Determining rubella immunity in pregnant Alberta women 2009–2012 |
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| Institution: | 1. Surveillance and Assessment, Alberta Ministry of Health, Edmonton, AB, Canada;2. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;3. Department of Microbiology, Immunology & Infectious Diseases (MIID), University of Calgary, Calgary, AB, Canada;4. Provincial Laboratory for Public Health (ProvLab), Calgary, AB, Canada;5. DynaLIFEDX Diagnostic Laboratory Services, Edmonton, AB, Canada;6. Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada;7. Public Health Agency of Canada, Ottawa, ON, Canada;8. Communicable Disease Control, Alberta Health Services, Edmonton, AB, Canada;9. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada;1. Department of Ophthalmology, University of Oklahoma/Dean McGee Eye Institute, Oklahoma City, Oklahoma;2. Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;1. Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota;2. Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, South Korea;1. Senior Adviser (Ophthalmology, Paed Ophthal & Squint), Army Hospital (R&R), Delhi Cantt, India;2. Addl DGAFMS (MR H & Trg), O/o DGAFMS, Ministry of Defence “M” Block, New Delhi 110001, India;3. Senior Adviser (Ophthalmology, VR Surgery), Military Hospital Jabalpur, India;4. Senior Adviser (Ophthalmology, VR Surgery), Command Hospital (Eastern Command) Kolkata, India;5. Senior Resident (VR Surgery), LV Prasad Eye Institute, Bhubaneswar, India;1. Division of Otolaryngology — Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7;2. Division of Otolaryngology — Head and Neck Surgery, Department of Surgery, McMaster University, Room G811, 50 Charlton Ave, Hamilton, ON, Canada L8N 4A6;3. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-105 Central Services Building, Edmonton, AB, Canada |
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| Abstract: | Rubella IgG levels for 157,763 pregnant women residing in Alberta between 2009 and 2012 were analyzed. As there have been no reported cases of indigenous rubella infection in Canada since 2005, there has been a lack of naturally acquired immunity, and the current prenatal population depends almost entirely on vaccine induced immunity for protection. Rubella antibody levels are significantly lower in younger maternal cohorts with 16.8% of those born prior to universal vaccination programs (1971–1980), and 33.8% of those born after (1981–1990) having IgG levels that are not considered protective (<15 IU/mL). Analysis across pregnancies showed only 35.0% of women responded with a 4-fold increase in antibody levels following post-natal vaccination. Additionally, 41.2% of women with antibody levels <15 IU/mL had previously received 2 doses of rubella containing vaccine. These discordant interpretations generate a great deal of confusion for laboratorians and physicians alike, and result in significant patient follow-up by Public Health teams. To assess the current antibody levels in the prenatal population, latent class modeling was employed to generate a two class fit model representing women with an antibody response to rubella, and women without an antibody response. The declining level of vaccine-induced antibodies in our population is disconcerting, and a combined approach from the laboratory and Public Health may be required to provide appropriate follow up for women who are truly susceptible to rubella infection. |
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| Keywords: | Prenatal screening Rubella Total IgG antibody levels |
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