Positive rates for rubella antibody in pregnant women and benefit of post-partum vaccination in a Japanese perinatal center

AIM: This study of pregnant women was undertaken to clarify their immune status for rubella and to evaluate the efficacy of, and adverse reaction to, post-partum rubella vaccination. METHODS: We determined the levels of both rubella antibody by hemagglutination inhibition test and IgM antibody by enzyme-linked immunosorbent assay in the first gestational trimester and surveyed the positive rates for rubella antibody in pregnant women at our perinatal center; we recommended post-partum vaccination for women with poor immune status. We also evaluated the effectiveness of the vaccine and any adverse reaction. RESULTS: Among 2741 pregnant women, 185 cases (6.7%) were seronegative for rubella virus. This rate was especially high (12.4%) in the population who had opted out of the vaccination because of a change in Japanese government policy. A total of 30 cases (1.1%) were positive or false-positive for IgM antibody, but no congenital rubella syndrome (CRS) developed. The seropositive rate was 93.3% in total, but this figure includes those who required post-partum vaccination (558 cases or 20.3%) because their titers were 16x or lower. Among 145 cases who received post-partum rubella vaccine, no severe adverse reaction was detected, and in all 37 cases with hemagglutination inhibition antibody titers of 8x or lower, the efficacy rate was 100%. CONCLUSIONS: It is necessary to appropriately evaluate the CRS risk. Also, we need to emphasize the importance and safety of post-partum rubella vaccination in Japan.     

Rates of Rubella Immunity Among Immigrant and Non-immigrant Pregnant Women

ObjectiveElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of susceptible women of childbearing age. Since many countries do not immunize against rubella, it is possible that some immigrant women may not be immune. Moreover, contemporary estimates of rubella immunity among Canadian-born mothers are lacking.Accordingly, we sought to compare the immunity status in pregnancy of a large number of immigrant and Canadian-born women in Toronto.MethodsWe examined data among 5783 consecutive pregnant women who gave birth at an inner city hospital in downtown Toronto between 2002 and 2007. Antenatal maternal rubella immunity status was recorded at the time of delivery, and assessed according to the mother’s birthplace. Odds ratios (OR) for rubella immunity were adjusted for maternal age, gravidity and duration of residency in Canada.ResultsRelative to a rate of 93.2% among Canadian-born mothers, the adjusted risk of being rubella immune was lowest among women from Northern Africa and the Middle East (OR 0.54, 95% CI 0.31–0.94) and China and the South Pacific (OR 0.78, 95% CI 0.59–1.03).ConclusionRates of rubella immunity are lower than desired among Canadian-born and, especially, new immigrant pregnant women. Under-immunized populations might be identified at the time of the immigration medical examination, while consideration should be given to screening for rubella immunity among all young Canadian women before puberty.     

Results of monitoring pregnant patients exposed to rubella

Report about the results of serologic diagnostics of rubella. In the years 1975 til 1984 we took care for 17,731 pregnant women. 455 of them had rubella contact. In 16.7 per cent (76 women) there was a titer of 1:16 or below. In 18 cases of them we had to guess the patients on artificial abortion, because there were hints at a rubella disease. Nevertheless out of 379 pregnant women with serologic immunity decided on abortion. Reasons have been discussed. We propose a serologic diagnostics in each case of rubella contact of a pregnant women for prevention of rubella embryopathy.     

Factors associated with low immunity to rubella infection on antenatal screening

BACKGROUND: Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at-risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non-immunity. METHODS: We looked at data on all confinements at two maternity hospitals in Sydney in the 2-year period between July 1999 and June 2001. Variables included in our data set included mother's country of birth, mother's date of birth, hospital status (public or private patient), parity, rubella status and postpartum rubella vaccination. RESULTS: Of the 8096 confinements, the mother was documented as being non-immune to rubella in 567 cases (7%) of cases. Of the 567 confinements where rubella status was documented as non-immune, Asian-born women comprised of 65% (366) of non-immune women while 13% (73) were Australian-born. Country of birth remained a strong predictor of immunity, even after controlling for age, parity and hospital status. Maternal age > 35 years and nulliparity were also significant risk factors for non-immunity. CONCLUSION: Programs targeting underimmunised populations for rubella vaccination should focus on overseas-born women, particularly those born in Asia, nulliparous women and also women > 35 years of age.     

Studies on the management of pregnant women having high hemagglutination inhibition (HI) antibody titer of rubella virus in the first trimester examination of rubella virus antibody in the pregnant women having high HI titer by different methods and prognosis of their infants after birth

Several serological studies of rubella virus (RV) infection were carried out on sera of 45 pregnant women having RV hemagglutination inhibition (HI) antibody titer more than 1:512 in the first trimester, including a follow-up study of these women's pregnancies. In order to detect RV-specific IgM antibody, various procedures were employed as follows: Complement fixation test (CF), HI test after treatment of the sera with Protein-A (ProA-HI), enzyme linked immunosorbent assay (ELISA) by indirect or sandwich procedures and several tests using fractionated sera by sucrose density gradient ultracentrifugation (SDG). Positive ratios found with the CF test and ProA-HI were 26.7% and 20.0%, respectively. In indirect ELISA, 4 cases were positive for RV-specific IgM, but all sera were negative in sandwich ELISA and SDG tests. Both RV isolation from urine of some infants and detection of high RV-specific IgM antibody in cord sera failed to be positive. Of 44 pregnancies, 4 cases resulted in spontaneous abortion and all others in normal delivery. These forty normal infants had no sign of congenital rubella syndrome, but one case among them showed polysyndactyly . The results obtained here seemed to indicate that sandwich ELISA is the most valuable and convenient method among the tested procedures for clinically determined diagnosis of recent RV infection in pregnant women having a high HI antibody titer.     

Congenital and maternal cytomegalovirus infections in a London population.

OBJECTIVE--To determine if women at risk of having babies infected with cytomegalovirus (CMV) can be identified antenatally. DESIGN--Prospective serological and demographic study of pregnant women and virological study of their newborn infants. SETTING--Teaching hospital in London. SUBJECTS--3315 pregnant women and 2737 of their babies. MAIN OUTCOME MEASURES--Quantitative detection of CMV IgG antibodies; qualitative detection of CMV IgM antibodies; demographic characteristics of mothers; qualitative and quantitative titration of CMV viruria in newborn. RESULTS--Congenital CMV infection was found in nine newborn babies (0.33%) two of whom had symptoms. Serological testing of the nine mothers showed four primary and five recurrent infections; both of the symptomatic children were born in the latter group. Testing for CMV specific IgM antibodies or quantitation of IgG antibodies in early pregnancy sera could not differentiate those women at risk of giving birth to babies infected or damaged by CMV from the rest of the population. Quantitation of viruria confirmed that those babies most at risk of CMV disease have the highest titres of CMV. CONCLUSIONS--(i) Since laboratory tests in pregnant women cannot reliably identify fetuses at risk of disease, screening for asymptomatic maternal infection coupled with termination of pregnancy cannot be recommended. (ii) Since 'immune' women can still give birth to babies affected by CMV, we propose that future CMV vaccines should be used to immunize children with the aim of eradicating CMV infection in preference to selective immunization of sero-susceptible females.     

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy

ObjectiveTo determine the prevalence of anti-rubella virus antibodies and the level of knowledge about congenital rubella syndrome (CRS) among pregnant women living in southern Italy.MethodsA seroepidemiologic study was conducted between July 1, 2006, and December 31, 2007. Five-hundred women resident in Messina were enrolled in the study; the participants were in the 4th to 39th week of pregnancy. Anti-rubella virus antibodies were assayed using a microparticle enzyme immunoassay. Demographic details, vaccination history, and participants’ knowledge of the potential risks of rubella infection during pregnancy were assessed via questionnaire.ResultsOn the basis of the questionnaire results, 70.4% of women were classed as immune to rubella virus infection; however, the prevalence of IgG anti-rubella virus antibodies measured in the participants’ serum was 85.8%. Although 55.2% of women had undergone pre-pregnancy rubella screening, only 81 participants reported that they had been vaccinated before becoming pregnant. The participants’ general knowledge about CRS was poor, as was their understanding of the importance of undergoing screening.ConclusionThe number of women at risk of rubella infection fell short of the national target set for elimination of CRS. Increased involvement and collaboration by all healthcare workers are, therefore, required to disseminate the information necessary to prevent CRS.     

Mode of delivery and level of passive immunity against herpes simplex virus

The level of passive neonate protection against HSV depends on the transplacentally acquired neutralized HSV antibodies' titer. In this study we investigated the anti HSV antibodies' transplacental passage in a group of women who delivered vaginally and pregnant women who had cesarean section, with the aim of examining the influence of the mode of delivery on the level of passive immunity to HSV. Serologic examination was performed in a group of 102 women who delivered vaginally and 80 pregnant women who had cesarean section, using the test of microneutralization. The titer of anti HSV type 1 and anti HSV type 2 antibodies in the mothers' and cord blood was determined and compared. The cord serum neutralizing HSV type 1 antibodies' titer, was twice higher as compared to those in mothers blood in 60.7% of paired sera in the group of women who delivered vaginally. The cord serum anti HSV type 1 titers were twice as high as compared to those in mothers' blood only in 15.5% of paired sera in group of pregnant women who had cesarean section. In the cases when cesarean section was performed, our results showed the lack of anti HSV type 2 antibodies in 15% of cord sera, even though the mothers' sera were anti HSV type 2 positive. The results of this study point to the possibility that antibody transfer through the placenta is an active and selective process that depends also on the mode of delivery: there are lower levels of HSV neutralizing antibodies in the cord sera of infants whose mothers had cesarean section compared to those who delivered vaginally.     

妊娠合并梅毒孕期规范治疗后新生儿梅毒血清学的变化特点及转归

目的 了解妊娠合并梅毒孕母所生新生儿梅毒血清学变化特点,初步探讨影响婴儿梅毒血清学转归的因素.方法 选择我院2006年1月至2008年1月经孕期规范治疗后的146例单胎妊娠合并梅毒的孕妇,孕妇产前和新生儿生后3 d内行快速血浆反应素试验(rapid plasma reagin,RPR)及梅毒螺旋体明胶凝集试验(treponema pallidum particle agglutination assay,TPPA).随访了其中92例婴儿生后24个月内RPR及TPPA的情况.结果 (1)146例新生儿中,140例(95.9%)TPPA阳性,其中94例(90.4%)新生儿期RPR滴度低于或等同于母亲产前RPR滴度;104例(71.2%)RPR和TPPA均为阳性,36例(24.7%)新生儿为TPPA单阳性.RPR和TPPA双阳性母亲的新生儿RPR阳性比例明显高于TPPA单阳性母亲新生儿(81.4%和36.4%,χ2=25.3,P<0.01).(2)随访的92例婴儿中,出生时RPR及TPPA双阳性者57例,56例(98.2%)的RPR在生后6个月内转阴,8个月内100%转阴,转阴高峰为生后2个月(78.9%,45例);TPPA在生后24个月内100%转阴.转阴高峰为生后10～18个月(64.9%,37例).TPPA单阳性的35例婴儿中,18个月内TPPA 100%转阴,转阴高峰在生后6～12个月(57.1%,20例).(3)母亲产前RPR滴度为1:1～1:4时,其婴儿RPR转阴时间晚于母亲RPR阴性者(P<0.05),1;4组为(2.5±0.8)月,长于1:1组的(1.2±0.4)月(P<0.01);但母亲产前RPR滴度与婴儿生后TPPA转阴时间无关(P>0.05).新生儿期的RPR滴度为1:4时,婴儿RPR转阴所需时间晚于1:1的新生儿[(3.7±0.9)月和(2.3±0.6)月,P<0.01];RPR滴度为1:1～1:4的新生儿,婴儿期TPPA转阴所需时间均晚于RPR阴性组[(11.0±2.2)月、(12.2±2.9)月、(11.2±2.8)月和(6.9±2.1)月,P<0.01)].结论 妊娠合并梅毒孕妇孕期规范治疗后分娩的新生儿梅毒血清学检测大部分仍呈阳性,母亲产前或分娩时静脉血RPR滴度高的婴儿,其阳性持续时间可能较长,但均能在生后一定时间内转阴.建议对梅毒血清学阳性新生儿生后长期随访,诊断先天性梅毒应慎重.     

Pregnancy outcomes of women with failure to retain rubella immunity

Abstract

Objective: We sought to explore the clinical variables associated with the loss of rubella immunity during pregnancy and to determine if these changes are linked to obstetrical complications.

Methods: This is a case-control study in which women were identified whose rubella antibody titers were equivocal or non-immune and compared to those who had retained immunity. Two hundred and eighty-five cases were identified and compared to the same number of controls using Student’s t test, Mann–Whitney U-test or Fisher’s exact test. Univariate and multivariate logistic regressions were employed.

Results: Subjects with diminished immunity were more likely to have public insurance and higher gravidity with a trend toward increased tobacco use. Diminished rubella immunity was not associated with adverse obstetrical outcomes, including preterm birth and pre-eclampsia and is likely not a risk factor for these pregnancy outcomes.

Conclusion: While no adverse pregnancy outcomes were associated with a loss of rubella immunity, women with greater number of pregnancies appear to lose their immunity to rubella. This relationship needs to be explored further and if proven, revaccination prior to pregnancy may need to be addressed.     

A prospective study of primary cytomegalovirus infection in pregnant women

During a four year study, sera were obtained from 5575 women attending for antenatal care and 3188 (57.2 per cent) were shown to possess complement fixing antibodies to cytomegalovirus (CMV). A total of 1608 seronegative women were followed to term and 14 (0.87 per cent) primary CMV infections occurred in either the second or third trimester. Transplacental spread of CMV occurred in 3 out of 12 (25 per cent) of the 14 babies born to infected mothers. All 14 babies were apparently normal at birth but short term clinical follow-up has already revealed that one child has impaired hearing whilst another is microcephalic. The women were also monitored serologically throughout pregnancy for evidence of rubella infections. Only 12 infections were detected and 7 of these occurred during the large rubella epidemic of 1978. Of the 10 pregnancies which were allowed to proceed to term, transplacental spread of rubella virus occurred in 1 out of 7 (14 per cent). During this study period, CMV infections occurred as frequently as did rubella infections. We therefore conclude that, apart from those years when extensive epidemics occur, many more pregnant women are infected with CMV than with rubella virus.     

Cytomegalovirus (CMV) and rubella virus infection during pregnancy. A study of CMV and rubella virus antibodies in 2014 pregnant women and follow-up studies of infants at risk for intrauterine CMV infections

Two blood samples, one in the first and one in the third trimester, were collected from 2014 pregnant women. Serological tests for CMV and rubella antibodies were performed in the paired samples. Seroconversion by the CF test for CMV antibodies was demonstrated in 15 women. However, seroconversion also by the IF test was found in only one of these. A rise in titer during pregnancy by the CF test was found in 16 woman. None of these specimens contained specific IgM. High CMV-CF antibody titer (greater than 128) in the first serum sample was found in 28 women, but none of the sera contained specific IgM. It is concluded that no single serological test can serve at present as a screening test for the diagnosis of CMV infection during pregnancy. In children thought to be at risk contracting congenital CMV infection, no case with CNS malfunction that could be attributed to a congenital CMV infection could be demonstrated at the age of 7-8 years. One case of seroconversion in the examination for rubella antibodies was found. The infant of this mother showed no clinical signs of rubella infection.     

Post partum rubella vaccination and anti-D prevention]

The effectiveness of a routinely performed puerperal rubella vaccination was tested. Additional a possible adverse influence of simultaneously administered anti-D immunoglobulin on the effectiveness of the rubella vaccination was examined. Rubella antibody titers (HHT) in pregnant women were determined; after delivery puerperal women with titers of less or equal 1:16 were selected for rubella vaccination. 2 1/2 to 3 months later rubella antibody titers were done again. 15% of 130 vaccinated women did not show a conversion of the former negative titer or a low titer of 1:8 remained. Also reductions of the antibody titers were seen. When simultaneously rubella vaccination and anti-D immunoglobulin was administered only in 1 case out of 27 patients a negative titer remained after vaccination. The used anti-D immunoglobulin contained rubella antibodies of a titer 1:256 to 1:512; according to experimental studies, this concentration should not have any influence to the immunologic response of rubella vaccination. Our practic results could not confirm the reservations concerning simultaneous rubella vaccination and anti-D prophylaxis.     

Seropositivity of cytomegalovirus, parvovirus and rubella in pregnant women and recurrent aborters in Leningrad County, Russia.

BACKGROUND: The objectives of this paper were to assess the prevalence of different viral infections in relation to late abortions, stillbirths, and congenital malformations in sera from Russian pregnant women and recurrent aborters in order to establish basic knowledge for future pregnancy care. METHODS: Patients were recruited at the Women's Clinic, Leningrad Regional Hospital during the period March-June 1995. One group of normally pregnant women (Group 1; n=182) and one group of recurrent aborters (Group 2; n=127) were evaluated, including demographic, medical, clinical, and serological data. RESULTS AND CONCLUSIONS: The mean age of the two groups was 27.1 and 28.2 years, respectively. The mean number of deliveries was low (0.4 and 0.5, respectively). Thirty-one point six percent of Group 1 and 41.9% of Group 2 were daily smokers. The group of normally pregnant women had a significantly increased frequency of induced abortions compared to the recurrent aborters, while the recurrent aborters reported more genital infections. There was little difference in total antibodies to cytomegalovirus (CMV) (78.0% and 81.1%, respectively) or B19 IgG (75.3% and 66.9%, respectively) between the groups, while the normal pregnant women had a significantly higher prevalence of rubella antibodies (77.5% and 59.8%, respectively). Our results indicate that less women remain susceptible to primary CMV infection in pregnancy in Russia compared to western Europe and North America. The prevalence of B19 IgG was slightly lower than data from Sweden. Natural immunization against rubella virus was lower than in other, unvaccinated female populations. Vaccination strategies for rubella are now initiated in the Russian Federation. Results from this study are utilized in a federally supported, comprehensive pregnancy care project of North-West Russia.     

Immunity to rubella among women of child-bearing age

The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Pregnancy and Medicine: sine qua non or non sequitur?

Pregnancy is intrinsically imperfect, with high rates of complications for mothers and babies. A minority of pregnancies is entirely uncomplicated. Medical disorders are frequent contributors to morbidity for mothers and babies, and have become the major source of maternal mortality. For these reasons, Medicine plays a central role in the care of pregnant women. Provision of resources to maternity services must recognise the changing demographics and clinical characteristics of pregnant women in Australia, and their increased medical risk status in recent years.     

Immunity to rubella among women of child-bearing age

Summary. The results of testing for rubella antibodies in over 6000 sera from women of child-bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non-pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child-bearing age from African or Asian countries.     

Deliveries in maternity homes in Norway: results from a 2-year prospective study

BACKGROUND: The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. METHODS: A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. RESULTS: The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. CONCLUSION: Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.