育龄妇女风疹病毒抗体检测结果分析

目的通过对育龄妇女血清风疹病毒(RUV)IgG和IgM浓度的检测,了解育龄妇女对RUV的免疫力和近期感染状况,从而指导优生优育。方法采用酶联免疫吸附试验(ELISA)方法检测7077例育龄妇女血清RUV-lgG和RUV-lgM浓度,并按照不同年龄进行分组和数据分析。结果 RUV-lgG总阳性率为80.94%,四个年龄组阳性率比较,差异有统计学意义(P0.05),阳性率随着年龄的增加而降低;RUV-lgM总阳性率为1.03%,四个年龄组阳性率比较,差异无统计学意义(P0.05)。结论大多数育龄妇女对RUV有免疫力,但仍存在一定的感染,应加强育龄妇女孕前及孕期RUV抗体检测,提高出生人口素质。     

Rubella vaccine: new horizon in prevention of congenital rubella syndrome in the India

Rubella is a contagious viral disease, which mainly affects the fetus, if the mother is infected in the 1st trimester of her pregnancy. All adolescent girls (aged 11 to 19 y) and women of childbearing age are at risk of developing rubella. This disease is mild and self-limiting, and incubation period is 2-3 weeks. Humans are the only hosts for rubella. Rubella infection during pregnancy may lead to abortions, stillbirth or congenital deformities (birth defects). Moreover it is surprising to know that over 200,000 babies are born with birth defects because of Rubella infection during pregnancy in the Indian sub-continent. The risk of fetal infection is highest in first trimester; the infection rate declines between 12-28 weeks, suggesting that the placenta may prevent transfer of virus but not completely. The incidence of defects is inversely related to the time of maternal infection. Rubella outbreaks have been reported from many countries in South East Asian region with congenital rubella syndrome (CRS) due to maternal rubella being on the increase in many countries. In India, although the endemicity of rubella is established, the majority of cases remain undiagnosed, being subclinical or clinically mild. Consequently, in spite of evidence of CRS in all States of India, no distinct policy has been envisaged for assessing the burden of rubella, and no control measures against this silent crippling disease are in place. The European Regional Committee of the World Health Organization has adopted the goals of "Elimination of CRS" in the Health for All programs. There is no treatment for rubella. Vaccination is the only way to prevent all these complications.     

Prevalence of HI antibody titer against rubella virus to determine the effect of mass vaccination in Tehran.

BACKGROUND: Rubella is an infectious viral disease, has a worldwide distribution and is normally a mild childhood disease. Infection during early pregnancy may cause fetal death or congenital rubella syndrome. The highest risk of CRS is found in countries with high susceptibility rates among women of childbearing age. In many developed and some developing countries, large-scale rubella vaccination during the past decade has drastically reduced or practically eliminated rubella and CRS. Mass vaccination campaigns and Expanded Program of Immunization (EPI) have increased vaccine coverage in the world with a substantial impact on the reduction of rubella infections, such as CRS. OBJECTIVE: The present study was preformed to evaluate the immune status against rubella before and after the mass campaign vaccination on 22 December 2003. STUDY DESIGN: A total of 320 samples were collected from the healthy subjects before and after the vaccination and 80 paired sera were collected and tested for the presence of rubella antibody using HI test. RESULTS AND CONCLUSIONS: Based on the results, 98.1% of the population has gained anti-rubella antibody, compared with 92.2% before the vaccination. The data revealed that 98.75% of the paired subjects had rubella antibody after mass vaccination which is statistically significant.     

育龄妇女风疹病毒化学发光法检测结果分析

目的 使用化学发光免疫分析技术对孕前及孕早期育龄妇女进行风疹病毒定量检测,通过对检测结果进行分析,了解本地区孕前及孕早期妇女风疹病毒的感染状况,为制定孕前及孕早期保健措施提供依据。方法 对2015年5月~2018年4月来我院进行孕前检查和孕早期建卡的1052例育龄妇女进行风疹病毒特异性抗体IgM和IgG的定量检测,并对检测结果进行统计分析。结果 育龄妇女中RV-IgM总阳性率为0.86%,RV-IgG总阳性率为80.13%。曾经感染过风疹病毒或接种疫苗有保护性抗体（IgM-/IgG+）总体比例为79.46%（836/1052）,对风疹病毒易感的妇女（IgM-/IgG-）总体比例为19.68%（207/1052）。孕前组及孕早期组（IgM-/IgG-）比例分别为9.20%、27.07%,总体比例为19.68%;（IgM-/IgG+）比例分别为89.43%、72.45%,总体比例为79.46%;（IgM+/IgG-）比例分别为0.46%、0,总体比例为0.19%;（IgM+/IgG+）比例分别为0.92%、0.49%,总体比例为0.67%。孕前组RV-IgM及RV-IgG阳性率高于孕早期组,差异有统计学意义（P＜0.05）。结论 CLIA法对风疹病毒IgM 抗体和IgG抗体的准确检测,为诊断和随访风疹病毒急性感染,评估孕前及孕早期育龄妇女的免疫状态,以及为可疑育龄妇女选择适当的预防措施提供了基本的工具和依据。RV-IgG 阳性率较高,对育龄妇女具有一定的保护作用,防治重点可放于RV-IgG阴性的育龄妇女。     

Postinfection and postvaccination antirubella immunity

Out of 1670 pregnant women contacts examined for antibodies to rubella virus, recent rubella infection was confirmed in 5.1% of subjects, 2.2% of which were symptomatic and 2.9% asymptomatic; 89.9% of tested women were seropositive. These results closely resembled those, obtained in serological surveys, carried out in Poland several times in the years 1969-82. Rubella antibodies were found in over 90% of women in childbearing age, with HI antibody geometric mean titre (GMT) 58.7-84.3 (depending on the epidemiologic situation). Especially high GMT--of 122--was detected in women of the 30-34 year age group after the rubella epidemic in 1980/81, which showed the highest rubella morbidity of 5-9 year-old children. Reactogenicity and immune response in 10-13 year-old vaccinated girls were investigated. Seroconversion among seronegatives, among subjects with low antibody level (less than 1:20) and among seropositives with antibody titres 40 or higher before vaccination occurred in 99.8%, 60% and 12.8% of cases, respectively. HI antibody GMT after immunization was 132.6-135, similar to GMT induced by naturally acquired infection in the women of 30-34 year age group after the rubella epidemic. The difference of GMT in vaccinated girls with joint symptoms (152) and without postvaccinal reactions (124) was statistically significant. Practical conclusions for rubella diagnostic and vaccination programmes based on the analogies and differences of antirubella immunity in infected pregnant women, in naturally infected children and adults, and in vaccinated subjects are discussed.     

Antigen requirements, sensitivity, and specificity of enzyme immunoassays for measles and rubella viral antibodies.

Enzyme immunoassay (EIA) systems for measles virus and rubella virus were studied from the standpoints of requirements for suitable viral antigens and control antigens, and the sensitivity and specificity of the tests for detecting antibody elicited by past infection (determination of immunity status), and for serodiagnosis of currenet infections. Crude or semipurified measles virus antigens were satisfactory for EIA, but antigens derived by pelleting virus from infected cell culture fluids were slightly more specific in their reactivity than were antigens produced from lysates of infected cells. However, reliable rubella EIA antigens could be produced only from infected cell culture fluids, and they required density gradient purification to render them suitably specific. Even with gradient-purified rubella antigens, it was necessary to use antigen prepared in an identical fashion from uninfected cell culture fluids as a control on the specificity of reactions obtained with test sera. With appropriate viral antigens and control antigens, both measles and rubella EIA systems were highly sensitive and specific for determination of immunity status and for serodiagnosis of current infections. Antibody was detectable earlier in the course of infection by EIA than by hemagglutination inhibition or complement fixation, but this did not limit the diagnostic value of the test, since titer increases demonstrable by EIA were usually greater than those detectable by hemagglutination inhibition or complement fixation tests.     

Comparative studies of rubella virus immunity of immunized and non-immunized pregnant women visiting Kogi State University Teaching Hospital,Anyigba, North Central Nigeria

ABSTRACT

Rubella is endemic worldwide and poses a serious threat to infants and pregnant women. Although the disease has been widely reported in parts of the country, there is currently no documented evidence of the disease in Anyigba. A comparative study of rubella immunity was conducted among immunized and non-immunized pregnant women visiting the Kogi State University Teaching Hospital, Anyigba. In a cross-sectional study, blood samples collected from 300 pregnant women (immunized = 127; non-immunized = 173) were tested for rubella antibodies using ELISA kit. Overall, anti-rubella-IgM and IgG seroprevalence rates of 38 (12.7%) and 83 (27.7%) were detected. Seventy (55.1%) of the immunized against 13 (7.5%) of non-immunized women had detectable IgG. The non-immunized women were significantly more seropositive for IgM than the immunized who recorded higher prevalence of IgG. Immunized and non-immunized women aged 23–32 years had higher IgG and IgM positivity rates. The difference in IgM and IgG seropositivity rates in relation to vaccination was statistically significant (P < 0.05) between the immunized (0.8%, 55.1%) and vaccine-naïve subjects (21.4%, 7.5%). Low level of awareness and high susceptibility to rubella virus infection especially among the non-immunized women was confirmed in study area, thus the need for government to strengthen education of masses and to make rubella vaccination freely available for women of childbearing age.     

A computerized audit of a screening programme to establish rubella immunity

This paper reports the use of a practice computer to help establish rubella immunity in all women that are likely to bear children. The rubella status by serological testing for each woman in the practice together with the date of the test is entered in the computer by ancillary staff as soon as results are obtained. The computer audit can be carried out by practice staff and takes half an hour. The resulting print-out gives details of rubella immunity for all women aged 14—39 years and also for all women at the beginning of pregnancy. Results of successive audits show consistent increases in the numbers of women with established rubella immunity.     

Rubella prevalence and its transmission in children

Rubella is a major cause of birth defects among the TORCH group of agents causing congenital anomalies. Almost all the symptomatic infected infants have long-term neurological sequelae & many asymptomatic infants also develop deafness or psychomotor retardation later in life. In India need for rubella prevention & control is being recognized. Before formulating any kind of rubella vaccination policies, data on the burden of disease is important. Hence the prevalence of rubella in children and their transmission was evaluated. Paired sera of 146 babies with suspected intra uterine infection and their mothers from lower socioeconomic strata was tested for IgM antibodies by commercially available Enzyme immunoassay (EIA) kits. Congenital Rubella Syndrome (CRS) was confirmed in babies presenting with rubella compatible defects with positive IgM antibodies against rubella. It was seen that out of 146-paired samples evaluated, 15-paired samples (10.27%) were positive for IgM antibodies. The transmission rate of rubella virus from mother to child when the mother was infected was around 55.55% according to this study. CRS prevalence of 10.27% among symptomatic infants is significant as a large majority of rubella infection remains undetected and hence the actual burden of the disease may be higher. Since the disease is preventable by an effective vaccination, strategies for rubella immunization should be developed and enhanced.     

Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.     

Susceptibility to rubella in a pregnant population after the introduction of vaccination.

The results of testing for the presence of rubella antibody by haemagglutination inhibition in pregnant women are presented for a number of years, together with an analysis of results for the year 1977. Levels of immunity are correlated with age and British nationality. The influence of vaccine availability on numbers with antibody cannot be demonstrated nor can any evidence for the boosting of antibody levels by natural infection can be discerned.     

The role of rubella-immunoblot and rubella-peptide-EIA for the diagnosis of the congenital rubella syndrome during the prenatal and newborn periods

Rubella infection during the first trimester of pregnancy can cause the congenital rubella syndrome (CRS). Patients with CRS were shown to have a decreased humoral and cellular immunity. It is not known whether asymptomatic newborns who had experienced intrauterine infection with rubella virus (RV) differ in their antibody response from newborns with CRS. In this study we compared both groups for a difference which might be a useful diagnostic criterion for CRS during the prenatal and newborn periods. We used the nonreducing Rubella-Immunoblot and the Rubella-IgG-Peptide-Enzyme Immunoassay (EIA) to determine the antibodies directed to rubella proteins E1, E2 and C. The results showed that only newborns with CRS who had experienced RV infection during the first 12 weeks of gestation showed significantly reduced levels of antibodies directed to both the linear RV E1 epitope (SP 15) and the topographic RV E2 epitope. Asymptomatic newborns infected mostly later than week 10 of gestation showed normal levels of antibodies. These data suggest that the lack of antibody response in CRS is linked to the immaturity of the fetal immune system during the first trimester of gestation. Rubella-IgG-Peptide-EIA and Rubella-Immunoblot should be used additionally for CRS diagnosis in the prenatal/newborn periods. These results may have an impact on the early treatment of late-onset symptoms of CRS patients. J. Med. Virol. 51:280–283, 1997. © 1997 Wiley-Liss, Inc.     

Transcriptional signatures associated with rubella virus-specific humoral immunity after a third dose of MMR vaccine in women of childbearing age

Multiple factors linked to host genetics/inherent biology play a role in interindividual variability in immune response outcomes after rubella vaccination. In order to identify these factors, we conducted a study of rubella-specific humoral immunity before (Baseline) and after (Day 28) a third dose of MMR-II vaccine in a cohort of 109 women of childbearing age. We performed mRNA-Seq profiling of PBMCs after rubella virus in vitro stimulation to delineate genes associated with post-vaccination rubella humoral immunity and to define genes mediating the association between prior immune response status (high or low antibody) and subsequent immune response outcome. Our study identified novel genes that mediated the association between prior immune response and neutralizing antibody titer after a third MMR vaccine dose. These genes included the following: CDC34; CSNK1D; APOBEC3F; RAD18; AAAS; SLC37A1; FAS; and JAK2. The encoded proteins are involved in innate antiviral response, IFN/cytokine signaling, B cell repertoire generation, the clonal selection of B lymphocytes in germinal centers, and somatic hypermutation/antibody affinity maturation to promote optimal antigen-specific B cell immune function. These data advance our understanding of how subjects’ prior immune status and/or genetic propensity to respond to rubella/MMR vaccination ultimately affects innate immunity and humoral immune outcomes after vaccination.     

An opportunistic approach to rubella screening in general practice

An opportunistic rubella screening programme in a general practice is described. Self-adhesive stickers placed on the medical records envelope were used to alert staff and to record information on rubella status. Out of the total target population of women aged between 10 and 40 years, three sample cohorts were audited: the 15, 20 and 30 years age groups. Between the first and second audits a practice policy on rubella immunization screening was implemented over a period of 11 months. After 11 months the proportions of 20- and 30-year-olds whose rubella status was known had risen from 50% to 88% and from 67% to 87% respectively. For the 15-year-old cohort, which would have been included in the schools immunization programme, the increase was negligible. Serological testing in the practice identified 24 women (7% of all those tested) who were seronegative and to date 19 of these women have been vaccinated. The screening method was shown to be simple and effective and to involve little extra staff time.     

Current seroepidemiology of rubella virus infection among female residents in Taiwan

To examine the epidemiological characteristics of rubella virus infection on Taiwan Island and in Orchid and Pescadore islets, a community-based survey was carried out in 19 townships and metropolitan precincts randomly selected through stratified sampling. Serum specimens of 4,770 healthy girls and women randomly sampled from study areas were screened for the rubella antibody by passive latex agglutination testing and confirmed by enzyme-linked immunosorbent assay. A total of 2,934 subjects were antibody positive, giving a prevalence of 61.5%. The mean ± standard deviation of rubella IgG index was 2.51 ± 0.37. The seropositive rate increased with age in all residential areas and ethnic groups. The age pattern indicated that the regular 10-year cycle of rubella epidemic was no longer existent after 1978. A higher prevalence was observed in the eastern island and Orchid Islets compared with other areas. The highest seropositive rate was found in Orchid Islets. The overall seronegative rate was 62.9% for females <20 years of age and 36.9% for women between the ages of 20 and 29 years. With such a high susceptible density among girls and women of child-bearing ages as well as the endemicity of rubella virus infection in Taiwan, mass vaccination against rubella should be enforced in order to prevent possible future outbreaks of the congenital rubella syndrome.     

The present situation and limitation of antibody assays for diagnosis of rubella virus infection in pregnant women]

Rubella virus infection during early stages of pregnancy often results in a number of developmental disorders referred to as congenital rubella syndrome(CRS). Both clinical and laboratory diagnosis of suspect cases of CRS can be made with relative ease, particularly when expectant mothers show the typical rubella-specific rash. Serological diagnosis of CRS is accomplished using hemagglutination inhibition (HI) and enzyme-linked immunosorbent(IgM-EIA) assays. Antibody titers as determined by these assays are generally very high following acute apparent rubella infections, thus making serological diagnosis relatively easy in most cases. However, the detection of possible CRS cases can be hampered by clinically inapparent rubella infections during early pregnancy. As much as 30 percent of all acute rubella cases are inapparent infections, and there is the very real potential for such inapparent infections to occur during pregnancy, to result in fetal infections, and consequently to cause CRS. Detection of CRS becomes extremely difficult in such settings. Complicating CRS detection even more are rare rubella re-infections that might occur in early pregnancy, and unknown risk of fetal infection and CRS. In re-infection cases, HI antibody titer becomes elevated due to a secondary immune response, and IgM antibody is produced in a significant number of cases. To determine directly the fetal infection, virus genome detection was developed and applied clinically for the past decade. Using a combination of serological and genomic detection methods, the results of the investigation suggest that when rubella infection during early pregnancy occurs 1) there is a significant risk of fetal infection that results from acute apparent rubella infection, 2) there is a measurable risk of fetal infection resulting from inapparent infections as defined by HI antibody titers > or = 256 and with and IgM-EIA index > or = 7, and 3) high HI antibody titers with low IgM-EIA indices or no detectable IgM antibody in cases of inapparent rubella infections may represent rubella re-infections and result in a low risk of fetal infections.     

Primary investigation of 31 infants with suspected congenital rubella syndrome in Sudan

Between 2005 and 2006, clinical specimens were collected from 31 infants with suspected congenital rubella syndrome (CRS) who presented at six hospitals in Khartoum, Sudan. Eleven (35.5%) were laboratory confirmed as CRS cases by testing for anti-rubella IgM, IgG and viral genome. For the first time in Sudan, the rubella virus genome was directly detected in clinical specimens of six CRS cases and two viruses were isolated in cell culture. Phylogenetic analysis suggested that three genotypes of rubella virus (RV; 1E, 2B and 1G) were co-circulating in Sudan. The study introduced the methodology for CRS confirmation and surveillance in Sudan and provides preliminary data.     

Seroprevalence of rubella among women of childbearing age in Switzerland

A seroepidemiological study was carried out in Switzerland to define the population susceptible to rubella among women of childbearing age. IgG antibodies to rubella virus were determined in 9,046 women giving birth between 1 August 1990 and 30 September 1991 in 23 of 26 Swiss cantons. These sera represented 10–20 % of the yearly total number of births in each Swiss canton. Anti-rubella IgG was measured by an automated enzyme-linked fluorescent assay for use with a commercial system (Vidas Rub IgG, bio-Mérieux, France). Before the study population was screened, the commercial system was compared to the traditional hemagglutination-inhibition (HAI) test using 500 consecutive samples from parturient women. The sensitivity was 97.7 %, the specificity was 100 %, and agreement between the two tests was 97.8 %. The discrepancies corresponded to very low titres of antibodies as measured by HAL The seroprevalence of rubella nationwide in women of childbearing age in Switzerland was 94.3 %. The seroprevalence was higher (96.5 %) in the 5,677 women of Swiss nationality than in the 3,090 women of a different nationality (90.4%) (p<0.001). In Swiss women the seroprevalence of rubella did not increase significantly with age and was identical in primiparous and in multiparous women, thus indicating that women of childbearing age are probably not sufficiently immunised.     

Epidemiological and molecular assessment of a rubella outbreak in North‐Eastern Italy

From January to June 2008, a rubella outbreak involving 111 laboratory confirmed cases occurred in the Friuli Venezia Giulia (FVG) region of North‐Eastern Italy. The outbreak occurred initially in two residential homes for young adults disabled mentally and physically. Subsequently, the epidemic spread to the general population. Young adult cohorts were mostly affected and the mean age of the patients was 26.8 years; the majority of cases were male (73.8%), with a mean age of 26.6 years in males and 27.4 in females. Three pregnant women had a primary infection and two had their pregnancies terminated. Genotyping of 16 isolates showed the circulation of RUBV 2B, a genotype originating from Asia and South Africa and now present in Europe. In addition, molecular analysis revealed a well defined space‐temporal spread of two viruses showing distinct sequences. A seroepidemiological survey carried out in a city within the same geographical area showed that the proportion of women of childbearing age still susceptible to rubella virus was 5.5%, fairly close to the figure (<5%) expected by 2010. J. Med. Virol. 82:1976–1982, 2010. © 2010 Wiley‐Liss, Inc.