dc.description.abstract | Background:
Rubella vaccination has been started since 1986 in Taiwan, the vaccination policy have changed many times. At present, children in Taiwan receive routine MMR vaccine at 15 months old and then receive a booster dose at primary school entry. Susceptible women of child-bearing age also receive MMR vaccine.
Objectives:
This study is carried out to examine age-specific seroprevalence of antibodies against rubella and to elucidate associated factors for seropositivity in northern Taiwan.
Study design:
A cross-sectional study was conducted to survey school girls aged 7∼9 years (1995∼1997 cohorts), 11∼13 years (1991∼1993 cohorts), 15∼17 years (1987∼1989 cohorts), and 19∼22 years (1982∼1985 cohorts) in Taipei County. Child bearing women aged 25∼33 years (1971∼1979 cohorts) and women older than 34 years old who came to Taipei Hospital for pre-marital, pre-labor examination, and other health examinations were also included. Rubella seropositivity was defined as serum rubella IgG antibody level ≧ 10 IU/ml by enzyme immunoassay. Participants are given an informed consent and a questionnaire detailing socioeconomic status, education level, race of mother, number of siblings, and history of rubella infection and rubella vaccination. For women older than 25 years old, ethnicity, marital status, and parity were also asked. Possible predictors of rubella seropositivity and differences in seroprevalence for each age group were calculated by multiple logistic regression. Vaccination coverage rate was also investigated.
Results:
Total 1144 cases were recruited. The geometric mean rubella specific IgG antibody value was found be 76.1± 61.7 IU/ml. Rubella seropositivity rates were 282/287 (98.3 %) positive in persons aged 7∼9 years, 234/235 (99.6%) in aged 11∼13 years, 179/185 (96.8%) in aged 15∼17 years, 110/119 (92.4%) in aged 19∼22 years, and 197/242 (81.4%) in aged 25∼33 years, in aged 34∼44 years 68/76 (89.5%). Seropositivity decreased with age and was the lowest in the 25∼33-year-old age group. For child bearing age women (25∼44 years old), 51 out of 53 (96.2%) seronegative women were foreigners. Age, maternal low education level, foreign mother, and no vaccination at 15 months old were correlated with seronegativity in students (p < 0.05). In addition to previous predictors, foreigners, not married, low parity, and low family income were associated with seronegativity in women. Vaccine coverage rate in students was 99.6%. Comparing with United States and Italy, rubella seropositivity rates and vaccine coverage rate are higher in Taiwan.
Conclusion:
The vaccine program has promoted effectively immunity. However, to eliminate rubella and chronic rubella syndrome, more effort should be made to vaccinate susceptible foreign brides and old age reproductive Taiwanese women. | en |
dc.relation.reference | 1. Low WL, HuangHY, HuangFY. Rubella and congenital rubella syndrome. Contemp Med 1997;24: 543–548.
2. Chen K-T, Lin Z-S. A changing pattern of rubella epidemiologyin Taiwan. Master thesis, 1988, National Taiwan University.
3. Department of Health. Reported cases of congenital rubella syndrome by year. Epidemiol Bull 1992; 8: 232.
4. Grayston JT, Gale JL, Watten RH. The epidemiology of rubella on Taiwan: I. introduction and description of the 1957–1958 epidemic. Int J Epidemiol 1972;1: 245–252.
5. Gale JL, Grayston JT, Beasley RP, Detels R, Kim KSW.The epidemiology of rubella on Taiwan: II. 1968–1969 epidemic. Int J Epidemiol 1972;1: 253–260.
6. Gale JL, Detels R, Kim KSW, Beasley RP, Chen KP, Grayston JT. The eidemiology of rubella on Taiwan: III. Family studies in cities of high and low attack rates. Int J Epidemiol 1:1972;261–265.
7.Yang TS, Deng SH, Lin MH. Detection of antibody to rubella virus in pregnant women in Taipei. J Obstetr and Gynecol ROC 1981; 20:168-170.
8.Shen HD, Chu ML, Lee KJ, Yang JS, Chao TJ. Detection of antibody to rubella virus in pregnant women and nurses in TSGH. Chin Med J .1982; 30:401-403.
9.Ko TM, Chang DY, Yang YS, Lee TY. Rubella infection in females of reproductive age and newborns in Taiwan. J Form Med Assoc 1986;85:856-861.
10.Tsai TY, Kang WB. The screening of rubella virus IgG antibody in Kaohsiung area women of successive age groups. Chin J Microbiol Immunol 1986; 19: 168-175.
11.Wu LC, Yen MH, Ng HT, Yuan FJ. The rubella immunity survey of unmarried school-aged women in Taipei and feasibility study of rubella vaccination. Chin Med J 1987: 40: 309–316.
12. Yuan C, Ng HT, Hu MM, Liu WT. Seroepidemiologic study of rubella in selected Chinese female. Chin Med J 1989: 43: 85–88.
13. Wang CH, Lin DB, Liu CB, Huang SH, Ho SL, Hwang MH. The survey of concept and antibody for rubella in college female students in Taichung area. Chung Shan Med J 2 1991: 41–51.
14. Lin DB, Chen CJ. Current seroepidemiology of rubella virus infection among female residents in Taiwan. J Med Virol. 1993;41:174-8.
15. Lin DB, Chen CJ. Seroepidemiology of rubella virus infection among female residents on the offshore islets of Taiwan. J Trop Med Hyg. 1994;97:75-80.
16. Su SB, Guo HR. Seroprevalence of rubella among women of childbearing age in Taiwan after nationwide vaccination. Am J Trop Med Hyg. 2002;67:549-53.
17. Center for Disease Control (Taiwan). Annual reports on morbidity and mortality of congenital rubella syndrome in Taiwan. Epidemiol Bull 2001;17: 103.
18. TangL-J. Baby boy died of trans-placental rubella. China Times 2001,March 3.
19. Department of Health. Epidemiol Bull, 1992:8: 142. Taipei, Taiwan : Department of Health, The Executive Yuan, Taiwan, Republic of China
20. Dai B. Study on the frequency of primary rubella infection among early pregnant women. Zhonghua Yu Fang Yi Xue Za Zhi. 1992;26:197-9.
21. Yue J. Sero-epidemiological survey of virus infections in pregnant women of the Changchun district. Zhonghua Fu Chan Ke Za Zhi. 1990;25:269-71, 315.
22. Barnett ED, Christiansen D, Figueira M. Seroprevalence of measles, rubella, and varicella in refugees. Clin Infect Dis. 2002:15;35:403-8.
23. Cutts FT, Robertson SE, Diaz-Ortega JL, Samuel R. Control of rubella and congenital rubella syndrome in developing countries, Part 1: Burden of disease from CRS. Bull World Health Organ. 1997;75:55-68.
24.Takahashi K, Suzuki H, Yamazi Y. Seroepidemiological study of rubella in Thailand. Nippon Ika Daigaku Zasshi. 1990;57:427-47.
25. Ki MR, Choi BY, Kim MH, Shin YJ, Park TS.Rubella seroprevalence in Korean children. J Korean Med Sci. 2003;18:331-6.
26. Park KS, Kim HS. Seroprevalence of rubella antibodies and effects of vaccination among healthy university women students in Korea. Yonsei Med J 1996;37:420-6.
27. Asari S, Deguchi M, Tahara K, Taniike M, Toyokawa M, Nishi I, Watanabe M, Iwatani Y, Makimoto K. Seroprevalence survey of measles, rubella, varicella, and mumps antibodies in health care workers and evaluation of a vaccination program in a tertiary care hospital in Japan. Am J Infect Control. 2003;31:157-62.
28. Lim MK, Fong YF, Soh CS.Rubella seroprevalence in the Singapore Armed Forces (SAF) and the changing need of the SAF rubella immunization program. Ann Acad Med Singapore. 1997;26:37-9.
29.Pebody RG, Edmunds WJ, Conyn-van Spaendonck M, Olin P, Berbers G, Rebiere I, Lecoeur H, Crovari P, Davidkin I, Gabutti G, Gerike E, Giordano C, Hesketh L, Plesner AM, Raux M, Rota MC, Salmaso S, Tischer A, Valle M, Miller E. The seroepidemiology of rubella in western Europe. Epidemiol Infect. 2000;125:347-57.
30. Health21: the health for all policy framework for the WHO European Region. European Health for All Series ; No 6: 49.
31. Dykewicz CA, Kruszon-Moran D, McQuillan GM, Williams WW, Van Loon FP, Cossen C, Forghani B, Hadler SC.Rubella seropositivity in the United States, 1988-1994.Clin Infect Dis. 2001: 15;33:1279-86.
32. Zanetta DM, Cabrera EM, Azevedo RS, Burattini MN, Massad E. Seroprevalence of
rubella antibodies in the State of Sao Paulo, Brazil, 8 years after the introduction of vaccine. Vaccine. 2003:8;3795-800.
33. Mossong J, Putz L, Schneider F.Seroprevalence of measles, mumps and rubella antibodies in Luxembourg: results from a national cross-sectional study. Epidemiol Infect. 2004;132:11-8.
34.Gioula G, Diza-Mataftsi E, Alexiou-Daniel S, Kyriazopoulou-Dalaina V. Seroepidemiology of rubella in northern Greece. Eur J Clin Microbiol Infect Dis. 2004;23:631-3.
35. de Melker HE, Nagelkerde NJ, Conyn-van Spaendonck MA. Non-participation in a population-based seroprevalence study of vaccine-preventable diseases. Epidemiol Infect 2000; 124: 255–262.
36. Measles. Mortality reduction and regional elimination plan 2001–2005. World Health Organization, Geneva.
37. Davidkin I, Peltola H, Leinikki P, Valle M. Duration of rubella immunity induced by two-dose measles. Vaccine 2000;18:3106–12.
38.Gabutti G, Rota MC, Salmaso S, Bruzzone BM, Bella A, Crovari P; Serological Study Group. Epidemiology of measles, mumps and rubella in Italy. Epidemiol Infect. 2002 ;129:543-50.
39.Gutierrez Trujillo G, Munoz O, Tapia Conyer R, Bustamante Calvillo ME, Alvarezy Munoz MT, Guiscafre Gallardo JP, Magos c, Sepulveda J. The seroepidemiology of rubella in Mexican women; a national preobability survey. Salud Publica Mex 1990;32: 623-31.
40.Aksit S, Egemen A, Ozacar T, Kurugol Z, Keskinoglu P, Tasbakan M, Caglayan S. Rubella seroprevalence in a unvaccinated population in lzmir: recommendations for rubella vaccination in Turkey. Pediatr Infect Dis J 1999; 18: 577-80.
41. Rubella and pregnancy. ACOG technical bulletin number 171—August1992. Int J Gynaecol Obstet 1993; 42:60–6.
42. Schluter WW, Reef SE, Dykewicz CA. Changing epidemiology of congenital rubella syndrome in the United States. J Infect Dis 1998;178: 636–641.
43. Tingle AJ, Chantler JK, Pot KH, Paty DW, Ford DK. Postpartum rubella immunization: association with development of prolonged arthritis, neurological sequelae, and chronic rubella viremia. J Infect Dis 1985; 152:606–12.
44. Slater PE, Ben-Zvi T, Fogel A, Ehrenfield M, Ever-Hadni S. Absence of an association between rubella vaccination and arthritis in underimmune postpartum women. Vaccine 1995; 13:1529–32.
45. Zimmerman RK, Barker WH, Strikas RA, et al. Developing curricula to promote preventive medicine skills. The Teaching Immunization for Medical Education (TIME) Project. Time Development Committee. JAMA 1997; 278:705–11. | en |