Author:
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Vilajeliu, Alba; García-Basteiro, Alberto L.; Valencia, Salomé; Barreales, Saul; Oliveras, Laura; Calvente, Valentín; Goncé, Anna; Bayas Rodríguez, José María
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Abstract:
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BACKGROUND: Elimination 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. METHODS:
Cross-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. RESULTS: A 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.
CONCLUSIONS: The 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. |