Maternal rubella at St. Thomas' Hospital: is there a need to change British vaccination policy?

Maternal rubella at St Thomas' Hospital in 1978 and 1986: support for augmenting the rubella vaccination programme

The effects of the rubella epidemics in 1978 and 1986 among patients attending antenatal clinics at St Thomas' Hospital were compared. Although many pregnant women who had been exposed to rubella-like illnesses were investigated in both 1978 (269) and 1986 (160), the number of cases of maternal rubella was substantially lower in 1986 (1) than in 1978 (17). Rubella vaccination of 11-14-year-old girls was introduced in the United Kingdom in 1970, but 10% of our patients were susceptible and only 36% gave a definite history of vaccination. Despite the smaller number of maternal rubella cases, substantial resources were expended on assessing patients who had been exposed to or who presented with rubella-like illnesses. In 1978 an intensification of the selective rubella vaccination campaign was recommended, but experience in the 1986 epidemic supports the view that the programme should be augmented by vaccination of preschool children with a combined measles, mumps, and rubella vaccine, with a view to rubella eradication.

The impact of a rubella prevention policy on the outcome of rubella in pregnancy

Surveillance of rubella vaccination in schoolgirls has continued intensively in Edinburgh since 1970. Screening for rubella antibody of all women attending antenatal clinics has been available since 1974. The analysis of cases of rubella occurring in pregnancy during an outbreak in 1979 confirmed the efficacy of schoolgirl vaccination in the city but indicated poor implementation of postnatal vaccination. Eighteen (67%) of 27 proven cases occurred in women who were screened in previous pregnancies and not immunized. Of the total of 13 liveborn infants the only two with congenital rubella defects were born to mothers in this group. Rubella immunization of schoolgirls and women of childbearing age must receive continued intensive effort if the problems of rubella in pregnancy are to be eradicated.

Is post partum rubella vaccination worthwhile?

This study was designated to determine whether a program of screening for rubella antibodies during pregnancy, coupled with selective vaccination after delivery, could effectively increase herd immunity. One thousand women were studied when they returned for further antenatal care after having been screened, and possibly vaccinated, during an earlier pregnancy. Overall, the program was shown to be 83% effective since 108 women were truly seronegative in their initial pregnancies and 90 of them had been rendered immune by the time of their next pregnancy. The 18 failures of the program were attributed to the haemagglutination inhibition test employed (eight cases), failure to administer vaccine (seven cases) and true vaccine failures (three cases). Five pregnant women became infected with rubella virus during the study but all were in their initial pregnancies. All seronegative women were shown to follow the instruction not to become pregnant within three months of vaccination. We conclude that a program of screening for immunity, together with selective vaccination post partum, can significantly reduce both the number of susceptible women and the number who experience rubella infection during pregnancy. Such programs should be vigorously encouraged as a means of helping to prevent congenital rubella.

Rubella susceptibility in inner-city adolescents: the effect of a school immunization law

In order to improve the immune status of girls in our medical clinic, we conducted a prospective sero-survey to identify susceptibles and developed a system for vaccinating non-immune girls. Over an 18-month period, 481 inner-city adolescents were screened. Susceptibility rate defined by a titer less than 1:8 was 12 per cent and did not differ significantly with regard to age or race. Nine months into the study period, the State of Wisconsin enacted a "no immunization-no school" law. The susceptibility rate dropped from 22 per cent prior to the enactment of the law, to 5 per cent after. Of the 60 girls identified as susceptible, 54 (90 per cent) kept their follow up appointments for vaccinations. Enforced state immunization laws appear to be effective in lowering rubella susceptibility.

Rubella antibody determination from heparinised finger-tip blood by single radial haemolysis and enzyme immunoassay

Rubella antibodies were determined by single radial haemolysis (SRH) and a micromodification of enzyme immunoassay (EIA) of samples of heparinised finger-tip blood or plasma collected into transportable vials, and the results were compared with antibody titres obtained from conventional samples of venous serum. The antibody titres of finger-tip specimens gave a high correlation with those of venous serum. For SRH only 5 microliters of heat-inactivated finger-tip plasma was needed, and for EIA only a single dilution, 1:100, in duplicate, of heparinised finger-tip plasma or while blood was sufficient. The minimal inconvenience in sample collection makes the finger-tip test particularly suitable for large-scale immunity screening when assessing the need for, or efficacy of, rubella vaccination.