Comparing the rubella seronegativity in pregnant women who received one dose of rubella vaccine at different ages in Taiwan

IntroductionVaccination is the best strategy to prevent rubella and congenital rubella. The aim of our study was to assess the immunity to rubella and determine rubella virus antibody titers in pregnant women who were offered a single dose of rubella vaccine at different ages of their lives.MethodsA total 15,067 rubella IgG antibody test results for Taiwanese pregnant women who received routine prenatal checkup at Fooyin University Hospital from 1999 to 2014 were analyzed in this study. The women were divided into five birth cohorts in order to compare their rubella seronegativities and antibody titers according to the different period of rubella vaccination policy in Taiwan.ResultsThe total rubella seronegativity rate was 11.2% (95% CI: 10.7–11.7%) and the mean rubella antibody titers was 51.0 IU/mL (SD = 54.7 IU/mL). The junior school cohort has the lowest rubella seronegativity of 7.6% (95% CI: 6.9–8.2%). The seronegativities were significantly high in the preschool cohort and in the 15-month-old cohort, 14.9% (95% CI: 13.2–16.6%) and 14.8% (95% CI: 11.5–18.1%), respectively. The OR values were 2.1 (95% CI: 1.8–2.5, p < 0.001) in the preschool cohort and 2.2 (95% CI: 1.6–2.8, p < 0.001) in the 15-month-old cohort, respectively, against the junior school cohort. Women in the 15-month-old cohort have lowest average rubella IgG titer, 25.4 IU/mL.ConclusionThe total rubella seronegativity rate was 11.2% in all native pregnant women. Women who received one dose rubella vaccine at preschool and 15-month-old have highest seronegativities. The 15-month-old cohort has the lowest average rubella IgG titer. We recommend a revised catch-up immunization policy to women who received one dose rubella vaccine at a younger age.     

Pertussis immunization in a high-risk postpartum population

We provided CDC recommended postpartum tetanus, diphtheria, acellular pertussis (Tdap) immunization to medically underserved, uninsured women in Houston through a standing order protocol. From January 7–April 30, 2008, 1129 of 1570 (72%) postpartum women (93% Hispanic; 11% ≤19 years) received Tdap before hospital discharge. Tdap uptake was 96.2% in women without self-reported contraindications. Recall of immunization history was inaccurate in 32% of unimmunized women who reported receiving antepartum immunization. Black women refused Tdap more often than other ethnicities (24% versus 8%; P = 0.003). Postpartum Tdap immunization was successfully implemented in a high-risk population through a standing order protocol. Barriers to postpartum immunization include inaccurate immunization history and the need for ongoing targeted education.     

Rubella virus immunization status in preconception period among Chinese women of reproductive age: A nation-wide,cross-sectional study

ObjectivePopulation-based studies on sero-epidemiology of Rubella in women before conception are lacking. The aim of this study was to investigate the sero-prevalence of Rubella in a nationwide survey among Chinese women planning to get pregnant within six months.MethodsThis population-based, cross-sectional, sero-survey of Rubella virus infection was a part of the National Free Preconception Health Examination Project covering all 31 provinces in Mainland China. Women intending to get pregnant within six months was enrolled between 2010 and 12. Information on demographic characteristics (age, residence status, race, education and occupation) and vaccination history was obtained by interviews. Rubella virus IgG sero-positivity was determined using venous blood samples.ResultsOf 2,120,131 women recruited to the study, Rubella virus IgG serology was available in 1,974,188 (99.3%). Participating women were of young age (median = 28 years), mostly engaged in agricultural activities (78%), and the majority (90%) had high school education or lower. The overall prevalence of Rubella virus IgG sero-positivity was 58.4% (1,161,129); geographical variation ranged from 92.5% in Jilin to 20.1% in Qinghai and 0.0% in Tibet. Only 4.6% (n = 91,604) women reported to have had Rubella virus vaccination, and it varied from 18.6% (Guangdong) to 0.2% (Qinghai). Self-reported vaccination status did not correlate with Rubella virus IgG seropositivity.ConclusionsPrevalence of Rubella sero-positivity is low among Chinese women of reproductive age and there are significant regional differences. Over 40% of women being susceptible to Rubella in preconception period calls for a targeted screening and vaccination strategy.     

Rubella virus neutralizing antibody response after a third dose of measles-mumps-rubella vaccine in young adults

BackgroundThird doses of measles-mumps-rubella (MMR) vaccine have been administered during mumps outbreaks and in various non-outbreak settings. The immunogenicity of the rubella component has not been evaluated following receipt of a third dose of MMR vaccine.MethodsYoung adults aged 18–31 years with documented two doses of MMR vaccine received a third dose of MMR vaccine between July 2009 and October 2010. Rubella neutralizing antibody titers were assessed before, 1 month, and 1 year after receipt of a third dose of MMR vaccine.ResultsAmong 679 participants, 1.8% had rubella antibody titers less than 10 U/ml, immediately before vaccination, approximately 15 years after receipt of a second dose of MMR vaccine. One month after receipt of a third dose of MMR vaccine, average titers were 4.5 times higher and >50% of participants had a 4-fold boost. Response was highest among those with titers less than 10 U/ml prior to vaccination (geometric mean titer ratio = 18.8; 92% seroconversion) and decreased with increasing pre-vaccination titers. Average titers declined 1 year postvaccination but remained significantly higher than pre-vaccination levels. The proportion classified as low-positive antibody levels increased from 3% 1 month postvaccination to 24% 1 year postvaccination.ConclusionsVaccination with a third dose of MMR vaccine resulted in a robust boosting of rubella neutralizing antibody response that remained elevated 1 year later. Young adults with low rubella titers are more likely to benefit from a third dose of MMR vaccine.     

Iodine nutritional status in pregnant women of two historically different iodine-deficient areas of Catalonia, Spain

Objective

Catalonia (Spain) has a historically worse situation of mild iodine deficiency in the Pyrenees Mountains compared with the coastal region. The aim of this study was to evaluate the current iodine status in pregnant women living in these two areas.

Methods

An epidemiologic prospective survey included 267 consecutive pregnancies in the Catalan mountains (n = 139) and coast (n = 128) studied during the first trimester; an additional subset of 135 women from the initial cohort was available for evaluation in the third trimester. Urinary iodine (UI) was measured, and questionnaires to determine iodized salt and sea fish consumption and potassium iodide supplementation were administered.

Results

The median UI in the first trimester was 163 μg/L for the entire cohort, with differences between mountain and coastal regions (209 versus 142 μg/L, P = 0.007). The highest prevalence of iodized salt consumption was in the mountain area (58% versus 36.4%, P < 0.001). For the entire group, a higher median UI was found in iodized salt consumers compared with non-consumers (193 versus 134 μg/L, P < 0.001). In the third trimester, an increase of median UI was seen in those to whom iodine supplements were given during pregnancy (190 versus 154 μg/L, P = 0.015).

Conclusion

A reversal in the historically iodine-deficient situation was observed in the Catalan Pyrenees compared with the coastal area, with a globally acceptable iodine status in pregnant women of the two geographic locations. Iodized salt consumption seems to have contributed to maintaining an acceptable iodine status in this population.     

Rubella in guipuzcoa (Basque Country,Spain) a four-year serosurvey

Since the early 1980s, Spain has practiced mass vaccination of preschool children and selective vaccination of prepubertal girls. Estimated vaccination coverage in the province of Guipúzcoa (Basque Country) in recent years is about 95% (confirmed minimums of 89% for preschool children and 87.5% for 11 to 12 year-old girls). From the seroepidemiological study we could deduce that there was extensive circulation of wild rubella virus until recently (72–75% of unvaccinated girls 10 to 11 years-old had rubella antibody). More than 98% of the population at risk, represented in this study by 13,564 women (67% of all who bore children over a four-year period), possessed rubella antibodies. In the course of the study period the number of subjects (puerperal women and children) susceptible to infection declined. In spite of this favorable situation, the seroepidemiological study disclosed certain gaps that should be corrected to meet the targets for the European Region of the Expanded Programme on Immunization, and to achieve the goal of elimination of wild rubella virus in the area.Corresponding author.     

安徽省农村地区风疹感染基线调查及风疹疫苗免疫效果观察

对安徽省农村地区115名≤2岁～≥23岁的健康人检测了风疹血凝抑制（HI）抗体,结果表明：风疹HI抗体平均阳性率为67．89％;≤5岁儿童为43.85％;育龄期妇女易感率为8．59％。对361名≤2岁～≥23对岁的健康人接种了BRDⅡ株风疹减毒活疫苗,免疫应答研究结果表明：各年龄组对风疹疫苗均有较好的免疫应答反应;免疫前HI抗体阳性者接种风疹疫苗后仍可获得良好的免疫应答．说明我国选育的BRDⅡ株风疹减毒活疫苗具有良好的免疫原性。作者建议：①在全省建立风疹的监测系统;②将风疹疫苗的接种纳入计划免疫管理,实行1岁儿童完成初种及对婚前育龄期妇女给予1剂风疹疫苗的接种方案;③在条件许可的情况下,对全省农村地区14岁以下儿童进行普种．     

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。     

天津市流行性腮腺炎疫苗纳入免疫规划效果评价

目的 麻疹、流行性腮腺炎和风疹联合疫苗纳入天津市免疫规划后,对流行性腮腺炎的控制效果进行评价。 方法 利用全国传染病报告管理系统和天津市流行性腮腺炎专报平台数据分析疾病流行特征和免疫状况,开展血清学监测评价人群抗体水平。 结果 2007-2014年天津市流行性腮腺炎发病率从40.34/10万下降到11.14/10万,0~4岁组病例比例从9.50%增加到32.50%,10~14岁组从33.20%降低到12.93%,5~9岁和10-14岁组发病率降幅分别为70.41%和81.05%。2013-2014年共调查<10岁组流行性腮腺炎病例2 195例,个案调查率分别是83.45%和96.78%,病例中87.19%有至少1剂次免疫史。其中18月龄~2岁85.85%有1剂次疫苗免疫史,在3~4岁组中达到91.33%,5-9岁组有73.81%的病例有≥2剂次免疫史。2007-2014年天津市开展了4次健康人群流行性腮腺炎IgG抗体监测,抗体阳性率分别是2007年73.52%、2011年74.09%、2013年74.04%和2014年79.85%,经χ2检验,各年份抗体阳性率无统计学差异(χ2=6.51,P=0.09)。不同年龄组中,18月龄~2岁、3~4岁和5~9岁组抗体阳性率近年来逐渐升高,其中2014年3~4岁和5~9岁组抗体阳性率分别达到91.53%和98.33%。 结论 加强流行性腮腺炎监测和实现消除目标,应提高病例实验室检测率和开展2剂次MMR疫苗接种。     

Effect of educational and financial incentive-based interventions on immunization attitudes,beliefs, intentions and receipt among close contacts of pregnant women

IntroductionCocooning, the vaccination of close contacts of a newborn, is a strategy to limit the risk of pertussis and influenza infection among vulnerable infants.MethodsPregnant women in Colorado and Georgia referred close contacts to an app that provided tailored educational videos about vaccines along with a small pharmacy-based financial incentive for vaccine receipt. The primary objective of this study was to determine the feasibility of implementing this app-based cocooning intervention.ResultsTwo hundred seventy seven contacts were enrolled in this study. Of those who received the educational videos, 96% found them interesting, 100% found them clear to understand, 97% found them helpful, and 99% trusted them. Completion of the videos led to significant increases in influenza vaccine knowledge (p = 0.025), Tdap vaccine knowledge (p < 0.001), and intention to receive these vaccines (p = 0.046). Of the 136 participants who reported receiving influenza vaccine, 41 (30%) reported receiving it at a pharmacy, and of the 66 who reported receiving Tdap vaccine, 15 (23%) reported receiving it at a pharmacy. Of all participants, 80% reported being comfortable receiving vaccines at a pharmacy instead of a doctor’s office. The provision of small pharmacy-based financial incentives combined with individually-tailored educational videos about vaccines led to 6.97 (95%CI: 2.25–21.64) times higher odds of self-reported receipt of influenza vaccine than providing small pharmacy-based financial incentives without these videos. No significant difference was found for Tdap vaccine.ConclusionsTailored vaccine education can positively impact vaccine knowledge and intentions among adults. An app-based referral program providing education and financial incentives for cocooning vaccination at pharmacies is feasible.     

珠海市1～30岁健康人群风疹抗体水平监测和风疹疫苗免疫的血清学效果

为给我省将风疹疫苗接种纳入计划免疫管理提供科学依据，１９９６年以珠海市为试点，在该市三个区选择９４４名１～３０岁健康人群，用微量血球凝集抑制（ＨＩ）试验检测风疹ＨＩ抗体，总阳性率为６８．２％，几何平均滴度倒数（ＧＭＲＴ）为３６．１，其中＜１６岁儿童的风疹抗体阳性率和ＧＭＲＴ均明显低于≥１６岁人群。从９４４人中随机抽取１６９人接种风疹疫苗，观察免疫后的血清效果，免疫成功率为４７．３％，其中免前抗体阴性者，免后阳转率为９６．５％，免前抗体≤１：６４者，免疫成功率为９５．６％，免后比免前ＧＭ－ＲＴ增长９．３倍。同时对珠海市１～７岁儿童普遍接种风疹功苗，接种率为６１．２％，其中１岁儿童接种率７１．１％。疫苗接后未发现严重副反应，显示风疹疫苗有良好的免疫原性，安全可靠，建议逐步将风疹疫苗接种纳入计划免疫管理。     

Symptoms of postpartum anxiety and depression among women in Canada: findings from a national cross-sectional survey

ObjectiveThis study presents national estimates on symptoms consistent with postpartum anxiety (PPA) and postpartum depression (PPD) and the association between these conditions and possible risk and protective factors in women who gave birth in Canada.MethodsData were collected through the Survey on Maternal Health, a cross-sectional survey administered in Canada’s ten provinces between November 2018 and February 2019 among women who gave birth between January 1 and June 30, 2018. A total of 6558 respondents were included. Weighted prevalence estimates were calculated, and logistic regression was used to model the relationship between symptoms consistent with PPA, PPD, and potential risk factors.ResultsOverall, 13.8% of women had symptoms consistent with PPA, while the prevalence of having symptoms consistent with PPD was 17.9%. Results of the logistic regression models indicated that women who had a history of depression were 3.4 times (95% CI 2.7–4.2) more likely to experience symptoms consistent with PPA and 2.6 times more likely to experience symptoms consistent with PPD (95% CI 2.2–3.2) compared with those who did not. Women who reported good, fair, or poor physical health were 2.4 times more likely to experience symptoms consistent with PPD (95% CI 2.0–2.9) and 2.0 times more likely to experience symptoms consistent with PPA (95% CI 1.7–2.4) compared with those who reported very good or excellent health. Maternal marital status, other postpartum maternal support, and sense of community belonging were also significant.ConclusionThis study highlights that a history of depression and good, fair, or poor physical health are associated with an increased odds of symptoms consistent with PPA and PPD, while other maternal support and sense of community belonging are associated with a decreased odds of these conditions.     

天津市麻疹风疹及流行性腮腺炎抗体水平分析

目的了解天津市健康人群麻疹、风疹、流行性腮腺炎抗体水平,评价疫苗接种需求。方法2007年3月采集0~57岁健康人群608人份血样品,用ELISA方法定量检测麻疹、风疹、流行性腮腺炎IgG抗体水平。运用直线相关分析抗体阳性率,保护率GMC与疾病发病率之间的关系,P0.05为差异有统计学意义。结果麻疹、风疹和流行性腮腺炎疫苗接种率分别为70.39%、16.78%和12.34%;抗体阳性率分别为91.78%,65.79%和73.52%;抗体几何平均浓度(GMC)分别为2 488.10 IU/L、200.4 IU/ml和759.91 U/ml。麻疹抗体阳性率,保护率与发病率存在明显相关关系(P0.01),而GMC与麻疹发病率没有显著性相关;风疹和流行性腮腺炎抗体阳性率、GMC与发病率无相关关系。结论本次调查显示2007年天津市麻疹人群抗体GMC总体保持在较高水平。风疹、流行性腮腺炎疫苗接种率和抗体水平较低,2剂次的麻腮风疫苗(MMR)纳入免疫规划既有助于消除麻疹,也有利于控制风疹和流行性腮腺炎。     

Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women

BackgroundIn the United States, seasonal inactivated influenza vaccine (IIV) is recommended for pregnant women; however, in early 2009, immunization rates were low, partly due to limited prospective data and concerns about vaccine safety.ObjectiveWe conducted a randomized study of two licensed seasonal trivalent IIVs (IIV3) to assess their safety and immunogenicity in pregnant women.Study DesignIn this prospective, randomized clinical study, 100 pregnant women, 18–39 years of age and ≥14 weeks gestation received a single intramuscular dose of 2008–2009 Fluzone® or Fluarix®. Injection site and systemic reactions were recorded for 7 days after vaccination and serious adverse events (SAEs) and pregnancy outcomes were documented. Serum samples collected before and 28 days after vaccination were tested for hemagglutination inhibition (HAI) antibody levels.ResultsThe majority of the injection site and systemic reactions were mild and self-limited after both vaccines. No fever ≥100 °F was reported. There were no vaccine-associated SAEs. Immune responses to influenza vaccine antigens were similar for the two study vaccines, with robust HAI responses against influenza A strains, and relatively lower responses for influenza B strains.ConclusionSeasonal inactivated influenza vaccines were well tolerated and immunogenic in pregnant women.

• ClinicalTrials.gov identifier NCT00905125.

Synopsis: In this prospective clinical trial, we demonstrated that immunization with seasonal trivalent, inactivated influenza vaccine in the second and third trimester of pregnancy is immunogenic and safe.     

Mumps outbreak and MMR IgG surveillance as a predictor for immunity in military trainees

In 2017, a mumps outbreak occurred in a barrack holding 249 service members. Suspected cases were evaluated with a combination of mumps IgG, IgM, viral culture, PCR and sequencing. Seven cases were diagnosed in febrile patients presenting with parotitis or orchitis. Mumps infection was confirmed by IgM or positive PCR with 5/7 cases having notable IgG levels before infection. Sequencing confirmed mumps genotype G strain. Serum from all 249 service members collected prior to the outbreak was withdrawn from the Department of Defense (DoD) Serum Repository and the IgG values of measles, mumps and rubella determined with 20.2%, 12.3% and 9.7% service members being seronegative, respectively. No specific IgG seronegativity combination predicted IgG marker levels to another virus within the same vaccine. This paper provides additional evidence that mumps serology is not a reliable surrogate for mumps immunity and that we need better laboratory correlates to confirm immunity.     

不良妊娠结局与TORCH感染相关性的临床研究

目的:探讨不良妊娠结局与妊娠期感染弓形体(TOX)、其他(OTH)、风疹病毒(RUV)、巨细胞病毒(CMV)、单纯疱疹病毒(HSV-Ⅱ)(TORCH)系列病原体的关系。方法:应用酶联免疫吸附试验(ELISA),检测48例有不良妊娠史的妇女(试验组)及48例正常孕妇(对照组)母血及胎儿脐血TORCH感染情况。结果:①试验组TORCH-IgG感染率分别为:TOX-IgG 14.58%,RUV-IgG 47.91%,CMV-IgG 45.83%,HSVⅡ-IgG 35.41%。②试验组TORCH-IgM感染率分别为:TOX-IgM 33.33%,RUV-IgM 52.08%,CMV-IgM 54.16%,HSVⅡ-IgM 58.33%。③试验组TORCH-IgG、IgM双项阳性发生率为:TOX 12.50%,RUV 37.50%,CMV 31.25%,HSV-Ⅱ18.75%。以上3个指标,试验组均显著高于对照组(P<0.01),不良妊娠结局发生率试验组亦显著高于对照组(P<0.01)。结论:TORCH系列病原体活动感染对围生儿预后会产生严重的不良影响,是导致妇女不良妊娠结局的重要原因之一,TORCH筛查应作为产前检查的常规项目。尤其对有不良妊娠结局史的妇女,行TORCH筛查对防止出生缺陷的发生是完全必要。     

孕产妇情绪评估调查与产后抑郁症预防

目的:探讨产后抑郁症的发生率及其相关危险因素,为产后抑郁症的预防提供科学依据。方法:对住院分娩的268例产妇进行产前及产后基本情况调查,应用医院焦虑抑郁量表(HAD)评估孕妇孕期情绪状况,应用爱丁堡产后抑郁量表(EPDS)对产妇进行随访调查至产后3～7天。结果:产后抑郁症的发生率为17.91%,分析显示夫妻双方的文化程度、家庭收入、孕产妇是否在职、围产期夫妻关系及家庭关系、新生儿的健康状况、婴儿的照顾方式等10个因素与产后抑郁症发生相关(P<0.05)。结论:产后抑郁症发病率高,早期筛查其危险因素及时采取积极的干预措施十分重要,应受到广大医务工作者的足够重视。     

Seroprevalence of rubella in school girls and pregnant women

Many studies have been assigned to investigate the surveillance of congenital rubella syndrome, acquired rubella and seroprevalence in different countries to determine the new vaccination program and national vaccination schedules. Seroprevalence of rubella in Turkey is still insufficient and national immunization schedules do not include routine rubella vaccination. In this study we aimed to investigate the seroprevalence of rubella at child bearing age in an unvaccinated population in Adana, southern Turkey, to help determine whether routine rubella vaccination is necessary, if so when it should be administered. Ninety-four school girls aged 12–18 years living in Adana were selected for the study and stratified according to the socioeconomic status of their parents and evaluated for rubella antibodies. One hundred pregnant women aged 18–25 years and 100 pregnant women aged 26–35 years were sampled rubella antibodies. Rubella specific IgG antibody was measured qualitatively and quantitatively by using microparticule enzyme immune assay technology. Rubella specific IgG antibody was positive in 87–94 school girls (92.5%). The geometric mean rubella specific IgG antibody value was found be 148.14 IU/ml. No correlation was found between socioeconomic status and rubella seropositivity (p = 0.6521). In all pregnant women rubella specific IgG antibody was found to be positive. In conclusion rubella vaccination should be considered carefully in developing countries. Because of the high seropositivity to rubella in our region we do not recommend rubella vaccination in early childhood. Yet this is a preliminary study and further studies with larger population size are needed to determine the national immunization policy for rubella.