、14．28岁和13．96岁，发病高峰年龄逐年后移，成人发病有所增加；学龄前儿童风疹疫苗基础免疫估算接种率约为60％，学龄儿童约为20％。结论风疹发病年龄后移，将威胁育龄期妇女，增加发生先天性风疹综合征的危险性；应在继续做好儿童风疹免疫的同时，积极开展育龄期妇女风疹抗体筛查及疫苗接种工作。     

上海市浦东新区2012年麻疹疑似病例IgM抗体检测结果分析

目的对2012年上海市浦东新区麻疹疑似病例进行IgM抗体检测,分析麻疹流行病学特征,为进一步制订麻疹防治策略提供科学依据。方法应用酶联免疫吸附试验（ELISA）对疑似麻疹病例血清标本同时检测麻疹、风疹IgM抗体。结果 2012年该区共检测麻疹疑似病例241例。检出麻疹IgM抗体阳性111例,阳性率为46.06%;风疹IgM抗体阳性38例,阳性率为15.77%;其中有4例麻疹、风疹IgM抗体均为阳性。麻疹阳性年龄主要分布于20-30岁年龄和8个月-10岁以下年龄,其次是8个月以下婴儿。流行高峰后移至5-9月份。风疹阳性年龄20-30岁组最高,其次为30-40岁组。流行高峰在3-6月份。麻疹、风疹IgM抗体阳性率与血清采集时间有密切关系。出疹4天后采集的血清标本IgM抗体阳性率（麻疹49.75%、风疹18.27%）明显高于3天内（麻疹为29.55%、风疹为4.55%）。麻疹、风疹病例中无免疫史或免疫不详者占88.29%和92.11%。结论建议对重点人群进行麻疹强化免疫,提高免疫接种率,开展查漏补,麻疹初免年龄应适当提早。提高疑似麻疹病例的血清标本采集率。同时也需要加强风疹的监测和预防接种工作,控制风疹疫情的蔓延,并进一步加强麻疹、风疹及其他出疹性疾病的监测。     

2011年天津市南开区麻疹风疹疑似病例IgM抗体检测结果分析

目的分析天津市南开区2011年麻疹与风疹的流行特征。方法采用酶联免疫吸附试验,同时检测麻疹和风疹IgM抗体。结果 2011年检测2份麻疹疑似病例血清,IgM抗体均为阴性;检测209份风疹疑似病例血清,IgM抗体阳性116份,阳性率为55.50%。风疹以暴发居多,年龄主要分布在15～25岁组,季节多集中在4～6月。出疹后4～28d采血的IgM抗体阳性检出率较高;风疹病例无免疫史或者免疫史不详的占89.00%。结论加强疫苗的常规免疫工作,加强大中专院校学生聚集场所风疹疫苗强化免疫工作,加大消毒和健康教育宣传力度。     

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.     

2009～2012年广州市白云区疑似麻疹、风疹病例血清学检测分析

目的分析广州市白云区疑似麻疹、风疹病例血清学检测情况,为防治麻疹、风疹提供科学依据。方法采用酶联免疫法(ELISA)对广州市白云区2009～2012年麻疹、风疹疑似病例血清标本进行IgM抗体检测,对检测结果进行统计分析。结果 4年共检测血液标本745份,麻疹IgM抗体阳性246份,总阳性率为33.02%,风疹IgM抗体阳性90份,总阳性率为12.08%,各年度麻疹、风疹阳性率差异有统计学意义。麻疹、风疹病例性别分布差异无统计学意义。麻疹主要分布在7岁以下年龄组,占总数的77.24%;风疹主要分布在15～39岁年龄组占总数的74.44%,麻疹、风疹不同年龄组抗体阳性率差异有统计学意义。麻疹、风疹发病时间都有明显的季节性,以春夏季高发。麻疹6～7月为发病高峰;风疹发病时间主要分布在3～8月份,占全年的96.67%。结论 2012年麻疹IgM抗体阳性率明显回升应引起重视,麻疹发病以儿童为主,风疹以青年居多。加强流动人口免疫规划管理是今后工作的重点,应进一步开展查漏补种和强化免疫工作,提高易感人群免疫水平。     

The development and use of an antibody capture radioimmunoassay for specific IgM to a human parvovirus-like agent.

An IgM-antibody capture radioimmunoassay (MACRIA) was developed for the detection of IgM antibody specific for the human parvovirus-like agent B19. Diagnosis of infection with this agent by either antigen detection or antibody seroconversion had been made by counter-current immunoelectrophoresis (CIE) in 18 cases of aplastic crisis occurring in children with homozygous sickle-cell disease. The MACRIA described here gave positive results in 17 of these 18 cases; in the remaining case only an acute specimen taken from the patient during viraemia and late convalescent specimens taken 184 and 247 days after onset of illness were available. The test was used to investigate 20 further cases of aplastic crisis in which neither viral antigen nor antibody seroconversion could be detected by CIE. Detection of virus-specific IgM permitted diagnosis of infection with this parvovirus-like agent in 17 of these cases. In the remaining three cases only single serum specimens taken late in convalescence, 82 days or more after the onset of symptoms, were available. In addition to these 34 cases of aplastic crisis in which primary infection with this agent was diagnosed by MACRIA, seven cases of apparent ''silent'' infection detected by CIE were investigated. The test permitted the discrimination between primary infection and re-exposure to the virus in six of these patients. The use of this assay has added a considerable weight of evidence implicating primary infection with this parvovirus-like agent as an important cause of aplastic crisis in children with sickle-cell disease. Furthermore, MACRIA permits diagnosis of infection when only single serum specimens taken up to ten weeks after infection are available. Thus the use of this test will significantly facilitate the investigation of other clinical syndromes of presumptive infectious aetiology.     

Rubella immunization of teenage girls in Iceland and follow-up after a severe rubella epidemic

Of 730 Icelandic schoolgirls, 12 years of age, screened for rubella antibodies by the haemagglutination-inhibition (HI) technique, 372 (50.9%) were found to be seronegative. Rubella vaccine was administered to 355 members of this group, and to 12 girls with an HI titre of 20. Blood samples were taken 6 weeks and 1 year after immunization from 336 previously seronegative girls and from the 12 low-positive vaccinees, and tested for HI antibodies. The seroconversion rate was 99.15%. One year after immunization, 94.8% of the girls tested had an HI antibody titre of 40 or more. The geometric mean titre (GMT) of the previously seronegative girls was 62.07 at 6 weeks and 61.69 at one year after vaccination. Of the girls with an initially low positive titre, only 3 (25%) showed a significant rise. The GMT was 40 at 6 weeks, but fell to 25.2 after 1 year. Re-immunization had no effect on antibody levels in either group.     

Rubella seroprevalence in an unvaccinated pregnant population in Malatya, Turkey

BACKGROUND: Controlling congenital rubella by 2010 is one of the targets of the World Health Organization. Most European countries currently include rubella vaccine in their national immunization programmes, but not yet in Turkey. OBJECTIVES: To define rubella seroprevalence in pregnancy in Malatya, Turkey. STUDY DESIGN: A cross-sectional interview survey was conducted among pregnant women living in Malatya province from November 2003 to May 2004, together with a follow-up component. METHODS: Stratified probability proportional to size sampling methodology. A total of 824 pregnant women from 60 clusters were enrolled. After obtaining informed consent, participants' socio-demographic and fertility characteristics were collected by interview questionnaire. Various blood samples were drawn. After storing serum samples at -20 degrees C for 6 months, anti-rubella IgM and IgG titres were studied by micro ELISA. Only 803 sera were eligible for serological study. RESULTS: Of the 803 samples tested for rubella antibodies, 753 cases (93.8%) had anti-rubella IgG positivity, indicating past infection. Five of the pregnant women (0.6%) had both anti-rubella IgM and IgG positive results, suggesting a recent infection. The remaining 45 women (5.6%) were seronegative for both antibodies. Seroprevalence was not associated with age or urban/rural residency. All the five anti-rubella IgM positive women were in the second trimester of pregnancy. CONCLUSIONS: As 5.6% of pregnant women were susceptible to rubella during pregnancy, and five of them had already had a recent infection, immunization efforts should be directed at babies and adolescents.     

Seroepidemiological profile of pregnant women after inadvertent rubella vaccination in the state of Rio de Janeiro, Brazil, 2001-2002.

OBJECTIVES: To analyze postvaccination serological status in pregnant women inadvertently vaccinated against rubella in the state of Rio de Janeiro, Brazil. METHODS: This was a cross-sectional study of pregnant women 15 to 29 years old, vaccinated against rubella and measles from November 2001 to March 2002, who were unaware of their pregnancy at the time of vaccination or who became pregnant within 30 days thereafter. They were tested for rubella-specific immunoglobulin M (IgM) and G (IgG) and classified as immune (IgM-negative, IgG-positive, tested within 30 days after vaccination), susceptible (IgM-positive after vaccination) or indeterminate (IgM-negative, IgG-positive, vaccination-serological testing interval greater than 30 days). RESULTS: Of 2 292 women, 288 (12.6%) were susceptible, 316 (13.8%) immune, 1 576 (68.8%) indeterminate, 8 (0.3%) ineligible, and 104 (4.5%) lost to follow-up. IgM seropositivity by vaccination-serological testing interval was 16.1% (相似文献   

2010-2013年深圳市罗湖区育龄期妇女风疹IgG抗体水平及发病情况

目的 结合罗湖区女性风疹发病情况,重点研究育龄期妇女风疹发病情况及风疹血清IgG抗体水平,为控制风疹疫情,完善风疹免疫策略,预防先天性风疹综合征( CRS) 提供科学依据。方法 在罗湖区体检中心随机抽取四家体检单位,筛选18—35岁育龄期妇女,采集血清标本共164份,用酶联免疫吸附法检查血清风疹IgG抗体,同时分析罗湖区2010-2013年女性风疹发病情况。结果应涵盖所有的结果 育龄期妇女风疹IgG抗体几何平均浓度和阳性率分别为103.1626 IU/mL 和93.3%,各年龄组统计分析 ,差异无统计学意义( χ² =2.7668,P =0．2507;F=1.00,P=0.905)全文类似描述,如此排序,且随年龄增长,风疹抗体水平有所增加;本市和外市的育龄期妇女风疹IgG 抗体阳性率间的差异无统计学意义( χ² = 0．0238,P =0．8774) ,本市和外市的育龄期妇女风疹抗体平均浓度间的差异有统计学意义(F=0.207,P=0.991) ;有接种史、无接种史和接种史不详的育龄期妇女风疹IgG抗体阳性率间的差异无统计学意义( χ² = 2．0691,P =0．3554,F=1.508,P=0.224)。2010—2013年罗湖区女性风疹发病年龄主要集中在15—35岁,占女性发病人数的74.84%,2010—2013年所占比例分别为75%、75.63%、75%、64.7%。结论 对育龄期妇女加强接种风疹疫苗( 或含有风疹疫苗的联合疫苗) ,提高育龄妇女风疹抗体水平,是控制小月龄发病和先天性风疹综合征的重要手段。     

Effect of low level immunity on response to live rubella virus vaccine

Serum specimens of 1075 young adults representing nursing and medical staff were collected for determination of rubella immunity using the radial haemolysis (RH) technique, also known as the haemolysis in gel (HIG) test. Of the sera 84 (7.8%) were negative (RH titre <4 mm) and an additional 93 (8.7%) gave an RH titre of 4–5 mm, which was regarded as the limit of immunity. Initially, 64 persons of these 177 were vaccinated with the RA27/3 strain of live attenuated rubella virus. Their serum samples were collected at the time of vaccination and at three weeks and three months after vaccination. Altogether 54 vaccinees could be followed for their immune response throughout the study. It became obvious that vaccination generally caused seroconversion only after three months rather than within three weeks. Only one person remained seronegative - even after a booster dose of vaccine. The mean final antibody titres in individuals with pre-existing low level immunity was 6 mm whereas in initially seronegative persons the antibody titre after vaccination was 8.5 mm on average. Thus a pre-existing low level immunity will effectively block the immune response to live rubella virus vaccine and this phenomenon may explain some apparent vaccination failures.     

2006年山东省风疹暴发地区孕妇风疹病毒早期感染状况调查

[目的]了解风疹暴发地区孕妇风疹病毒早期感染状况,为监测与预防先天性风疹综合症（CRS）提供依据。[方法]2006年4月,在山东省5处近期风疹暴发地区采集部分未发生风疹的孕妇血清,检测风疹IgM抗体,并对阳性孕妇所生儿童进行追踪观察。[结果]调查孕妇1030名,风疹IgM抗体阳性5例,阳性率为0．49％;5例孕妇孕周分别为16周、19周、20周、21周和40周,其中2例（孕周16周、20周）流产,3例均顺利生产,跟踪观察1年,儿童未发现出生缺陷。[结论]山东省风疹暴发地区孕妇风疹病毒早期感染率不高。     

Outcome of asymptomatic infection with rubella virus during pregnancy.

We have tried to detect prenatal infection in 34 infants whose mothers were re-infected with rubella virus during pregnancy and in six infants whose mothers had primary subclinical rubella during pregnancy. Two methods of assessment were used: first, serum obtained soon after birth was tested for IgM antibody; secondly, serum obtained after the age of 8 months was tested for specific IgG. The 34 women with re-infections had increases in IgG antibody titre but no IgM response. No evidence of prenatal infection was found in 33 of their 34 infants. One infant was found to have IgG antibody at the age of 11 months. This infant was IgM-negative at birth and had a rubelliform rash at the age of 5 1/2 months; it therefore probably contracted post- rather than pre-natal infection. Fetal infection from maternal re-infection during pregnancy is probably rare. The six women with primary subclinical rubella produced both IgG and IgM classes of antibody. Three of their six infants showed serological evidence of intrauterine infection. One, infected when its mother was 8 weeks pregnant, had clinical evidence of congenital rubella. Primary subclinical rubella during pregnancy therefore carries a significant risk of fetal infection. Because of the difference in outcome, great care should be taken to distinguish between primary infection and re-infection when investigating symptomless increases in antibody titre after contact with rubella during pregnancy.     

Specific IgG subclass antibody in rubella virus infections

A solid-phase antigen enzyme-linked immunosorbent assay (ELISA) was developed for the detection of rubella-specific IgG subclasses. For rubella-specific IgG1 and IgG3 sera were quantitated in arbitrary units (au) by comparison with standard curves. A concentration of 3 au was taken as that indicating positivity for specific IgG1 and specific IgG3. No sera reactive for specific IgG2 and IgG4 have been found, and thus the assay reagents were controlled by testing dilutions of a standard calibrant serum containing known concentrations of the specific IgG subclasses. Of 105 unselected sera negative for rubella antibody by radial haemolysis (RH), two gave concentrations of specific IgG1 greater than 3 au and both were positive by rubella latex agglutination (LA). The sensitivity of the assay for specific IgG1 was confirmed by examining 25 selected sera negative by RH but reactive by LA. Twenty-one gave concentrations greater than 3 au. None of these 130 was positive for specific IgG3. All 63 sera containing greater than 15 international units rubella antibody by RH from cases of rubella in the remote past contained specific IgG1 and eight contained specific IgG3. In 79 cases of primary rubella, specific IgG1 developed in all cases by day 8. Specific IgG3 became detectable in all cases except one by day 16. Serum taken on day 21 from one case was negative for specific IgG3 but the absence of later sera precluded further investigation. One case had become negative for specific IgG3 by day 56. Sera from 24 cases of rubella reinfection were examined and all contained specific IgG1. In three cases of symptomatic reinfection, specific IgG3 was detectable in two but not in the remaining case. In 2 of the 21 cases of asymptomatic reinfection only a very early or a very late serum was available. Of the remaining 19 cases, 7 had detectable specific IgG3. However, only one of 9 sera collected 30-50 days after contact contained specific IgG3. Thus for the asymptomatic patient for whom other serological tests suggest a recent rubella infection, the failure to detect specific IgG3 in sequential sera collected after contact suggests reinfection rather than primary rubella. The detection of specific IgG3 did not correlate with the presence of specific IgM. Sera collected 6-8 weeks after rubella vaccination had detectable specific IgG1 in 32 of 33 cases and specific IgG3 in 9 of 33. The remaining vaccinee was seronegative.     

720例麻疹疑似病例血清学检测结果分析

目的:分析太原市720例麻疹疑似病例的实验室检测结果,为更好的开展麻疹监测工作和控制麻疹提供依据。方法:应用酶联免疫吸附试验检测血清标本中麻疹和风疹IgM抗体。结果:太原市2000~2006年共检测麻疹疑似病例血清720例,检出麻疹IgM抗体阳性399例,实验室诊断符合率为55.42%。麻疹IgM抗体阳性者中,>18岁年龄组人数最多。在太原市3~5月份是麻疹发病高峰,小店区发病人数最多。2004~2006年从256例血清中检测出风疹IgM抗体阳性113例,阳性率为44.14%。结论:2000~2006年太原市大年龄组麻疹发病人数最多。风疹是干扰麻疹诊断的一个重要因素。为控制和消除麻疹,应提高麻疹的免疫接种率和接种质量,提高人群的免疫覆盖率。