Ching-Chiang Lin, Department of Medical Laboratory Science and Biotechnology, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung 83102, Taiwan.

Email: [email protected]

Search for more papers by this author

Wan-Ju Kung,

Wan-Ju Kung

Department of Laboratory Medicine, Fooyin University Hospital, Pingtung, Taiwan

Search for more papers by this author

Ching-Tang Shih,

Ching-Tang Shih

Department of Family Medicine, Fooyin University Hospital, Pingtung, Taiwan

Search for more papers by this author

Yung-Luen Shih,

Yung-Luen Shih

Department of Pathology & Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan

Search for more papers by this author

Ling-Yao Liu,

Ling-Yao Liu

Department of Laboratory Medicine, Mennonite Christian Hospital, Hualien, Taiwan

Search for more papers by this author

Chiou-Huey Wang,

Chiou-Huey Wang

Alere Health Corp., Taipei, Taiwan

Search for more papers by this author

Ya-Wen Cheng,

Ya-Wen Cheng

Department of Clinical Pathology, E-Da Hospital, Kaohsiung, Taiwan

Search for more papers by this author

Hsueh-Chiao Liu,

Hsueh-Chiao Liu

Department of Laboratory Medicine, Fooyin University Hospital, Pingtung, Taiwan

Search for more papers by this author

Ching-Chiang Lin,

Corresponding Author

Ching-Chiang Lin

[email protected]

orcid.org/0000-0002-2417-6903

Department of Education and Research, Fooyin University Hospital, Pingtung, Taiwan

Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan

Correspondence

Ching-Chiang Lin, Department of Medical Laboratory Science and Biotechnology, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung 83102, Taiwan.

Email: [email protected]

Search for more papers by this author

First published: 22 June 2020

https://doi.org/10.1111/aji.13294

Citations: 6

Funding information

The study was funded by Fooyin University Hospital (Grant No: FH-HR-108-09).

Share a link

Email
Wechat
Bluesky

Abstract

Problem

Vaccination is the best protection against rubella and congenital rubella infection. Although a high rate of immunization coverage is achieved in Taiwan, it is unknown if the vaccine-induced immunity persists from the age of vaccination to childbearing age.

Methods of study

A total of 5,988 prenatal rubella IgG test results of young pregnant women aged 19-23 years old from six hospitals during January 2001 to December 2008 and January 2013 to December 2017 were analyzed. We compared the rubella seropositivity rates and titers in these women who were vaccinated with MMR vaccine in four different vaccination age cohorts.

Results

The overall rubella seropositivity rate was 87.4% (95% CI: 86.6%-88.3%), and the mean rubella IgG level was 39 IU/mL among young pregnant women aged 19-23 years. Women in the elementary cohort had the highest rubella positivity of 90.8% (95% CI: 89.6%-91.9%), and levels gradually decrease to 84.6% (95% CI: 82.4%-86.7%) in 15-month plus cohort. The average rubella IgG was only 25 IU/mL for the 15-month plus cohort. Women in cohorts immunized at younger age exhibited significantly lower chances of being seropositive relative to women in older cohort after adjusting other factors (all P < .01).

Conclusion

The rubella seropositivity rate and rubella IgG levels were low among young women aged 19-23 years, especially in cohorts immunized at younger age. As rubella immunity wanes over time, a third dose of MMR may be a protective strategy for women who conceive later in life.

CONFLICT OF INTEREST

None to declare.

REFERENCES

1Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA. Rubella. Lancet. 2015; 385: 2297-2307.
10.1016/S0140-6736(14)60539-0
PubMed Web of Science® Google Scholar
2Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015; 73: 199-213.
10.1111/aji.12355
CAS PubMed Web of Science® Google Scholar
3 World Health Organization. Global vaccine action plan. Geneva, Switzerland: World Health Organization; 2012. http://apps.who.int/iris/bitstream/10665/78141/1/9789241504980_eng.pdf?ua=1 Accessed October 01, 2019
Google Scholar
4 Taiwan Centers for Disease Control . Notifiable Infectious Disease Statistics System, Taiwan. 2000–2019. https://nidss.cdc.gov.tw/ch/SingleDisease.aspx?dc=1&dt=2&disease=056 Accessed September 05, 2019
Google Scholar
5McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013; 62(RR-04): 1-34.
PubMed Web of Science® Google Scholar
6Portella G, Galli C. Multicenter Italian Group for Hospital ToRC evaluation. Multicentric evaluation of two chemiluminescent immunoassays for IgG and IgM antibodies towards Rubella virus. J Clin Virol. 2010; 49: 105-110.
10.1016/j.jcv.2010.07.011
CAS PubMed Web of Science® Google Scholar
7Nokes DJ, Anderson RM. Measles, mumps, and rubella vaccine: what coverage to block transmission? Lancet. 1988; 2: 1374.
10.1016/S0140-6736(88)90920-8
CAS PubMed Web of Science® Google Scholar
8 Taiwan Centers for Disease Control. Vaccine-Preventable Diseases Control. https://www.cdc.gov.tw/En/Category/ListPage/4TFK95zgsUb9k8XYFFj2Dw. Accessed September 05, 2019.
Google Scholar
9Vilajeliu A, García-Basteiro AL, Valencia S, et al. Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain. Vaccine. 2015; 33: 1767-1772.
10.1016/j.vaccine.2015.02.043
PubMed Web of Science® Google Scholar
10Alsibiani SA. Rubella Immunity among Pregnant Women in Jeddah, Western Region of Saudi Arabia. Obstet Gynecol Int. 2014; 2014: 659838.
10.1155/2014/659838
PubMed Google Scholar
11Song N, Gao Z, Wood JG, et al. Current epidemiology of rubella and congenital rubella syndrome in Australia: progress towards elimination. Vaccine. 2012; 30: 4073-4078.
10.1016/j.vaccine.2012.04.025
PubMed Web of Science® Google Scholar
12Davidkin I, Jokinen S, Broman M, Leinikki P, Peltola H. Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. J Infect Dis. 2008; 197: 950-956.
10.1086/528993
PubMed Web of Science® Google Scholar
13Byrne L, Brant L, Reynolds C, Ramsay M. Seroprevalence of low rubella IgG antibody levels among antenatal women in England tested by NHS Blood and Transplant: 2004–2009. Is rubella susceptibility increasing? Vaccine. 2012; 30: 161-167.
10.1016/j.vaccine.2011.11.045
PubMed Web of Science® Google Scholar
14Barlinn R, Vainio K, Samdal HH, Nordbo SA, Nokleby H, Dudman SG. Susceptibility to cytomegalovirus, parvovirus B19 and age-dependent differences in levels of rubella antibodies among pregnant women. J Med Virol. 2014; 86: 820-826.
10.1002/jmv.23757
CAS PubMed Web of Science® Google Scholar
15Voigt EA, Haralambieva IH, Larrabee BL, et al. Polymorphisms in the wilms tumor gene are associated with interindividual variations in rubella virus-specific cellular immunity after measles-mumps-rubella II vaccination. J Infect Dis. 2018; 217: 560-566.
10.1093/infdis/jix538
CAS PubMed Web of Science® Google Scholar
16Ovsyannikova IG, Salk HM, Larrabee BR, Pankratz VS, Poland GA. Single nucleotide polymorphisms/haplotypes associated with multiple rubella specific immune response outcomes post-MMR immunization in healthy children. Immunogenet. 2015; 67: 547-561.
10.1007/s00251-015-0864-z
CAS PubMed Web of Science® Google Scholar
17Lambert ND, Haralambieva IH, Kennedy RB, Ovsyannikova IG, Pankrantz VS, Poland GA. Polymorphisms in HLA-DPB1 are associated with differences in rubella-specific humoral immunity after vaccination. J Infect Dis. 2015; 211: 898-905.
10.1093/infdis/jiu553
CAS PubMed Web of Science® Google Scholar
18Kennedy RB, Ovsyannikova IG, Haralambieva IH, Lambert ND, Pankratz VS, Poland GA. Genome-wide SNP associations with rubella-specific cytokine responses in measles-mumps-rubella vaccine recipients. Immunogenet. 2014; 66: 493-499.
10.1007/s00251-014-0776-3
CAS PubMed Web of Science® Google Scholar
19Ovsyannikova IG, Pankratz VS, Larrabee BR, Jacobson RM, Poland GA. HLA genotypes and rubella vaccine immune response: additional evidence. Vaccine. 2014; 32: 4206-4213.
10.1016/j.vaccine.2014.04.091
CAS PubMed Web of Science® Google Scholar
20Smits G, Mollema L, Hahné S, et al. Seroprevalence of rubella antibodies in The Netherlands after 32 years of high vaccination coverage. Vaccine. 2014; 32: 1890-1895.
10.1016/j.vaccine.2014.01.066
PubMed Web of Science® Google Scholar
21Vandermeulen C, Mathieu R, Geert LR, Pierre VD, Karel H. Long-term persistence of antibodies after one or two doses of MMR-vaccine. Vaccine. 2007; 25: 6672-6766.
10.1016/j.vaccine.2007.07.008
PubMed Web of Science® Google Scholar
22LeBaron C, Forghani B, Matter L, et al. Persistence of rubella antibodies after 2 doses of measles-mumps-rubella vaccine. J Infect Dis. 2009; 200: 888-899.
10.1086/605410
PubMed Web of Science® Google Scholar
23Paunio M, Hedman K, Davidkin I, et al. Secondary measles vaccine failures identified by measurement of IgG avidity: high occurrence among teenagers vaccinated at a young age. Epidemiol Infect. 2000; 124: 263-721.
10.1017/S0950268899003222
CAS PubMed Web of Science® Google Scholar
24Siegrist CA. Neonatal and early life vaccinology. Vaccine. 2001; 19: 3331-3346.
10.1016/S0264-410X(01)00028-7
CAS PubMed Web of Science® Google Scholar
25Pichichero ME. Challenges in vaccination of neonates, infants and young children. Vaccine. 2014; 32: 3886-3894.
10.1016/j.vaccine.2014.05.008
PubMed Web of Science® Google Scholar
26Bonhoeffer J, Siegrist CA, Heath PT. Immunization of premature infants. Arch Dis Child. 2006; 91: 929-935.
10.1136/adc.2005.086306
CAS PubMed Web of Science® Google Scholar
27Minges Wols HA, Underhill GH, Kansas GS, Witte PL. The role of bone marrow-derived stromal cells in the maintenance of plasma cell longevity. J Immunol. 2002; 169: 4213-4221.
10.4049/jimmunol.169.8.4213
CAS PubMed Web of Science® Google Scholar
28Shih CT, Chang YC, Wang HL, Lin CC. Comparing the rubella seronegativity in pregnant women who received one dose of rubella vaccine at different ages in Taiwan. Vaccine. 2016; 34: 4787-4791.
10.1016/j.vaccine.2016.08.024
CAS PubMed Web of Science® Google Scholar
29Lin C-C, Yang C-Y, Shih Y-L, et al. Persistence and titer changes of rubella virus antibodies in primiparous women who had been vaccinated with strain RA 27/3 in junior high school. Clin Vaccine Immunol. 2012; 19: 1-4.
10.1128/CVI.05334-11
PubMed Web of Science® Google Scholar
30Lin CC, Yang CY, Shih YL, et al. Rubella seroepidemiology and estimations of the catch-up immunization rate and persistence of antibody titers in pregnant women in Taiwan. BJOG. 2011; 118: 706-712.
10.1111/j.1471-0528.2011.02903.x
PubMed Web of Science® Google Scholar
31 Department of Statistics, Ministry of the Inferior R.O.C (Taiwan). https://www.moi.gov.tw/chi/chi_site/stat/node.aspx?cate_sn=&belong_sn=5137&sn=6868 Accessed September 05, 2019.
Google Scholar
32Tookey P. Rubella in England, Scotland and Wales. Euro Surveil. 2004; 9: 21-23.
10.2807/esm.09.04.00464-en
CAS PubMed Google Scholar
33Robinson JL, Canadian Paediatric Society (CPS) and Infectious Diseases and Immunization Committee. Prevention of congenital rubella syndrome. J Paediatr Child Health. 2007; 12: 795-797.
10.1093/pch/12.9.795
Web of Science® Google Scholar
34 World health organization. https://www.who.int/immunization/newsroom/measles-data-2019/en/. Accessed September 05, 2019
Google Scholar
35Kang JH, Yoo JH. The Measles Strikes Back. J Korean Med Sci. 2019; 34:e59.
10.3346/jkms.2019.34.e59
PubMed Web of Science® Google Scholar
36Shimizu K, Kinoshita R, Yoshii K, et al. An investigation of a measles outbreak in Japan and China, Taiwan, China, March-May 2018. Western Pac Surveill Response J. 2018; 9: 25-31.
10.5365/wpsar.2018.9.2.005
PubMed Web of Science® Google Scholar
37Zhao S. Epidemiology of an unexpected measles outbreak in Hong Kong, from March to April, 2019. Travel Med Infect Dis. 2019; 30: 133-136.
10.1016/j.tmaid.2019.06.002
PubMed Web of Science® Google Scholar
38Chen C-J, Lee P-I, Hsieh Y-C, et al. Waning population immunity to measles in Taiwan. Vaccine. 2012; 30: 6721-6727.
10.1016/j.vaccine.2012.05.019
PubMed Web of Science® Google Scholar
39Ho Y-H, Tsai C-C, Tsai Y-W, et al. Humoral immunity to mumps in a highly vaccinated population in Taiwan. J Microbiol Immunol Infect. 2019; 52: 379-385.
10.1016/j.jmii.2017.09.001
CAS PubMed Google Scholar

Citing Literature

Volume84, Issue4

October 2020

e13294

Faster waning of the rubella-specific immune response in young pregnant women immunized with MMR at 15 months

Abstract

Problem

Methods of study

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Faster waning of the rubella-specific immune response in young pregnant women immunized with MMR at 15 months

Abstract

Problem

Methods of study

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Related

Information