Seroprevalence of measles and rubella antibodies in pregnant women Haiti, 2012

Background

Haiti had set a national goal to eliminate measles and rubella, as well as congenital rubella syndrome (CRS) by 2010. A 2007–2008 nationwide measles and rubella vaccination campaign targeting 1–19 years, however, reached only 79% of the target population. To assess whether population immunity was adequate to support elimination, we conducted a national serosurvey.

Methods

We systematically selected 740 serum specimens collected from pregnant women in a 2012 national antenatal HIV sentinel serosurvey across four age strata: 15–19, 20–24, 25–29 and 30–39 years. Sera were tested for measles and rubella specific immunoglobulin G antibodies (IgG) using commercial immunoassays. We classified sera as seropositive, seronegative or indeterminate per manufacturer's instructions, and analyzed seroprevalence according to age strata, and rural or urban residence. We assessed immunity by estimating antibody concentrations in international units per milliliter (IU/mL) for seropositive and indeterminate sera. Measles IgG concentrations >0.12 IU/mL and rubella IgG concentrations >10 IU/mL were considered clinically protective.

Results

Of 740 sera, 696 (94.1%) were seropositive and 20 (2.7%) were indeterminate for measles IgG; overall 716 (96.8%) sera had IgG concentrations >0.12 IU/mL. For rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%) was indeterminate; a total of 687 (92.8%) had IgG concentrations >10 IU/mL. Measles seropositivity varied across age strata (p = 0.003); seropositivity increased from 88.6% among 15–19 year olds to 98.4% among 30–39 year olds (Cochran–Armitage trend test ≤ 0.0001). Rubella seropositivity did not differ across age strata. There were no statistically significant differences in measles or rubella seropositivity by urban versus rural residence.

Conclusion

Despite previous low vaccination coverage for measles, results from this serosurvey indicate high levels of measles and rubella seropositivity in pregnant women, and contribute to the evidence for measles, rubella and CRS elimination from Haiti by the target date.     

Surveillance of congenital rubella syndrome (CRS) in tertiary care hospitals in Hanoi,Vietnam during a rubella epidemic

ObjectiveTo describe the epidemiology and clinical features of congenital rubella syndrome (CRS) in Hanoi, Vietnam.MethodsProspective surveillance of CRS between May 2011 and March 2012 in Hanoi, Vietnam. CRS burden was assessed by clinical examination and collection of serum samples from infants in neonatology, cardiology and pediatric departments of two tertiary care hospitals in Hanoi. All infants born during the study period with clinical manifestations of CRS and seropositivity (IgM) for rubella were included in this study.ResultsDuring the surveillance period 113 infants were identified with confirmed CRS (clinical features and positive rubella IgM). Their mean age at diagnosis was 38.4 days (range 1–152 days) and 61% were female. Clinical manifestations of CRS included low birth weight <2500 g (86.0%), congenital heart disease (63.7%), hearing impairment (63.7%) and ophthalmological abnormalities (46.9%). Other clinical features at birth included: thrombocytopenia (85.0%), neonatal purpura (74.3%), splenomegaly (63.7%), hepatomegaly (62.8%) and blueberry muffin rash (61.1%). Among the mothers of infants with confirmed CRS none had received a rubella vaccine in the past and 88.4% gave a history of rubella contact during the pregnancy under study. In most cases (84.1%) maternal infection occurred in the first trimester. During the surveillance period the estimated annual incidence of CRS was 1.13/1000 live births (95% CI 0.92–1.34).ConclusionsThese preliminary baseline data show a high burden of CRS in Hanoi, Vietnam and the urgent need for universal vaccination. Surveillance to determine and monitor the national burden of CRS is essential.     

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.     

Safety profile of rubella vaccine administered to pregnant women: A systematic review of pregnancy related adverse events following immunisation,including congenital rubella syndrome and congenital rubella infection in the foetus or infant

BackgroundData on the safety of inadvertent rubella vaccination in pregnancy is important for rubella vaccination programs aimed at preventing congenital rubella syndrome.MethodsThe association between monovalent rubella or combination vaccinations in or shortly before pregnancy and potential harm to the foetus was examined by conducting a systematic review and meta-analysis using fixed effect methods and simulation.ResultsFour cohort studies of inadvertently vaccinated and unvaccinated women were found, 15 cohorts of pregnant women who were rubella susceptible at time of inadvertent vaccination and 9 cohort studies with no information on susceptibility and case series. No case of vaccine associated congenital rubella syndrome (CRS) was identified. Cohort studies with an unvaccinated comparison group were limited in number and size, and based on these only a theoretical additional risk of 6 or more cases of CRS per 1000 vaccinated women (0% observed, upper 95% CI 0.6%) could be excluded. Based on cohorts of vaccinated rubella susceptible pregnant women a maximum theoretical risk of 1 CRS case in 1008 vaccinated women (0% observed, upper 95% CI 0.099%) was estimated. Asymptomatic rubella vaccine virus infection of the neonate was also noted (fixed effects estimate of risk overall 1.74%, 95% CI 1.21, 2.28).ConclusionThere is no evidence that CRS is caused by rubella-containing vaccines but transplacental vaccine virus infection can occur. CRS is effectively prevented by vaccination, thus the risk/benefit balance is unequivocally in favour of vaccination. The data confirm previous recommendations that inadvertent vaccination during pregnancy is not an indication for termination of pregnancy.     

2010-2014年哈尔滨市先天风疹综合征监测分析

目的 分析2010-2014年哈尔滨市先天风疹综合征（CRS）的监测结果。方法 采用描述流行病学方法,对监测的CRS病例进行分析,并对监测指标进行评价。结果 2010-2014年,哈尔滨市共报告CRS疑似病例611例,诊断为CRS的37例,发病率在6.88/10万~15.23/10万之间,年平均发病率为10.05/10万活产儿童;临床表现主要为先天性心脏病、听力损失和眼部疾病,患儿母亲均无明确风疹疫苗接种史;实验室诊断病例感染风疹病毒的时间集中在孕4~6周。结论 我市CRS发病率仍在较高水平。应继续加强疫苗接种,开展育龄期妇女血清抗体水平监测,继续开展CRS病例监测,为制定CRS防控策略提供依据。     

孕妇和育龄妇女阴道微生态及影响因素分析

目的探讨孕妇和育龄妇女阴道微生态的状况并分析相关影响因素,为临床预防和控制妇女阴道菌群失衡提供依据。方法选择某医院门诊2011年1月至2012年12月育龄妇女1500例,为育龄组,妊娠妇女1200例为妊娠组,对阴道分泌物微生态及相关指标进行检测。结果妊娠组菌群正常为62．50％（750／1200）,高于育龄组的55．93％（839／1500）,差异有统计学意义（P〈0．05）;妊娠组细菌性阴道病检出率8．50％（348／1200）,低于育龄组的11．93％（179／1500）（P〈0．05）;妊娠组pH为4．22±0．77,低于育龄组的4.62±0．84（P〈0．05）;妊娠组H,0,和白细胞酯酶阳性率分别为（2．51±0．49）μmol／L和8．42％（101／1200）,育龄组为（2．28±0．41）μmol／L和11．20％（165／1500）,差异有统计学意义（P〈0．05）;妊娠组FSH和E2分别为（13．58±3．63）U／L和（421．09±42．47）pmol／L,均高于育龄组（P〈0．05）;妊娠组乳酸杆菌检出率为39．58％（475／1200）,高于育龄组的34．87％（523／1500）（P〈0．05）;妊娠组大肠埃希菌和支原体分别为11．33％（136／1200）和10．08％（121／1200）,均低于育龄组（P〈0．05）;妊娠组乳酸杆菌强度大于育龄组（P〈0．01）。结论妊娠组雌激素水平较育龄组高,阴道乳酸杆菌数量多于育龄组,pH值升高,阴道微生态好于育龄组。     

Epidemiology of rubella and congenital rubella syndrome in Japan before 1989

Epidemiological studies of rubella and congenital rubella syndrome (CRS) in Japan have been conducted since the first nationwide rubella epidemic of 1965–1969 and subsequent epidemics of 1975–1977, 1982, 1987–1988, and 1992–1993. Rubella was non-endemic in Japan before the 1975–1977 epidemic, and endemic thereafter. Japan started a selective rubella vaccination program for junior high school girls in 1977, and universal rubella vaccination of children of both sexes in 1989. No nationwide rubella epidemics have occurred since 1994.Only three children with CRS were reported in Japan before 1964; however, many children with CRS were identified in 1965 when a rubella epidemic struck Okinawa, which has many the United States military bases. After the 1965–1969 and 1975–1977 rubella epidemics on the Japanese mainland, small numbers of children with CRS were identified (hospital survey). These findings led to the hypothesis that, compared to U.S. rubella virus strains, Japanese strains of rubella virus are less teratogenic. This hypothesis strongly affected the development of rubella vaccines in Japan. However, retrospective seroepidemiological studies attributed the CRS in many children in Okinawa to the high rate of rubella infection in pregnant women. According to the survey conducted at special schools for the deaf, 83, 232, 77, and 167 children were born with CRS on the Japanese mainland respectively after the 1965–1969, 1975–1977, 1982, and 1987–1988 nationwide rubella epidemics, suggesting that the incidence of CRS in Japan is in fact comparable to that in the U.S. and Europe.Rubella epidemics in children have been effectively prevented since 1994. However, a rubella outbreak among adult males and CRS occurred between 2012 and 2014.     

不同育龄妇女人群细菌性阴道病调查及临床分析

目的: 调查细菌性阴道病(BV) 在不同育龄妇女人群的流行情况, 并分析其临床特征。方法: 对深圳市三种不同类型的育龄妇女共4 744名进行包括细菌性阴道病在内的阴道分泌物实验室检查、妇科检查及问卷调查。结果: 细菌性阴道病在一般人群中患病率为11. 72%, 门诊病人患病率为15 .19%, 高危人群患病率为19. 52%, 合计患病率为12 .73%。研究发现深圳市育龄妇女细菌性阴道病患病率与年龄大小呈负相关, 主要症状、体征表现为分泌物增多( 35 .43% )、糊状分泌物(34 .36% ) 等。结论: 深圳市三类人群育龄妇女细菌性阴道病合计患病率居各种阴道感染首位, 当地育龄妇女年龄越小, 患病率越高。建议各级计生服务机构在进行宫腔操作时应进行细菌性阴道病的常规检查并做治疗。     

Estimating the burden of rubella virus infection and congenital rubella syndrome through a rubella immunity assessment among pregnant women in the Democratic Republic of the Congo: Potential impact on vaccination policy

BackgroundRubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo’s (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC’s historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country’s strategy for RCV introduction.MethodsA rubella antibody seroprevalence assessment was conducted using serum collected during 2008–2009 from 1605 pregnant women aged 15–46 years attending 7 antenatal care sites in 3 of DRC’s provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC.ResultsOverall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p = 0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p ⩽ 0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p = 0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS.ConclusionsIn the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15 years. However, approximately 10–20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9 months to 14 years of age as well as vaccination of women of child bearing age through routine services.     

脐血巨细胞病毒抗体阳性患儿尿中巨细胞病毒DNA水平调查

目的 调查脐血巨细胞病毒(CMV)抗体IgG、IgM阳性的发生率,并进一步研究阳性患儿尿巨细胞病毒DNA(CMV-DNA)水平,为临床对高危患儿早期干预提供依据.方法 分析调查2010年10月-2011年3月在医院分娩的350例新生儿脐血CMV抗体IgG和IgM的阳性例数,并进一步检测2组抗体阳性的患儿在0、1、3月时的CMV-DNA水平,分析其排毒情况.结果 350例新生几中,共检测出CMV抗体IgG阳性例数212例占60.6％,IgM阳性例数17例占4.9％,IgG阳性组患儿在0、1、3月龄时的CMV-DNA水平＞上限的分别为:41、33、40例;IgM阳性组患儿在0、1、3月龄时的CMV-DNA水平＞上限的分别为:8、4、3例.结论 脐血巨细胞病毒抗体阳性患儿,尿巨细胞病毒DNA检出率较高,体内CMV复制活跃,应加强其防治措施.     

Current epidemiology of rubella and congenital rubella syndrome in Australia: progress towards elimination

This study evaluates the evidence for elimination of rubella and congenital rubella syndrome (CRS) in Australia, drawing on three national serosurveys conducted between 1996 and 2007 and supported by statutory notification and vaccine coverage data. Anti-rubella IgG seropositivity was defined as ≥ 10 IU/ml by EIA. Between 1998 and 2007, rubella notifications fell >100-fold, to an average of 2 cases per million and there were five confirmed cases of CRS, two of which were locally acquired in 2003. Weighted overall seropositivity remained constant among 1-49 year-olds (89.6% in 1999; 88.1% in 2007). Between 2002 and 2009, 95% of children received at least one dose of the measles-mumps-rubella (MMR) vaccine. All three serosurveys provided estimates for R less than 0.5, well below the epidemic threshold of 1. All available data are supportive of Australia being considered for elimination status. Further reductions in incidence of CRS will require continued attention to vaccine coverage in overseas-born women, as well as the maintenance of current high coverage level of two-dose MMR vaccination.     

A systematic review of rubella vaccination strategies implemented in the Americas: impact on the incidence and seroprevalence rates of rubella and congenital rubella syndrome

Objective

To evaluate the impact of rubella vaccination strategies on the rates of acquired rubella and congenital rubella syndrome in the Americas.

Methods

We conducted a systematic review of the literature (MEDLINE, PubMed, EMBASE, Cochrane Library, Artemisa Database, LILACS Database, Evidence Portal, VHL-PAHO Portal, Scielo, and Grey-Literature sources) that was published from 1969–2010. We included studies on rubella incidence and seroprevalence rates that were associated with rubella vaccination. The quality of the studies was evaluated according to international guidelines.

Results

A total of 14 studies were identified: 2 clinical trials, 2 cohort studies, 3 transversal studies, 5 ecological studies, and 2 mathematical models. Childhood vaccination reduced the incidence of rubella by 23.6% to 99.6%, increased the occurrence of epidemic cycles in Argentina and in the United States, and shifted the illness to susceptible adults. Vaccination strategies that focused on women and children in Brazil were associated with a 5.5-fold greater incidence of rubella in men leading to new outbreaks and CRS. A combined vaccination strategy with a universal approach that included routine vaccination for boys, girls, women, and men in Mexico and in Costa Rica reduced the incidence of rubella by more than 98% and led to absence of CRS since 2008. A medium and a low risk of bias were found in 3 and 4 articles, respectively.

Conclusion

The results of this review demonstrate that the combined vaccination strategy with a universal approach was the most effective strategy as evidenced by a drastic reduction in the number of cases and the interruption of endemic transmission of rubella in the Americas.     

山东省监测地区先天性风疹综合征流行病学回顾性调查

风疹是由风疹病毒引起的急性呼吸道传染病.妇女孕早期感染风疹病毒会引起流产、死胎或婴儿出生后发生多器官严重损害的先天性风疹综合征(CRS).     

Serological statuses of pregnant women in an urban Brazilian population before and after the 2008 rubella immunization campaign

BackgroundVaccinating populations against rubella aims to mitigate viral circulation and to ensure that women of childbearing age are immunized to reduce the incidence of congenital rubella syndrome. This study determined the serological statuses of pregnant women in an urban Brazilian population before and after the national rubella immunization campaign that was undertaken in 2008, and it assessed the socio-demographic factors associated with seronegativity.MethodsPregnant women living in Maceió, Alagoas, Brazil, who participated in a municipal prenatal screening program that involved blood tests for rubella, were assessed between June 2007 and May 2012. Socio-demographic factors associated with seronegativity were assessed, including the year of the blood test, categorized as before or after the 2008 immunization campaign, and the women's birth cohorts, the women's ethnicities, the gestational ages at the first prenatal visit, and the women's districts of residence.ResultsA total of 54,717 capillary blood samples were tested for rubella. The prevalence of pregnant women who were seronegative for rubella declined from 9.4% before the national immunization campaign to 2.8% after the national immunization campaign. Women were more likely to be seronegative for rubella before and after the immunization campaign if they were born between 1990 and 2000 or delayed starting prenatal care.ConclusionsThe decline in the prevalence of pregnant women who were seronegative for rubella to <5% indicates that the 2008 Brazilian rubella immunization campaign was successful in Maceió.     

南昌地区育龄妇女弓形虫、风疹病毒、巨细胞病毒感染情况分析

目的:调查分析南昌地区已婚育龄妇女弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)感染的情况,为预防感染,降低出生缺陷提供科学依据。方法:回顾性分析江西省生殖保健中心、南昌市人口计生委宣教服务中心及南昌市所辖地区的各免费孕前优生健康检查项目点进行TOX、RV、CMV特异性抗体检测的15 879例妇女的临床资料及TOX、RV、CMV感染情况。结果:南昌地区育龄妇女TOX-IgM阳性率为4.20%、TOX-IgG阳性率为5.50%、RVIgG阳性率为96.70%、CMV-IgM阳性率为6.50%、CMV-IgG阳性率为95.20%。地域、季节、动物接触史及不良孕产史均为影响3种病原微生物感染率的重要因素,差异有统计学意义(P均0.05)。结论:针对南昌地区上述3种病原微生物的感染特点,将农村地区的育龄妇女列为重点筛查人群,对有不良孕产史的育龄妇女加强孕前优生指导,建议育龄妇女妊娠前三个月的致畸敏感期尽量避开春季,以有效降低不良妊娠。     

育龄妇女和孕妇阴道微生态环境的比较研究

目的:对比育龄妇女和孕妇阴道内微生态状况。方法:分别取800例育龄妇女和孕妇的阴道分泌物标本,涂片后用革兰染色,显微镜下计数后进行Nugent评分分析。结果:育龄妇女和孕妇假丝酵母菌感染的阳性率分别为20.4%和8.9%,滴虫感染的阳性率分别为4.6%和1.1%,细菌性阴道病(BV)阳性率分别为33.9%和8.8%,乳酸杆菌的含量分别为63.6%和84.5%,两组之间差异均有统计学意义(P<0.05)。结论:相较于育龄妇女,孕妇的阴道微生态状况更健康,对假丝酵母菌、滴虫和细菌性阴道病等常规疾病感染的抵抗力更强。     

福建省边远山区育龄妇女乙型肝炎表面抗原携带情况与KAP调查

目的 了解福建省边远山区育龄妇女乙肝表面抗原(下称HBsAg)携带情况及与乙肝知识、态度、行为(KAP)的关系.方法 采用统一问卷对调查对象进行调查,利用ELISA法对其进行HBsAg检测.结果 该省边远山区育龄妇女HBsAg为7.14％,乙肝知识合格、积极的乙肝态度的育龄妇女HBsAg携带率分别低于乙肝知识不合格、负向乙肝态度者;多因素分析表明,掌握一定的乙肝知识会降低HBsAg阳性的危险,OR为0.472 (95％Cl:0.249～0.896).结论 针对不同人群采取不同乙肝健康教育策略,使人群掌握乙肝知识,转变乙肝态度及行为,从而降低人群的HBsAg携带率.     

陕西省城乡20~49岁育龄妇女血红蛋白分布及贫血患病状况分析

铁和叶酸等微营养素的缺乏可导致早产、出生缺陷、生长迟缓、智力发育障碍以及学习或劳动能力下降等.育龄妇女是微营养素缺乏的高危人群,而且最容易发生贫血[1,2].我们于2007年对陕西省育龄妇女血红蛋白状况进行调查.     

2006～2010年天津市大港区育龄妇女死亡原因分析

目的分析天津市大港区育龄妇女死亡情况和主要原因,探讨相应的干预措施。方法对天津市大港区2006~2010年育龄妇女死亡资料进行回顾性分析。结果天津市大港区5年内育龄妇女死亡率为55.62/10万。死亡原因前3位依次为恶性肿瘤、意外伤害、心血管疾病。由恶性肿瘤致死的前3位肿瘤分别为支气管肺癌、乳腺癌、胃癌;交通事故和自杀是意外伤害死亡的主要原因。结论继续加强育龄妇女健康普查和健康教育,降低恶性肿瘤和意外伤害死亡的发生率,是降低育龄妇女死亡率的关键。     

武汉市育龄妇女优生优育知识的知晓情况和需求分析

目的:了解育龄妇女优生优育知识的知晓情况和需求,以便科学地指导优生优育工作。方法:采用整群随机抽样、面对面问卷调查的方法进行调查。结果:调查对象优生优育知识的知晓率较低,孕早期应进行优生5项(TORCH)检查的知晓率为53.0%、孕前需进行口腔检查的知晓率仅为16.6%、妊娠中晚期需注意血压监测的知晓率为49.3%。调查对象中,70.3%不清楚服用长效避孕药应停药多久才能受孕、44.9%不了解孕期服用药物的相关禁忌、49.5%认为孕期超声检查对胎儿有影响、41.5%不清楚非法接生易使新生儿患破伤风、56.0%不清楚何时给孩子添加辅食。98.2%的调查对象有强烈学习优生优育知识的需求。结论:绝大部分的育龄妇女有强烈学习优生优育知识的需求,但优生优育相关知识的知晓率仍有待提高,相关部门应加强优生优育知识的宣传教育,做好育龄妇女的优生优育咨询工作。