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Arnold JN, Gundlach N, Böckelmann I, Sammito S. Vaccination coverage rates of military personnel worldwide: a systematic review of the literature. Int Arch Occup Environ Health 2020; 94:1-8. [PMID: 32561973 PMCID: PMC7826299 DOI: 10.1007/s00420-020-01559-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
Objectives Due to the professionally specific risk of infection in the armed forces, recommendations for vaccination are usually adapted for soldiers and are subject to special regulations. Little data is available on scientifically measured vaccination coverage of soldiers. Methods A systematic literature research was carried out in the PubMed database using the search terms “army” or “military” or “Bundeswehr” and “vaccination” or “vaccine”. Studies covering the period from 1990 to 2018 that contain statements on vaccination coverage rates of soldiers were identified. Twenty-two out of the initially found 1801 results were used. Results The studies found were conducted in nine different countries with eight out of the 22 studies originating from the USA. The size of study was between 180 and 32,502 subjects. On average, the vaccination rates determined in the studies were between 26.8 and 94.7%. Hepatitis A coverage was lowest (a minimum of 11.3%) and tetanus vaccination coverage was highest (with a maximum of 94.7%). Vaccination rates decreased with increasing age and coverage tended to be lower for men than for women. The term of service did not have a significant effect on vaccination rates. Conclusions On the whole, most studies referred to recruits. They showed high vaccination rates for standard vaccinations and lower vaccination rates for indication and seasonal vaccinations. However, there were also vaccination gaps of temporary-career volunteers. This leads to a considerable effort at the armed forces to complete vaccine protection in case of a short-term operational commitment.
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Affiliation(s)
- Jana Nele Arnold
- Bundeswehr Hospital Hamburg, Hamburg, Germany.,Occupational Medicine, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | | | - Irina Böckelmann
- Occupational Medicine, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Sammito
- Occupational Medicine, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany. .,Air Force Centre of Aerospace Medicine, Department I 3, Flughafenstraße 1, 51147, Cologne, Germany.
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Meyer R, Bar-Yosef O, Barzilay E, Hoffman D, Toussia-Cohen S, Zvi E, Achiron R, Katorza E. Neurodevelopmental outcome of fetal isolated ventricular asymmetry without dilation: a cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:467-472. [PMID: 29607569 DOI: 10.1002/uog.19065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/10/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and founded principally on ultrasound-based studies. The purpose of this study was to assess the neurodevelopmental outcome of IVA cases in a magnetic resonance imaging (MRI)-based study. METHODS Cases referred for fetal brain MRI as part of the assessment of IVA without ventriculomegaly (lateral ventricular atrial diameter ≤ 10 mm), identified during routine ultrasound examination, were assessed for possible inclusion. Asymmetry was defined as a difference in width of ≥ 2 mm between the two lateral ventricles. Forty-three cases were included in the study group and compared with a control group of 94 normal cases without IVA. Children were assessed at ages 13-74 months using the Vineland-II Adaptive Behavior Scales (VABS-II). RESULTS VABS-II scores were within normal range. There was no significant difference in composite VABS-II score between the study and control groups (106.5 vs 108.0; P = 0.454). VABS-II scores did not differ between the groups when matched for gender and age at VABS-II interview (109.6 in study group vs 107.8 in control group; P = 0.690). CONCLUSION In cases of IVA without ventriculomegaly on MRI, neurodevelopmental test scores were normal and did not differ from cases without IVA. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - O Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Pediatric Neurology Unit, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - E Barzilay
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - D Hoffman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - S Toussia-Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Katorza
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Hui SYA, Sahota DS, Lao TT. Impact of Maternal BMI on Rubella Nonimmunity at Antenatal Screening. Obesity (Silver Spring) 2018; 26:1392-1395. [PMID: 30120821 DOI: 10.1002/oby.22244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between BMI and the incidence of rubella nonimmunity among pregnant women with regard to the World Health Organization categories. METHODS This was a retrospective cohort study of 117,063 eligible gravidas, managed between 1998 and 2015 in a university hospital of Hong Kong, China. BMI at antenatal booking was banded using the following World Health Organization definitions: < 18.5 kg/m2 , 18.5 to 24.9 kg/m2 , 25.0 to 29.9 kg/m2 , and ≥30.0 kg/m2 . Maternal rubella nonimmunity status by BMI was assessed. Incidence rates were also assessed after adjusting for maternal advanced age, short stature < 151 cm, mothers' birthplace, and postobstetric history covariates. RESULTS Rubella nonimmunity incidence increased as the BMI increased (P < 0.001). Gravidas with high BMI were more likely to be nonimmune if born in Hong Kong (odds ratio [OR], 1.234; 95% CI: 1.159-1.315; P < 0.001) compared with those born outside of Hong Kong (OR, 1.066; 95% CI: 0.997-1.141; P = 0.063). After adjusting for covariates, women with BMI ≥ 25 kg/m2 had 1.127 (P < 0.001; 95% CI: 1.074-1.182) greater odds of being nonimmune. CONCLUSIONS High maternal BMI (≥ 25.0 kg/m2 ) is associated with reduced rubella immunity, an effect confined to gravidas with almost complete vaccine coverage in childhood.
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Affiliation(s)
- Shuk Yi Annie Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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Siira L, Nøkleby H, Barlinn R, Riise ØR, Aaberge IS, Dudman SG. Response to third rubella vaccine dose. Hum Vaccin Immunother 2018; 14:2472-2477. [PMID: 29771601 PMCID: PMC6284511 DOI: 10.1080/21645515.2018.1475814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/05/2018] [Indexed: 02/07/2023] Open
Abstract
Limited data exist on the immunogenicity of a third dose of the measles, mumps, and rubella vaccine (MMR). In this study, our aim was to evaluate the long-term rubella immunogenicity afforded by two childhood MMR doses of the Norwegian vaccination program in a cohort of conscripts and to determine the effect of an additional dose of MMR vaccine, in order to inform vaccination policy. Blood samples from Norwegian conscripts (n = 495) taken both before and eight months after administration of a dose of MMR vaccine were tested using an enzyme immunoassay to measure anti-rubella IgG. Concentrations <5 IU/mL were regarded as negative, 5.0-9.9 IU/mL as equivocal, and ≥10 IU/mL as positive. Overall, the seropositivity before vaccination was 84.6%, and 99.0% of the conscripts had anti-rubella IgG concentrations ≥5 IU/mL. The seropositivity after vaccination was 94.5%, and 99.8% of the conscripts had antibody concentrations ≥5 IU/mL. The geometrical mean IgG concentrations increased from 21.4 IU/mL before vaccination to 28.9 IU/mL after. Four out of five conscripts, with seronegative concentrations before administrations of an additional MMR dose, had equivocal or seropositive results following vaccination. The cohort of young adults in Norway, which was eligible for two childhood MMR doses, was protected against rubella, and efforts should be made to maintain high vaccine coverage to ensure immunity in the future. A third dose of MMR administered in early adulthood led to an increase in the antibody concentration in our cohort and seroconversion for the majority of seronegative persons.
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Affiliation(s)
- Lotta Siira
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Hanne Nøkleby
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Regine Barlinn
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Øystein R. Riise
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Ingeborg S. Aaberge
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Susanne G. Dudman
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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Hui SYA, Sahota DS, Lao TT. Impact of the two-dose rubella vaccination regimen on incidence of rubella seronegativity in gravidae aged 25 years and younger. PLoS One 2017; 12:e0183630. [PMID: 28854204 PMCID: PMC5576672 DOI: 10.1371/journal.pone.0183630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022] Open
Abstract
Objective This study compared the incidence of rubella seronegativity among gravidae of 25 year-old and younger, between those born in Hong Kong after 1983 when the two-dose rubella vaccination was implemented, versus gravidae born before, to examine the impact of the two-dose regimen. Methods In this retrospective cohort study, the incidence of antenatal rubella seronegativity in our parturients managed in1997-2015 was analysed by their age from ≤16 to 25 years, and the effect of year of birth was determined adjusting for confounding factors including teenage status, obstetric history, anthropometric factors, and health parameters including anaemia, thalassaemia trait and hepatitis B carrier status. Results Among the 12743 gravidae, the 6103 gravidae born after 1983 had overall higher rubella seronegativity (9.1% versus 4.4%, OR 2.061, 95% CI 1.797–2.364), with significant difference (p = 0.006) and inverse correlation (p<0.001) with age, in contrast to the 6640 gravidae born in/before 1983 whom there was significant difference (p = 0.027) but a positive correlation (p = 0.008) with age. For each year of age, the former had significantly higher incidence of rubella seronegativity except for those of ≤16 years. Regression analysis confirmed that birth after 1983 was independently associated with rubella seronegativity (aOR 2.207, 95% CI 1.902–2.562). Conclusion There was a significant trend between rubella seronegativity with age in young gravidae, but the pattern was opposite between gravidae born after versus in/before 1983, with the former having a higher incidence of seronegativity at all ages. Young women covered by the two-dose rubella immunisation programme have a paradoxically higher incidence of rubella seronegativity.
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Affiliation(s)
- Shuk Yi Annie Hui
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Daljit S Sahota
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Lai FY, Dover DC, Charlton CL. Economic impact of switching rubella IgG methodologies to the prenatal public health program in Alberta. J Clin Virol 2016; 83:43-7. [PMID: 27567094 DOI: 10.1016/j.jcv.2016.08.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/01/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite widespread use of a universal rubella standard, variability in rubella antibody titre can be observed between assays, particularly at the low end of the linear range. OBJECTIVES Here, we investigate the impact of a methodology change for rubella IgG from the Abbott AXSYM to the Abbott Architect in a comprehensive prenatal screening program in the Canadian province of Alberta. STUDY DESIGN 51,815 specimens (21,399 tested by AxSYM and 30,416 tested by Architect) submitted for routine prenatal screening between January 2006 and December 2012 from women who lived in Alberta after the universal childhood immunization programme for rubella was implemented, and whose immunization records were available, were included in the study. RESULTS Prenatal samples tested by AxSYM for rubella IgG were approximately 30% higher than those reported by Architect. Among individuals who had tests across multiple pregnancies, the change in test platform led to an additional 7% of women who initially tested positive, becoming non-positive (i.e. negative or indeterminate) in their subsequent tests. The tendency of the Architect IgG assay to report lower quantitative values was demonstrated across all birth cohorts and vaccination status, and resulted in an additional 2800 women requiring vaccination between 2010 and 2012 with an estimated cost of $38,500. CONCLUSION The change in rubella IgG screening assay resulted in a significant increase in the number of women who required post partum vaccination and Public Health follow-up.
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Affiliation(s)
- Florence Y Lai
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Douglas C Dover
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Carmen L Charlton
- Provincial Laboratory for Public Health (ProvLab), Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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Thompson KM, Odahowski CL. Systematic Review of Measles and Rubella Serology Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1459-1486. [PMID: 26077609 DOI: 10.1111/risa.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Serological tests provide information about individual immunity from historical infection or immunization. Cross-sectional serological studies provide data about the age- and sex-specific immunity levels for individuals in the studied population, and these data can provide a point of comparison for the results of transmission models. In the context of developing an integrated model for measles and rubella transmission, we reviewed the existing measles and rubella literature to identify the results of national serological studies that provided cross-sectional estimates of population immunity at the time of data collection. We systematically searched PubMed, the Science Citation Index, and references we identified from relevant articles published in English. We extracted serological data for comparison to transmission model outputs. For rubella, serological studies of women of child-bearing age provide information about the potential risks of infants born with congenital rubella syndrome. Serological studies also document the loss of maternal antibodies, which occurs at different rates for the different viruses and according to the nature of the induced immunity (i.e., infection or vaccine). The serological evidence remains limited for some areas, with studies from developed countries representing a disproportionate part of the evidence. The collection and review of serological evidence can help program managers identify immunity gaps in the population, which may help them better understand the characteristics of individuals within their populations who may participate in transmission and manage risks.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Lao TT, Sahota DS, Law LW, Leung TY. Rubella seronegativity in antenatal screening - Is it influenced by the introduction of universal childhood rubella immunization? Vaccine 2015; 33:4776-81. [PMID: 26271826 DOI: 10.1016/j.vaccine.2015.07.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 07/22/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examined the impact of rubella immunization, implemented in Hong Kong in phases since 1978, on antenatal rubella serological status in Chinese women. METHODS In a retrospective cohort study, the incidence of antenatal rubella seronegative status in our parturients managed from 1998 to 2013 was analyzed by their year-of-birth as follows: <1965 (no childhood immunization), 1965-1982 (single dose at Primary 6), and ≥1983 (two doses at age 12 months and 12 years), adjusting for other factors including age, parity, body mass index, place-of-birth status and hepatitis B surface antigen (HBsAg) status. FINDINGS Rubella seronegativity decreased from 12.9%, 10.5%, to 9.8% respectively, and correlated inversely (P<0.001) with year-of-birth cohorts. Despite similar demographic profiles, this correlation was found only in Hong-Kong-born women (from 12.6%, 7.5% to 6.5% respectively), who also had significant lower incidences of rubella seronegativity (OR 0.73, 0.31 and 0.29 respectively) and HBsAg seropositivity (OR 1.09, 0.63 and 0.48 respectively) than China-born women. On regression analysis, rubella seronegativity was actually significantly increased following the implementation of immunization (aOR 1.20) while it was the reverse for non-residents (aOR 0.61). CONCLUSION Although rubella seronegativity decreased with immunization, the effect was less than expected when adjusted for other risk factors.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | - Daljit S Sahota
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | - Lai-Wa Law
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | - Tak-Yeung Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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Levine H, Zarka S, Ankol OE, Rozhavski V, Davidovitch N, Aboudy Y, Balicer RD. Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel. Hum Vaccin Immunother 2015; 11:1400-5. [PMID: 25891446 PMCID: PMC4514436 DOI: 10.1080/21645515.2015.1032489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/26/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022] Open
Abstract
Evidence-based vaccination policy is important for the global and local efforts of achieving control over measles. In 2007, the first Israeli birth cohort to be twice vaccinated during childhood with Measles-Mumps-Rubella vaccine reached adulthood. In parallel, Israel experienced its largest measles outbreak since 1994. We aimed to assess the seroprevalence of measles IgG antibodies and concordance with rubella and mumps seroprevalence among young Israeli adults born 1988-9 in comparison to previous birth cohorts, in order to inform evidence based prevention policy. We conducted a seroprevalence study of IgG antibodies among 439 Israeli adults born in 1988-9, based on a representative sample of sera collected at age 18-19 upon recruitment to mandatory military service in 2007. In total, 85.7% were seropositive for measles as compared with 95.6% in the 1996 recruitment (P < 0.001). The absolute decline was significant both for males (8.8%, P = 0.001) and females (12.1%, P < 0.001). There were no significant differences in seropositivity by gender, years of education, country of birth or smoking status. Rubella seropositivity among measles seropositives was 90.4%, significantly (P < 0.001) higher than 72.1% among measles seronegatives. Mumps seropositivity among measles seropositives was 87.0%, significantly (P < 0.001) higher than 62.3% among measles seronegatives. Results were similar for Israeli-born only. Our findings indicate that measles seroprevalence decreased after the last change in vaccination policy and reach sub-optimal level. Until global eradication is reached, a proactive vaccination program to supplement routine childhood vaccination program should be considered in Israel and in other countries.
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Affiliation(s)
- Hagai Levine
- Israeli Defense Force, Medical Corps; Tel Hashomer, Israel
- Braun School of Public Health and Community Medicine; Hebrew University-Hadassah Medical Organization; Jerusalem, Israel
| | - Salman Zarka
- Israeli Defense Force, Medical Corps; Tel Hashomer, Israel
- Haifa University School of Public Health; Haifa, Israel
| | - Omer E Ankol
- Israeli Defense Force, Medical Corps; Tel Hashomer, Israel
- Department of Health Management; School of Health Sciences; Ariel University; Ariel, Israel
| | | | - Nadav Davidovitch
- Israeli Defense Force, Medical Corps; Tel Hashomer, Israel
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva, Israel
| | - Yair Aboudy
- Central Virology Laboratory; Ministry of Health; Sheba Medical Center; Tel Hashomer, Israel
| | - Ran D Balicer
- Israeli Defense Force, Medical Corps; Tel Hashomer, Israel
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva, Israel
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Lai FY, Dover DC, Lee B, Fonseca K, Solomon N, Plitt SS, Jaipaul J, Tipples GA, Charlton CL. Determining rubella immunity in pregnant Alberta women 2009-2012. Vaccine 2014; 33:635-41. [PMID: 25533327 DOI: 10.1016/j.vaccine.2014.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022]
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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Affiliation(s)
- Florence Y Lai
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, AB, Canada
| | - Douglas C Dover
- Surveillance and Assessment, Alberta Ministry of Health, Edmonton, AB, Canada
| | - Bonita Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kevin Fonseca
- Department of Microbiology, Immunology & Infectious Diseases (MIID), University of Calgary, Calgary, AB, Canada; Provincial Laboratory for Public Health (ProvLab), Calgary, AB, Canada
| | - Natalia Solomon
- DynaLIFEDX Diagnostic Laboratory Services, Edmonton, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | | | - Joy Jaipaul
- Communicable Disease Control, Alberta Health Services, Edmonton, AB, Canada
| | - Graham A Tipples
- Provincial Laboratory for Public Health (ProvLab), Calgary, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Carmen L Charlton
- Provincial Laboratory for Public Health (ProvLab), Calgary, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
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