Screening for potential susceptibility to rubella in an antenatal population: A multivariate analysis.

Rubella causes disease in the fetus. Immunity to rubella is therefore, routinely screened in pregnant women. In this retrospective observational study, we assessed the levels of potential susceptibility to rubella in the population of a north London antenatal clinic. Risk factors for potential susceptibility to rubella and changes in potential susceptibility to rubella over time were studied. Almost all women were screened for potential susceptibility to rubella (99.8%). The majority were predicted to be immune (96.8%). Women booking in later years within the study period showed higher levels of potential susceptibility to rubella. Booking during each subsequent year in the study gave women an odds ratio of 0.91 (CI:0.84, 0.98, P = 0.009) of being predicted to have immunity against rubella. Age was associated with predicted immunity to rubella, with a 5.1% (CI:3.3%, 6.9%, P < 0.001) increased likelihood for every year older. Previous pregnancy was predictive of immunity against rubella with an odds ratio of 1.41 (CI 1.21, 1.61, P = 0.001). Those from a non-white ethnicity were less likely to have antibodies predictive of immunity (OR: 0.730, CI: 0.581, 0.879 P < 0.001). Country of birth was associated with differences in potential susceptibility, with those being born outside of the British Isles having an odds ratio for predicted immunity of 0.63 (CI:0.35,0.91, P = 0.001). Being born in a high-risk country for rubella non-immunity was also a risk factor, giving an odds ratio of predicted immunity to rubella of 0.55 (CI:0.32, 0.77, P < 0.001).

Seroprevalence of cytomegalovirus, Epstein Barr virus and varicella zoster virus among pregnant women in Bradford: a cohort study.

OBJECTIVE: To estimate the seroprevalence of cytomegalovirus (CMV), Epstein Barr virus (EBV) and varicella zoster virus (VZV) among pregnant women in Bradford by ethnic group and country of birth. METHODS: A stratified random sample of 949 pregnant women enrolled in the Born in Bradford birth cohort was selected to ensure sufficient numbers of White UK born women, Asian UK born women and Asian women born in Asia. Serum samples taken at 24-28 weeks' gestation were tested for CMV IgG, EBV IgG and VZV IgG. Each woman completed a questionnaire which included socio-demographic information. RESULTS: CMV seroprevalence was 49% among the White British women, 89% among South Asian UK born women and 98% among South Asian women born in South Asia. These differences remained after adjusting for socio-demographic factors. In contrast, VZV seroprevalence was 95% among women born in the UK but significantly lower at 90% among South Asian women born in Asia. EBV seroprevalence was 94% overall and did not vary by ethnic group/country of birth. CONCLUSIONS: Although about half of White British women are at risk of primary CMV infection in pregnancy and the associated increased risk of congenital infection, most congenital CMV infections are likely to be in children born to South Asian women with non-primary infection during pregnancy. South Asian women born in South Asia are at risk of VZV infection during pregnancy which could produce congenital varicella syndrome or perinatal chickenpox. Differences in CMV and VZV seroprevalence by ethnic group and country of birth must be taken into account when universal immunisation against these viruses is contemplated.

Seroprevalence of common vaccine-preventable viral infections in HIV-positive adults.

SUMMARY OBJECTIVES: Guidelines recommend a proactive approach for offering vaccination to susceptible HIV-infected patients. The size of the HIV-positive population that remains susceptible to vaccine-preventable infections is largely unknown. The study determined serostatus and recalled infection and vaccination history for measles, mumps, rubella, varicella-zoster virus (VZV), hepatitis A, and hepatitis B among HIV-positive adults accessing routine care. METHODS: The study recruited 200 consecutive patients with a median CD4 count of 461 (interquartile range 326, 641) cells/mm(3); 62.5% were on suppressive antiretroviral therapy. Patients underwent serological testing and completed a questionnaire about recalled infection and vaccination history. RESULTS: Seronegativity rates were 7.0% [95% confidence interval 3.9-11.5%] for measles, 12.0% [7.5-16.5%] for mumps, 5.0% [2.4-9.0%] for rubella, 1.5% [0.3-4.3%] for VZV, 19.5% [14.0-25.0%] for hepatitis A, and 22.5% [16.7-28.3%] for hepatitis B. For hepatitis B, seropositivity rates were 6.5% [3.5-10.9%] for surface antigen, 38.0% [31.3-44.7%] for anti-core antibody, and 33.0% [26.5-39.5%] for anti-surface antibody alone. While patients who recalled a history of infection were generally seropositive, up to 50.5% of patients were unsure of their vaccination history. CONCLUSIONS: A proportion of HIV-positive adults lack evidence of immunity against common, vaccine-preventable viral infections. Efforts are needed to improve knowledge and records of vaccination history.