Vacinação contra rubéola em mulheres em idade reprodutiva no Município de Campinas, São Paulo, Brasil / Rubella vaccination in women of childbearing age in Campinas, São Paulo State, Brazil / Vacunación contra la rubeola de mujeres en edad reproductiva en el municipio de Campinas, São Paulo, Brasil

As mulheres em idade reprodutiva são a população de maior interesse para a prevenção da síndrome da rubéola congênita. O objetivo do trabalho foi avaliar a prevalência de vacinação contra rubéola em mulheres e identificar fatores associados e motivos da não adesão. Trata-se de estudo transversal de base populacional, realizado em Campinas, São Paulo, Brasil, em 2008/2009, com amostra por conglomerados e em dois estágios. Das 778 mulheres de 10 a 49 anos, 83,8% (IC95%: 79,6-88,0) referiram vacinação em algum momento da vida. Faixa etária (30-39 anos), renda familiar per capita superior a três salários mínimos e a orientação de profissional de saúde estiveram positivamente associadas à vacinação contra a rubéola. Os principais motivos da não adesão foram a falta de orientação do profissional de saúde sobre sua importância (48,5%) e não considerá-la necessária (18,9%). A recomendação do profissional de saúde foi o fator mais fortemente associado à adesão das mulheres à vacinação. Nesse sentido, sua indicação pelas equipes de saúde pode ampliar o conhecimento sobre sua importância e seus benefícios.

Women of reproductive age are the population of greatest interest for the prevention of congenital rubella syndrome. The aim of this study was to evaluate the prevalence of rubella vaccination in women and to identify factors associated and motives for non-adherence. A cross-sectional population-based study, in Campinas, São Paulo State, Brazil, in 2008/2009, was carried out with stratified random, two-stage cluster sampling. Of the 778 women aged 10 to 49 years, 83.8% (95%CI: 79.6-88.0) reported vaccination in life. Age group (20-39 years), per capita household income greater than 3 times the minimum wage and orientation of health care professionals about the vaccine, were positively associated with rubella vaccination. The main motives for non-adherence were lack of orientation of professionals about their importance (48.5%) and not consider it necessary (18.9%). The recommendation of professionals was the factor most strongly associated with women's adherence to vaccination. In this sense, an indication of vaccination by health care teams can increase the knowledge about the importance their and benefits.

Las mujeres en edad reproductiva son la población de mayor interés para la prevención del síndrome de la rubeola congénita. El objetivo del trabajo fue evaluar la prevalencia de vacunación contra la rubeola en mujeres e identificar factores asociados y motivos de la no adhesión al programa de vacunación. Se trata de un estudio transversal de base poblacional, realizado en Campinas, São Paulo, Brasil, en 2008/2009, con una muestra por conglomerados y en dos fases. De las 778 mujeres, de 10 a 49 años, un 83,8% (IC95%: 79,6-88,0) informaron de vacunación en algún momento de la vida. La franja de edad (30-39 años), renta familiar per cápita superior a tres salarios mínimos y la orientación de un profesional de salud estuvieron positivamente asociadas a la vacunación contra la rubeola. Los principales motivos de la no adhesión fueron la falta de orientación del profesional de salud sobre su importancia (48,5%) y no considerarla necesaria (18,9%). La recomendación del profesional de salud fue el factor más fuertemente asociado a la adhesión de las mujeres a la vacunación. En este sentido, su indicación por los equipos de salud puede ampliar el conocimiento sobre su importancia y sus beneficios.

Rubéola, soroprevalência de anticorpos em puérperas e recém-nascidos durante a campanha de vacinação de 2008, em Botucatu, Brasil / Rubella: seroprevalence of antibodies among puerperae and newborns during the 2008 vaccination campaign in Botucatu, Brazil

Objetivo: Avaliar o estado sorológico contra rubéola de uma amostra, representativa e randomizada de puérperas e seus filhos durante a campanha de vacinação. Métodos: Estudo transversal de amostr representativa e randomizada de puérperas e recém-nascidos, durante campanha de vacinação e inquérito sobre antecedente de doença e vacinas. Nas crianças, a dosagem em IgG contra rubéola foi repetida aos 9 meses de vida. Resultados: Noventa e duas, puérperas e 51 recém-nascidos foram avaliados. A menor positividade (66,6%), foi encontrada entre as mulheres com menos de 20 anos, e a maior (90,4%), entre as com 30 ou mais anos de idade. Houve forte correlação entre IgG da mãe e do recém-nascido. Entre as mulheres com antecedentes de doença exantemática, os valores médios de IgG foram significativamente maiores. A maioria das mães (62,0%) não sabia informar se tinha recebido vacina anteriormente. Aos nove meses, nenhuma das crianças avaliada apresentou IgG detectável.

An outbreak of rubella in a hilly district of Kangra- Chamba, Himachal Pradesh,India, 2006.

Objective. We investigated the outbreak as a suspected outbreak of measles with the objectives of confirming diagnosis, estimating the magnitude of outbreak and formulating recommendations for control and prevention. Methods. We defined a case of the rubella as occurrence of fever with rash in any resident of these three villages between 20th October to 9th December, 2006. We line listed the cases and collected information on age, sex, residence, date of onset, symptoms, signs, treatment history, traveling history, vaccination status and pregnancy status. We described the outbreak by time, place and person characteristics. Sera of a sample of case patients were tested for IgM antibodies to measles and later rubella viruses. Results. We identified 61 cases in three villages - 39 cases in Hattli, 17 in Thulel and 5 in Dramman. The overall attack rate (AR) was 8.7%. Sex specific AR for males was 10% and females 7.4%. All case patients were less than 20 years of age and the attack rate was highest in the age group 11-20 years (median age 12 years). The index case was traced in Hattli Bengali slum and occurred on 20th October 2006 where majorities (41%) of the cases were reported. No pregnant woman was found to be affected. The number of cases peaked on 19th November and the last case was reported on 9th December 2006. Of 61 case-patients, 50 (82%) were immunized against measles while proportions of children vaccinated for measles were 96% (672/700) and none of them were immunized against rubella (including two (3%) who had MMR immunization privately). Out of six blood samples tested, all tested negative for measles IgM antibodies but four were positive for IgM antibodies to rubella. Only 36% (22/61) of the cases took the treatment from modern system of medicine. Conclusion. An outbreak of rubella was confirmed and was possibly due to the frequent traveling of Bengali colony patients to other areas for selling the food items. We advised the local health authorities to provide MMR vaccination to the unexposed and energetic IEC in three affected and neighboring villages.

Seroprevalence of antibodies to measles, mumps, and rubella among Thai population: evaluation of measles/MMR immunization programme.

Stored serum specimens, from four regions of Thailand, of healthy children attending well baby clinics and of healthy people with acute illnesses visiting outpatient clinics were randomly sampled and tested for IgG antibody to measles, mumps, and rubella (MMR). The immunity patterns of rubella and mumps fitted well with the history of rubella and MMR vaccination, seroprotective rates being over 85% among those aged over seven years. A high proportion of younger children acquired the infection before the age of vaccination. MMR vaccination should preferably be given to children at an earlier age. For measles, 73% seroprotective rates among children, aged 8-14 years, who should have received two doses of measles/MMR vaccine, were lower than expected. This finding was consistent with the age-group reported in outbreaks of measles in Thailand. The apparent ineffectiveness (in relation to measles) of MMR immunization of 1st grade students warrants further studies.

Congenital rubella syndrome in infants of women vaccinated during or just before pregnancy with measles-rubella vaccine.

BACKGROUND & OBJECTIVE: Measles and Rubella Control Campaign was conducted in Iran in December 2003 targeting both males and females 5 to 25 yr old using measles-rubella vaccine. During the campaign, some pregnant women received vaccine during the first trimester of pregnancy or some others became pregnant shortly thereafter. The goal of this study was to evaluate the risk of congenital rubella syndrome (CRS) among the infants born to the vaccinated mothers. METHODS: A total of 106 pregnant women, who had received vaccine during the first trimester of pregnancy or become pregnant less than three months after vaccination were included in the study for comparison 40 pregnant women without rubella vaccine were also included. The mothers' blood samples at the time of delivery, infants' cord blood and blood samples at the end of the second month of birth of sixty children whose parents agreed about blood sampling, were tested for rubella IgM and IgG antibodies using ELISA method. RESULTS: There were 107 live births in the exposed group and 42 in the control group. Serological study showed no IgM rubella antibody in the maternal and infant cord blood; it was not found in the second blood specimens of 60 infants tested at 8 wk of age. IgG rubella antibody was positive in all infants' cord blood but it decreased in the second blood specimens of the infants. None of the children exhibited signs of congenital rubella syndrome. INTERPRETATION & CONCLUSION: Finding of our study showed that none of the infants born to mothers vaccinated by MR vaccine during the first trimester of pregnancy or had become pregnant within three months after vaccination, had CRS.

Impacto da vacinação contra rubéola na ocorrência da síndrome da rubéola congênita / Impact of rubella vaccination strategy on the occurrence of congenital rubella syndrome

OBJETIVO: A vacinação rotineira contra a rubéola foi implementada na Paraíba, nordeste brasileiro, através de uma campanha de catch-up direcionada a crianças com idades entre 1 e 11 anos em 1998. Uma campanha entre as mulheres em idade reprodutiva foi realizada em 2001. Descrevemos a epidemiologia da rubéola e da síndrome da rubéola congênita (SRC) no estado da Paraíba entre 1999 e 2005. MÉTODOS: Foram analisados os dados de vigilância da rubéola e da SRC entre 1999 e 2005. Os casos suspeitos de rubéola foram confirmados por exames laboratoriais, vínculo epidemiológico ou por critério clínico. Foram utilizadas as definições internacionais padrão de SRC. RESULTADOS: Dos 5.924 casos suspeitos de rubéola entre 1999 e 2005, 1.266 (21 por cento) foram confirmados, 766 (61 por cento) deles através dos exames laboratoriais. Durante uma epidemia de rubéola em 2000 (18,8/100.000), a incidência entre os indivíduos com idades entre 14 e 19 anos (42/100.000) quadruplicou em relação a crianças com idades entre 1 e 13 anos (intervalo de confiança de 95 por cento = 3,2-5,1). A incidência geral da rubéola foi de 0,9/100.000 em 2005. Dos 177 casos suspeitos de SRC entre 1999 e 2005, 167 (94 por cento) foram testados para a presença de IgM. Dos 14 (8 por cento) casos de SRC confirmados laboratorialmente, 12 (86 por cento) haviam nascido em 2001, com uma incidência de 0,2/100.000 crianças menores de 1 ano nesse ano. CONCLUSÕES: A campanha de vacinação contra a rubéola em 1998 não foi suficiente para prevenir um surto entre adultos jovens em 2000, com uma alta incidência de SRC em 2001. Entre 2002 e 2005, as incidências de rubéola e de SRC diminuíram; entretanto, a alta cobertura da vacina e a vigilância de alta qualidade são importantes para que se atinja a erradicação da SRC até 2010.

OBJECTIVE: Routine rubella vaccination was introduced in Paraíba, northeastern Brazil, through a catch-up campaign targeting children aged 1-11 years, in 1998. A campaign among women of childbearing age was conducted in 2001. We describe the epidemiology of rubella and congenital rubella syndrome (CRS) in the state of Paraíba between 1999 and 2005. METHODS: Rubella and CRS surveillance data for the 1999-2005 period were analyzed. Suspected cases of rubella were confirmed by laboratory findings, epidemiological link, or clinical data. International standardized CRS definitions were used. RESULTS: Of 5,924 suspected cases of rubella between 1999 and 2005, 1,266 (21 percent) were confirmed, 766 (61 percent) by laboratory findings. During a rubella epidemic in 2000 (18.8/100,000), the incidence among individuals aged 14-19 years (42/100,000) had a fourfold increase relative to children aged 1-13 years (95 percent confidence interval = 3.2-5.1). The overall rubella incidence was 0.9/100,000 in 2005. Of 177 suspected cases of CRS between 1999 and 2005, 167 (94 percent) were tested for IgM. Of 14 (8 percent) laboratory confirmed cases of CRS, 12 (86 percent) were born in 2001, with an incidence of 0.2/100,000 children aged less than 1 year. CONCLUSIONS: The 1998 rubella vaccination campaign was insufficient to prevent an outbreak among young adults in 2000, with a high CRS incidence in 2001. Between 2002 and 2005 the incidence of rubella and CRS decreased; however, high routine vaccination coverage and high-quality surveillance remain critically important to achieve CRS elimination by 2010.

Vigilância epidemiológica do sarampo e da rubéola no Município de Campinas (SP), Brasil: confiabilidade dos dados / Epidemiologic surveillance of measles and rubella in Campinas (SP), Brazil: the reliability of the data

OBJETIVO: Avaliar e validar as informações sobre o sarampo e a rubéola existentes no Sistema Nacional de Informação de Agravos de Notificação (SINAN) em Campinas, tomando como referência os dados do Sistema de Vigilância Sindrômica de Febre e Exantema (VigiFEx), que funcionou paralelamente ao SINAN no período de maio de 2003 a junho de 2004. MÉTODO: Foram comparados os dados anuais do SINAN de 1999 a 2003 e os dados do SINAN e do VigiFEx para o período de junho de 2003 a maio de 2004. Analisou-se o preenchimento dos campos número, data e município da notificação (variáveis chaves), nome da doença, data dos primeiros sintomas, nome do paciente, data de nascimento e idade, sexo e município de residência, data da investigação, antecedentes vacinais, presença de exantema, data de início do exantema e presença de febre; e casos suspeitos em gestantes, sinais e sintomas, data da coleta da primeira amostra, resultados, coleta de isolamento viral, classificação final, critério de confirmação/descarte, diagnóstico do caso descartado, evolução do caso e data de encerramento. Também foi analisada a concordância dos casos registrados entre as bases de dados. RESULTADOS: Foram identificadas 211 suspeitas de sarampo ou rubéola na base VigiFEx e 275 na base SINAN 12 meses. Todos os casos registrados apresentaram dados completos em relação às variáveis chaves. Os campos nome do paciente, agravo ou doença e município de residência também tiveram 100 por cento de preenchimento. Mais de 95 por cento de preenchimento foi observado para data de investigação, vacina contra o sarampo, vacina contra o sarampo e a rubéola e vacina contra a rubéola. As demais variáveis vacinais (número de doses e data da última dose) apresentaram elevados percentuais de não-preenchimento, assim como as variáveis exantema, febre e data de início do exantema. Houve inconsistência entre os sistemas, principalmente em relação às variáveis sobre antecedentes epidemiológicos, dados clínicos e conclusão do caso. Os dados do VigiFEx apresentaram melhor qualidade. CONCLUSÕES: É preciso avaliar rotineiramente os sistemas de informação de vigilância, imunização e laboratório para garantir a confiabilidade dos dados, de forma que possam embasar o planejamento de ações em saúde.

Strategies for immunisation against rubella: evidence from a study in the Kalutara District.

OBJECTIVE: To simulate different immunisation programs against rubella and estimate the proportion of the population susceptible to rubella infection of each. METHODS: The impact of 3 immunisation schedules on the susceptibility of women of childbearing age and the community to rubella infection was simulated using a probabilistic approach. The first schedule involved selective immunisation of 12-year old girls, the second immunisation of all children at 3 years of age for different immunisation coverages, and the third comprised a combination of the first two. The proportion of different segments of the population currently susceptible to rubella was obtained from a field study conducted in the Kalutara District in 1999. RESULTS: An immunisation program of 12-year old girls will reduce the susceptibility to rubella in 5 years in only the 15 to 19 year age group. In 10 years, the susceptibility in both the 15 to 19 and 20 to 24 year age groups will be reduced. Immunisation only of children at 3 years will take 20 years for a reduction in the susceptibility to rubella infection in the 15 to 19 year and the 20 to 24 year age groups, and the proportion of the population susceptible to rubella can be reduced to less than 10% in 20 years if 90% coverage is attained. If a combination of the two strategies i.e. selective immunisation of girls at 12 years for 10 years and immunisation of all children at 3 years is adopted, the proportion of the community susceptible to rubella will be less than 14% in 10 years. CONCLUSIONS: The combination of immunising girls at 12 years of age for 10 years and all children at 3 years of age against rubella is recommended for Sri Lanka to reduce the risk of congenital rubella syndrome in the short term and the proportion susceptible to rubella in the community in the long term.

A randomized comparative trial in order to assess the reactogenicity and immunogenicity of a new measles mumps rubella (MMR) vaccine when given as a first dose at 12-24 months of age.

An open, randomized multi-center trial, involving 700 infants, was conducted in order to compare a new measles mumps rubella (MMR) vaccine, SB MMR (containing a Jeryl Lynn derived mumps strain RIT 4385) with a widely used vaccine, Merck MMR, when given to children between 12-24 months. Infants were divided between 2 groups; group 1 received SB MMR while group 2 received Merck MMR. Solicited local and general symptoms were recorded using diary cards and antibody levels were measured using ELISA assays. There was a significantly lower incidence of redness (p < 0.001) and swelling (p = 0.03) observed in group 1 compared with group 2. The incidence of all other solicited local and general symptoms were comparable between groups. In initially seronegative subjects equivalent seroconversion rates and post-vaccination GMTs were observed between groups. In conclusion, these results demonstrate that SB MMR is safe and well tolerated when given to children at this age range, and has an equivalent immunogenic profile compared to the widely used Merck MMR vaccine.

Imunização para o clínico geral / Immunization for the general clinic

O autor apresenta o panorama atual dos recursos de imunização disponíveis, enfocando o antígeno de cada produto e as indicações para as diferentes faixas etárias e grupos de risco

Evaluation of serological status of rubella & mumps in children below five years.

A cross-sectional study was carried out on 321 serum samples to detect rubella and mumps antibodies in children below five years and to assess the optimum age for immunization against rubella and mumps. Seropositivity to rubella was 33.3 per cent in children below nine months, 16.9 per cent at 9-12 months and 25.5 per cent by two years. Mean antibody levels for rubella were low at nine months to one year and remained so till five years of age. Similarly, seropositivity for mumps was 53.3 per cent below nine months, 20.3 per cent at 9-12 months and 40 per cent by two years. Mean antibody levels for mumps were low between nine months to two years with a slight rise by five years. The findings suggest that a large majority of children are at risk by the age of nine months in our population and the measles, mumps and rubella (MMR) vaccination at this age may be most beneficial.

Rational use of rubella vaccine for prevention of congenital rubella syndrome in the Americas

Rubella is a viral disease with minor morbidity and few complications unless it is contracted by a pregnant woman. Rubella infection during the first trimester of pregnancy often leads to fetal death or severe congenital defects (congenital rubella syndrome, CRS). Rubella remains endemic in many countries of Latin America and the Caribbean. It has been estimated that 20000 or more infants are perhaps born with CRS each year in Latin American and Caribbean countries. While the inclusion of rubella vaccination into routine childhood immunization will decrease rubella virus circulation among young children, it will not have immediate impact on the transmission of rubella among adults or the occurrence of CRS. A one-time mass campaign targeting both males and females 5 to 39 years of age with measles-mumps-rubella or measles-rubella vaccine followed by the use of measles-mumps-rubella vaccine in routine early childhood vaccination will prevent and control both rubella and CRS promptly. In April 1988, the Ministers of Health of the English-speaking Caribbean targeted rubella for elimination by the end of the year 2000 using the vaccination strategy outlined above. The rubella elimination experience of these countries will provide useful information for the eventual elimination of rubella virus from the Americas.

La rubéola es una enfermedad vírica que produce poca morbilidad y pocas complicaciones, a no ser que la contraiga una mujer embarazada. La infección con rubéola durante el primer trimestre del embarazo a menudo termina en muerte fetal o en deformidades congénitas graves (síndrome de anomalías congénitas por rubéola, o SCR). La rubéola sigue siendo endémica en muchos países de América Latina y el Caribe. Se estima que quizá 20 000 niños o más nacen cada año con SCR en países latinoamericanos y caribeños. Si bien la adición de la vacuna contra la rubéola a los programas de inmunización infantil de rutina disminuirá la circulación del virus entre los niños pequeños, no tendrá un impacto inmediato sobre la transmisión de la rubéola entre los adultos o sobre la frecuencia de SCR. Una campaña única dirigida a toda la población de hombres y mujeres de 5 a 39 años de edad en que se aplique la vacuna triple contra el sarampión, la parotiditis y la rubéola, o la vacuna doble contra el sarampión y la rubéola seguida de la vacuna triple como parte de la inmunización rutinaria de niños pequeños servirá para controlar y prevenir de manera inmediata tanto la rubéola como el SCR. En abril de 1988, los Ministros de Salud de países del Caribe angloparlante establecieron la meta de eliminar la rubéola para fines del año 2000 mediante la aplicación de la estrategia de vacunación aquí descrita. La experiencia que han tenido estos países en sus actividades de eliminación de la rubéola será fuente de información provechosa para la eliminación futura del virus de la rubéola de todo el territorio americano.

Efficacy of two dose measles vaccination in a community setting.

OBJECTIVE: To compare the efficacy of two dose and single dose measles vaccination in a community setting. DESIGN: Two community ICDS blocks with populations of 8990 and 8550 children below 12 years of age were selected. Block A had 1560 children between 9 mo to 1 year of age and Block B had 1380 children between the age of 9 mo to 1 year. METHODS: All eligible children between 9 mo to 1 year of age were given measles vaccination in October 1994. Only the children in Group A were given a second dose of measles (as MMR) in April 1995; six months after the first dose. A survey was undertaken from January 1996 to April 1996 to clinically evaluate the number of cases of measles in both these blocks. RESULTS: In Block A 3 children developed measles, whereas in Block B, there were 16 cases of measles (p < 0.01). All other parameters in both groups, e.g., cold chain maintenance were similar. CONCLUSION: This study supports the superiority of two dose measles vaccination given at an interval of 6 months over a single dose measles in a community setting.

Programa de inmunización para adultos / Program of immunization for adults

Mediante estudios epidemiológicos realizados por la Dirección General de Epidemiología SSA México, se ha detectado el resurgimiento de enfermedades virales o bacterianas en poblaciones fuera de la edad pediátrica, las cuales considerábamos superadas con la edad adulta, identificándose la necesidad de planterar un esquema de inmunizaciones para el adulto, desafortunadamente por nuestras propias limitantes no es posible llevar a cabo planteamientos más ambiciosos que obviamente originarían una cobertura más amplia en padecimientos susceptibles a prevención por medio de inmunización activa. La sugerencia de un programa básico de inmunización ofrece prevención a los siete padecimientos más frecuentes en nuestro medio (tétanos, difteria, sarampión, rubéola, parotiditis, neumonía neumocócica, hepatitis B), además presenta la ventaja de modificar o ampliar la aplicación de inmunógenos de acuerdo a las necesidades especifícas del individuo a tratar, la obtención de estos inmunógenos es posible ya sea por medio de las autoridades sanitarias o bien por su compra en laboratorios de productos médicos. En el presente trabajo se incluye: información general de cada padecimiento, datos epidemiológicos actualizados, indicaciones de inmunización, tipos de inmunógenos, vía de administración y dosis recomendadas, finalmente se propone en un esquema básico de inmunización para adultos y un formato que puede ser aplicado a la población en general con fines preventivos. Diseño del programa: basado en información bibliográfica y programas establecidos en las Instituciones de Salud. Estrategia: Inmunizaciones específicas a la población adulta en general con el fin de reactivar el programa vacunal efectuado en la etapa pediátrica

Vacunación pre y posgestacional / Pre and postgestational vaccine

Las vacunas se encuentran entre los principales recursos con que se cuenta para prevenir enfermedades infecciosas. La vacunación consiste en la introducción de un antígeno inerte, con la finalidad de simular una infección natural y que, de esta manera, se despierte una respuesta inmunológica que deja como resultado final inmunidad del individuo vacunado contra el antígeno utilizado. En la mujer en edad reproductiva las vacunas de importancia son; 1) antirrubéolica, en el caso de no contar con anticuerpos séricos naturales contra este virus y desee embarazarse; 2) toxoide tetánico, en aquellas que no han recibido ningún refuerzo de este en los últimos 10 años; se aplica con la finalidad de prevenir el tétano neonatal; 3) vacuna conta hepatitis B, en cuyo caso la inmunización es a los recién nacidos, hijos de mujeres con infección aguda o crónica por el virus de la hepatitis B; 4) antirrábica, en el caso de una embarazada que tenga exposición al virus de la rabia