Rubella immune status of neonates – a window towards seroprevalence among childbearing women


Background:
When contracted in pregnancy, rubella may cause serious chronic infection of the fetus and development of Congenital Rubella Syndrome. Despite widespread application of rubella vaccination, periodical outbreaks are still being reported worldwide. The aim of this study was to determine rubella seroprevalence and antibody levels in neonates in Serbia as a proxy of maternal serostatus.

Methods:
ELISA based serological testing for rubella was done in 599 neonates treated at the Institute of Neonatology in Belgrade, from January 2010 to December 2011. All individuals with rubella IgG concentration ≥10 IU/ml were considered seropositive for rubella.

Results:
The mean age of enrolled neonates was 18 ± 6 days. The overall seroprevalence of rubella IgG antibodies among the tested neonates was 540/599(90.2 %, 95 % CI: 87.5–92.3). Seropositivity rate among sera of the neonates enrolled in 2010 was significantly higher than those collected in 2011 (p < 0.0001). There was no difference in average maternal age, gestational age or frequency of receiving blood products among the two study years. Significant high seropositivity rate was observed among neonates from mother aged >30 as compared to those from mothers aged <20 years (p = 0.02). Significant difference was also found between average IgG titers in the two study years (79 IU/mL in 2010 vs. 46 IU/mL in 2011, p < 0.0001).

Conclusion:
We report on high rubella seroprevalence among newborns in Serbia, as a proxy of rubella serostatus of childbearing aged women. Notably, declining trend of rubella antibodies toward diminishing titers suggest the importance of sustained rubella serosurvey and antenatal screening at the national level.

Keywords:
Rubella, Seroprevalence, IgG titer, Neonates, Mothers


Autoři: Iris Pejcic 1;  Milica Rankovic Janevski 1;  Aleksandra Knezevic 2;  Djordje Jevtovic 2,3;  Maja Stanojevic 2*
Působiště autorů: Institute of Neonatology, Belgrade, Serbia. 1;  University of Belgrade School of Medicine, Belgrade, Serbia. 2;  Infectious and Tropical Diseases University Hospital, Clinical Center Serbia, Belgrade, Serbia. 3
Vyšlo v časopise: BMC Public Health 2016, 16:838
Kategorie: Research article
prolekare.web.journal.doi_sk: 10.1186/s12889-016-3514-y

© 2016 The Author(s).

Open access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3514-y

Souhrn

Background:
When contracted in pregnancy, rubella may cause serious chronic infection of the fetus and development of Congenital Rubella Syndrome. Despite widespread application of rubella vaccination, periodical outbreaks are still being reported worldwide. The aim of this study was to determine rubella seroprevalence and antibody levels in neonates in Serbia as a proxy of maternal serostatus.

Methods:
ELISA based serological testing for rubella was done in 599 neonates treated at the Institute of Neonatology in Belgrade, from January 2010 to December 2011. All individuals with rubella IgG concentration ≥10 IU/ml were considered seropositive for rubella.

Results:
The mean age of enrolled neonates was 18 ± 6 days. The overall seroprevalence of rubella IgG antibodies among the tested neonates was 540/599(90.2 %, 95 % CI: 87.5–92.3). Seropositivity rate among sera of the neonates enrolled in 2010 was significantly higher than those collected in 2011 (p < 0.0001). There was no difference in average maternal age, gestational age or frequency of receiving blood products among the two study years. Significant high seropositivity rate was observed among neonates from mother aged >30 as compared to those from mothers aged <20 years (p = 0.02). Significant difference was also found between average IgG titers in the two study years (79 IU/mL in 2010 vs. 46 IU/mL in 2011, p < 0.0001).

Conclusion:
We report on high rubella seroprevalence among newborns in Serbia, as a proxy of rubella serostatus of childbearing aged women. Notably, declining trend of rubella antibodies toward diminishing titers suggest the importance of sustained rubella serosurvey and antenatal screening at the national level.

Keywords:
Rubella, Seroprevalence, IgG titer, Neonates, Mothers


Zdroje

1. Best JM. Rubella. Semin Fetal Neonat M. 2007;12:182–92.

2. Lee JY, Bowden DS. Rubella virus replication and links to teratogenicity. Clin Microbiol Rev. 2000;13:571–87.

3. Rubella vaccines: WHO position paper. WHO Weekly epidemiological record. No. 29, 2011, 86, 301–316. http://www.who.int/wer

4. Eliminating measles and rubella and preventing congenital rubella infection. WHO European Region strategic plan 2005–2010. Copenhagen, WHO Regional Office for Europe, 2005 – http://www.euro.who.int/document/E87772.pdf

5. World Health Organization (WHO). WHO Regional Committee for Europe resolution EUR/RC60/R12 on renewed commitment to elimination of measles and rubella and prevention of congenital rubella syndrome by 2015 and sustained support for polio-free status in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2010. Available at: http://www.euro.who.int/__data/assets/pdf_file/0016/122236/RC60_eRes12.pdf.

6. WHO vaccine-preventable diseases: monitoring system. 2015 global summary. http://apps.who.int/immunization_monitoring/globalsummary/incidences?c=SRB. Accessed 20 May 2016

7. Kovacevic M, Derkovic V, Pokorni D. Contagious diseases in the Belgrade region in the period 1991–1996. Stanovništvo. 1998;1–2:125–44.

8. Zimmerman LA, Muscat M, Jankovic D, Goel A, Bang H, Khetsuriani N, Martin R. Status of Rubella and congenital Rubella syndrome surveillance, 2005–2009, the World Health Organization European Region. JID. 2011;204:S381–8.

9. WHO vaccine-preventable diseases: monitoring system. 2014 global summary (http://apps.who.int/immunization_monitoring/globalsummary/incidences?c=SRB). Accessed 20 May 2016.

10. Third meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC) The Regional Office for Europe of the World Health Organization, 2014. Available online at http://www.euro.who.int/__data/assets/pdf_file/0011/275519/3rd-Meeting-European-RVC-Measles-Rubella-Elimination.pdf?ua=1

11. Milosevic V, Jerant-Patić V, Mrda E, Hrnjaković-Cvjetković I. Acute rubella virus infection in women of reproductive age in Vojvodina 1994–1995. Med Pregl. 1997;50:81–5.

12. Hardelid P, Cortina-Borja M, Williams D, Tookey PA, Peckham CS, Cubitt WD, Dezateux C. Rubella seroprevalence in pregnant women in North Thames: estimates based on newborn screening samples. J Med Screen. 2009;16:1–6.

13. Bradstreet CMP, Kirkwood B, Pattison JR, O’H TJ. The derivation of a minimum immune titre of rubella haemagglutination-inhibition (HI) antibody- a public health laboratory service collaborative survey. J Hyg (Lond). 1978;81(3):383–8.

14. Kurtz JB, Mortimer PP, Mortimer PR, Morgan-Capner P, Shafi MS, White GB. Rubella antibody measured by radial haemolysis. Characteristics and performance of a simple screening method for use in diagnostic laboratories. J Hyg (Lond). 1980;84(2):213–22.

15. Skendzel LP. Rubella immunity: defining the level of protective antibody. Am J Clin Pathol. 1996;106:170–4.

16. WHO. The immunological basis for immunization series. Module 11: Rubella. 2008, (http://whqlibdoc.who.int/publications/2008/9789241596848_eng.pdf).

17. World Health Organization. Preventing congenital rubella syndrome. Wkly Epidemiol Rec. 2000;75:290–5.

18. WHO. Proceedings: progress toward Rubella elimination and CRS prevention in Europe, Rome, Italy, 8–10 February 2012.

19. Centers for Disease Control and Prevention. Nationwide Rubella epidemic — Japan, 2013. MMWR. 2013;62:457–62.

20. Paradowska-Stankiewicz I, Czarkowski MP, Derrough T, Stefanoff P. Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections. Euro Surveill. 2013;18(21):20485.

21. WHO vaccine-preventable diseases: monitoring system. 2015 global summary. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria[country][]=ROU. Accessed 20 May 2016

22. Janta D, Stanescu A, Lupulescu E, Molnar G, Pistol A. Ongoing rubella outbreak among adolescents in Salaj, Romania, September 2011–January 2012. Euro Surveill. 2012;17(7):20089.

23. Novo A, Huebschen JM, Muller CP, Tesanovic M, Bojanic J. Ongoing rubella outbreak in Bosnia and Herzegovina, March-July 2009 - preliminary report. Euro Surveill. 2009;14(39):19343.

24. Nardone A, Tischer A, Andrews N, Backhouse J, Theeten H, Gatcheva N, et al. Comparison of rubella seroepidemiology in 17 countries: progress towards international disease control targets. Bull World Health Organ. 2008;86:118–25.

25. Smits G, Mollema L, Hahné S, de Melker H, Tcherniaeva I, van der Klis F, Berbers G. Seroprevalence of rubella antibodies in The Netherlands after 32 years of high vaccination coverage. Vaccine. 2014;32:1890–5.

26. Stojanovski K, McWeeney G, Emiroglu N, Ostlin P, Koller T, Licari L, Kaluski DN. Risk factors for low vaccination coverage among Roma children in disadvantaged settlements in Belgrade, Serbia. Vaccine. 2012;30:5459–63.

27. Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increase in congenital rubella occurrence after immunization in Greece: retrospective survey and systematic review. BMJ. 1999;319:1462–7.

28. Barlinn R, Vainio K, Samdal HH, Nordbø SA, Nøkleby H, Dudman SG. Susceptibility to cytomegalovirus, parvovirus B19 and age-dependent differences in levels of rubella antibodies among pregnant women. J Med Virol. 2014;86:820–6.

29. Byrne L, Brant L, Reynolds C, Ramsay M. Seroprevalence of low rubella IgG antibody levels among antenatal women in England tested by NHS Blood and Transplant: 2004–2009. Is rubella susceptibility increasing? Vaccine. 2012;30:161–7.

30. Lin CC, Yang CY, Shih YL, Huang YY, Yang TH, Liang JY, Chang CF, et al. Persistence and titer changes of rubella virus antibodies in primiparous women who Had been vaccinated with strain RA 27/3 in junior high school. Clin Vaccine Immunol. 2012;19:1.

31. Kakoulidou M, Forsgren M, Lewensohn-Fuchs I, Johansen K. Serum levels of rubella-specific antibodies in Swedish women following three decades of vaccination programmes. Vaccine. 2010;28:1002–7.

32. Mwambe B, Mirambo MM, Mshana SE, Massinde AN, Kidenya BR, Michael D, Morona D, et al. Sero-positivity rate of rubella and associated factors among pregnant women attending antenatal care in Mwanza, Tanzania. BMC Pregnancy Childbirth. 2014;14:95.

33. Mirambo MM, Majigo M, Aboud S, Groß U, Mshana SE. Serological makers of rubella infection in Africa in the pre vaccination era: a systematic review. BMC Res Notes. 2015;8:716.

34. Davidkin I, Peltola H, Leinikki P, Valle M. Duration of rubella immunity induced by two-dose measles, mumps and rubella (MMR) vaccination. A 15-year follow up in Finland. Vaccine. 2000;18:3106–12.

35. Leuridan E, Van Damme P. Passive transmission and persistence of naturally acquired or vaccine-induced maternal antibodies against measles in newborns. Vaccine. 2007;25:6296–304.

36. Palmeira P, Quinello C, Silveira-Lessa AL, Zago CA, Carneiro-Sampaio M. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol. 2012; 985646: 13. doi:10.1155/2012/985646.

37. Neil G, Simister E. Placental transport of immunoglobulin. Vaccine. 2003; 21:3365–9.

38. Leineweber B, Grote V, Schaad UB, Heininger U. Transplacentally acquired immunoglobulin G antibodies against measles, mumps, rubella and varicella-zoster virus in preterm and full term newborns. Pediatr Infect Dis J. 2004;23:361–3.

39. van den Berg JP, Westerbeek EAM, van der Klis FRM, Berbers GAM, van Elburg RM. Transplacental transport of IgG antibodies to preterm infants: a review of the literature. Early Hum Dev. 2011;87:67–72.

40. van den Berg JP, Westerbeek EA, Berbers GA, van Gageldonk PG, van der Klis FR, van Elburg RM. Transplacental transport of IgG antibodies specific for pertussis, diphtheria, tetanus, Haemophilus influenzae type b, and Neisseria meningitidis serogroup C is lower in preterm compared with term infants. Pediatr Infect Dis J. 2010;29:801–5.

41. Waaijenborg S, Hahné SJM, Mollema L, Smits GP, Berbers GAM, van der Klis FRM, et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. JID. 2013;208:10–6.

42. Gans HA, Maldonado YA. Highly vaccinated populations: an emerging need to define the ontogeny of infant immune responses. JID. 2013;208:1–3.

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