Aim and objective: Congenital rubella syndrome (CRS), a consequence of rubella virus infection in the first trimester of pregnancy is a silent crippling disease endemic in India. This study sought to find out and vaccinate rubella susceptible women attending a fertility clinic in an urban setup.
Materials and methods: As an institutional policy, all females attending fertility clinic were screened for anti-rubella IgG antibodies. A total 2272 non-duplicate serum samples received between January 2011 and December 2017 were processed using enzyme-linked fluorescent assay using mini VIDAS system following standard recommendations. Any value <10 IU/mL was regarded negative, between 10 and 15 as equivocal and >15 as positive.
Results: An average of 10.95% women was susceptible to rubella whereas 86.75% were immune to it. Samples from 52 women gave equivocal results and they were considered to be susceptible. All susceptible females were vaccinated with R-vac and treated for infertility one month after vaccination. Age-specific immune status was not significant. A trend analysis revealed steady increase in immunity from 2011 to 2017 with a slight drop in 2016.
Conclusion: The proportion of susceptible females of reproductive age who need to be vaccinated is significant. This study emphasizes the need for preconception screening as we would have an opportunity to vaccinate susceptible women.
Clinical significance: There is a need for preconception screening of rubella not only in infertile women but also normal reproductive age females. With successful eradication of polio, elimination of rubella and measles being the next targets, combined vaccination strategy is the key to rubella elimination.
Grangeot-Keros L. Rubella and pregnancy. Pathol-Biol 1992;40(7):706–710.
WHO. Rubella vaccines position paper. Wkly Epidemiol Rec 2000;20:161–172.
Dewan P, Gupta P. Burden of congenital rubella syndrome (CRS) in India: a systematic review. Indian Pediatr 2012;49(5):377–399. DOI: 10.1007/s13312-012-0087-4.
Mascarenhas MN, Flaxman SR, Boerma T, et al. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012;9(12):e1001356. DOI: 10.1371/journal.pmed.1001356.
Ganguly S, Unisa S. Trends of infertility and childlessness in India: findings from NFHS sata. Facts Views Vis Obgyn 2010;2(2):131–138.
Lambert N, Strebel P, Orenstein W, et al. Rubella. Lancet 2015;385(9984):2297–2307. DOI: 10.1016/S0140-6736(14)60539-0.
Ghosh A, Measles-Rubella Vaccine to Roll Out in February. The Indian Express; 10 January, 2017. Available from: http://www.indianexpress.com/article/india/measles-rubella-vaccine-to-roll-out-in -february-4467248/. [Last cited on 2017 Dec 14].
Gomber S, Arora SK, Das S, et al. Immune response to second dose of MMR vaccine in Indian children. Indian J Med Res 2011;134:302–306.
Singhal T, Amdekar YK, Agarwal RK, ed. IAP Guidebook on Immunisation, IAP Committee on Immunization 2007-2008. New Delhi: Jaypee Brothers Medical Publishers; 2009. p. 16–98.
Singh S. Indian Academy of Paediatrics Committee on Immunization. Update on immunization policies, guidelines and recommendations. Indian Pediatr 2004;41(3):240–242.
Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009;24(11):2683–2687. DOI: 10.1093/humrep/dep343.
Gandhoke I, Aggarwal R, Lal S, et al. Seroprevalence and incidence of rubella in and around Delhi (1988-2002). Indian J Med Microbiol 2005;23(3):164–167. DOI: 10.4103/0255-0857.16587.
Gohil DJ, Kothari ST, Chaudhari AB, et al. Seroprevalence of measles, mumps, and rubella antibodies in college students in Mumbai, India. Viral Immunol 2016;29(3):159–163. DOI: 10.1089/vim.2015.0070.
Sharma H, Chowdhari S, Raina TR, et al. Sero-surveillance to assess immunity to rubella and assessment of immunogenicity and safety of a single dose of rubella vaccine in school girls. Indian J Community Med 2010;35(1):134–137. DOI: 10.4103/0970-0218.62575.
Phalgune DS, Yervadekar RC, Sharma HJ, et al. Sero-surveillance to assess rubella susceptibility and assessment of immunogenicity and reactogenicity of rubella vaccine in Indian girls aged 18-24 years. Hum Vaccin Immunother 2014;10(10):2813–2818. DOI: 10.4161/21645515.2014.970947.
Singla N, Jindal N, Aggarwal A. The seroepidemiology of rubella in Amritsar (Punjab). Indian J Med Microbiol 2004;22(1):61–63. DOI: 10.1016/S0255-0857(21)02955-8.
Jarour N, Hayajneh WA, Balbeesi A, et al. Seroprevalence of rubella among jordanian women of childbearing age. Vaccine 2007;25(18):3615–3618. DOI: 10.1016/j.vaccine.2007.01.058.
Makhseed M, Moussa MA, Ahmed MA, et al. The status of rubella immunity among pregnant women in Kuwait: screening in childbearing age should be reintroduced. Acta Trop 2001;78(1):35–40. DOI: 10.1016/s0001-706x(00)00163-7.
Ganjooie TA, Mohammadi MM. The prevalence of antibodies against rubella in pregnant women in Kerman, Iran. Saudi Med J 2003;24(11):1270–1271.
Haas DM, Flowers CA, Congdon CL. Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating. Obstetr Gynecol 2005;106(2):295–300. DOI: 10.1097/01.AOG.0000171110.49973.e3.
Kaushal M, Baxi A. Rubella immune status of pregnant & non-pregnant women in Indian population. Int J Gynecol Obstet 2007;6(2):1–6.
Alsibiani SA. Rubella immunity among pregnant women in Jeddah, Western Region of Saudi Arabia. Obstet Gynecol Int 2014;2014:659838. Available from: 10.1155/2014/659838.
Matter L, Kogelschatz K, Germann D. Serum levels of rubella virus antibodies indicating immunity: response to vaccination of subjects with low or undetectable antibody concentrations. J Infect Dis 1997;175(4):749–755. DOI: 10.1086/513967.
Grant GB, Reef SE, Dabbagh A, et al. Rubella and congenital Rubella syndrome control and elimination – Global progress, 2000-2014, WHO. Wkly Epidemiol Rec 2015;90:510–516.
Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increase in congenital rubella occurrence after immunization in Greece: retrospective survey and systematic review. BMJ 1999;319(7223):1462–1467. DOI: 10.1136/bmj.319.7223.1462.
Vardas E, Lancet Laboratory Newsletter [Internet]. 2011 [Cited 2018 Apr 8]. Available from: http://secure.lancet.co.za/files/1813/2257/6116/RubellaNewsletterNov2011.pdf.
Robertson SE, Cutts FT, Samuel R, et al. Control of rubella and congenital rubella syndrome (CRS) in developing countries, part 2: vaccination against rubella. Bullet World Health Organizat 1997;75(1):69–80.
WHO Publication. Rubella vaccines: WHO position paper—recommendations. Vaccine 2011;29(48):8767–8768.