Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia,Spain |
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| Institution: | 1. Department of Preventive Medicine and Epidemiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain;2. ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain;3. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique;4. Department of Maternal-Fetal Medicine, BCNatal – Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain;1. Minicare BV, Eindhoven, the Netherlands;2. Philips BG Emerging Businesses, Eindhoven, the Netherlands;3. Department of Internal Medicine III — Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria;4. Diagnostiek voor U, Eindhoven, the Netherlands;5. Future Diagnostics Solutions, Wijchen, the Netherlands;1. Center for Health Research (Naleway, Kurosky, Henninger, Gold, Irving), Kaiser Permanente Northwest, Portland, Oregon;2. the HealthPartners Institute for Education and Research (Nordin, Kharbanda), Minneapolis, Minnesota;3. the Marshfield Clinic Research Foundation (Irving), Marshfield, Wisconsin;4. the Department of Research and Evaluation and Pharmacy Analytical Services (Cheetham), Kaiser Permanente Southern California, Downey;5. the Kaiser Permanente Vaccine Study Center (Klein), Oakland, California;6. the Center for Health Research (Nakasato), Kaiser Permanente Hawaii, Honolulu, Hawaii;7. the Institute for Health Research (Glanz, Hambidge), Kaiser Permanente Colorado;8. the Community Health Pediatrics (Hambidge), Denver Health, Denver, Colorado;9. the Center for Health Research (Davis), Kaiser Permanente Georgia;10. the Immunization Safety Office (McCarthy, Weintraub), CDC, Atlanta, Georgia;1. Preventive Medicine and Epidemiology Unit, Hospital Clínic, Barcelona, Spain;2. Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain;3. Clinical Microbiology and Parasitology Unit, Hospital Clinic, Barcelona, Spain;4. Infectious Diseases Unit, Hospital Clinic, Barcelona, Spain;1. WHO Country Office, Hanoi, Viet Nam;2. Centers for Disease Control and Prevention, Atlanta, GA, USA;3. National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam;1. Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan;2. Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Sakamoto, Nagasaki, Japan;3. Modelling & Economics Unit, Public Health England, Colindale Ave, London, Greater London, UK;4. Khanh Hoa Provincial Public Health Service, Nha Trang, Viet Nam;5. National Institute of Hygiene and Epidemiology, Yecxanh, Hai Ba Trung, Ha Noi, Viet Nam;6. Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, England, United Kingdom |
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| Abstract: | BackgroundElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine.MethodsCross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations.ResultsA total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI 1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity.ConclusionsThe higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases. |
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| Keywords: | Rubella Pregnancy Susceptibility Postpartum immunization Adherence MMR vaccine |
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