RESUMO
Congenital rubella syndrome (CRS), an important cause of severe birth defects, remains a public health problem in a significant number of countries. Therefore, global health experts encourage use of rubella vaccination, with the primary aim of preventing CRS. While large-scale rubella vaccination during the last decade has drastically reduced or eliminated both the virus and CRS in Europe and the Americas, many countries in Africa, South-East Asia, the Eastern Mediterranean, and the Western Pacific have not yet incorporated any type of rubella-containing vaccine into their immunization schedule. As a result, through travel and migration, rubella has been imported into countries that had successfully eliminated the virus, leading to outbreaks and the reestablishment of endemic transmission. The objective of this study was to identify the key factors required for CRS elimination (prevalence reduction, vaccination strategies, and surveillance methods) by reviewing publications in PubMed on rubella and CRS (systematic reviews, country experiences, and position papers from the World Health Organization (WHO) and other intergovernmental organizations). Based on the results of the review, to eliminate rubella and CRS in endemic areas and reduce re-emergence in previously disease-free areas, all countries should carry out two types of mass rubella vaccination campaigns: 1) one single mass national immunization campaign targeting all men and women 5-39+ years old (with the upper age limit depending on the year in which the rubella-containing vaccine was introduced and the epidemiology of rubella in the country) and 2) incorporation of an rubella-containing vaccine in routine childhood immunization programs, including regular vaccination campaigns for 12-month-olds and measles follow-up campaigns. In addition to mass rubella immunization campaigns and routine childhood vaccination programs, the following measures should be taken to help fight rubella and CRS: 1) surveillance of the number of susceptible women of childbearing age, and the emergence of imported cases; 2) coverage of susceptible populations with "second-chance" ("catch-up") campaigns (vaccination of older children and adults who may have missed earlier immunization programs); 3) rapid response to outbreaks; 4) strengthening of CRS surveillance; 5) involvement of the private sector in awareness and vaccination campaigns; and 6) reduction of the number of false-positive laboratory test results.
El síndrome de rubéola congénita (SRC), una causa importante de defectos congénitos graves, sigue siendo un problema de salud pública en un número significativo de países. Por consiguiente, los expertos mundiales en salud promueven el uso de la vacunación antirrubeólica con el objetivo primario de prevenir el SRC. Aunque, durante el último decenio, la vacunación antirrubeólica administrada a gran escala ha reducido drásticamente o eliminado tanto el virus como el SRC en Europa y la Región de las Américas, muchos países de África, Asia Sudoriental, el Mediterráneo Oriental y el Pacífico Occidental aún no han incorporado ningún tipo de vacuna con componente antirrubeólico en su calendario de vacunaciones. Como resultado, y a consecuencia de los viajes y las migraciones, la rubéola se ha importado a países que habían eliminado eficazmente el virus, provocando brotes y el restablecimiento de la transmisión endémica. El objetivo de este estudio fue determinar los factores clave requeridos para la eliminación del SRC (reducción de la prevalencia, estrategias de vacunación y métodos de vigilancia) mediante la revisión de publicaciones aparecidas en PubMed sobre la rubéola y el SRC (revisiones sistemáticas, experiencias de países y documentos de posición de la Organización Mundial de la Salud y otras organizaciones intergubernamentales). Con base en los resultados de la revisión, y con objeto de eliminar la rubéola y el SRC en las zonas endémicas y reducir su reaparición en las zonas previamente libres de la enfermedad, todos los países deben llevar a cabo dos tipos de campañas de vacunación antirrubeólica masivas: 1) una única campaña de vacunación masiva a escala nacional dirigida a todos los hombres y mujeres de 5 a 39 años de edad (el límite superior de edad depende del año de introducción de la vacuna con componente antirrubeólico y de la epidemiología de la rubéola en el país), y 2) la incorporación de una vacuna con componente antirrubeólico en los programas sistemáticos de vacunación infantil, incluidas las campañas regulares de vacunación dirigidas a lactantes de 12 meses de edad y las campañas de seguimiento de las enfermedades exantemáticas. Además de las campañas de vacunación masiva contra la rubéola y los programas sistemáticos de vacunación infantil, se deben aplicar las siguientes medidas para ayudar a combatir la rubéola y el SRC: 1) la vigilancia de las mujeres en edad fecunda susceptibles, y de la aparición de casos importados; 2) la cobertura de las poblaciones vulnerables mediante campañas de "segunda oportunidad" ("puesta al día") (vacunación de niños mayores y adultos a los que no hubieran alcanzado los programas de vacunación anteriores); 3) la respuesta rápida ante los brotes; 4) el fortalecimiento de la vigilancia del SRC; 5) la participación del sector privado en las campañas de concientización y vacunación; y 6) la reducción del número de resultados de pruebas de laboratorio falsamente positivos.
Assuntos
Síndrome da Rubéola Congênita/complicações , Síndrome da Rubéola Congênita/diagnóstico , Síndrome da Rubéola Congênita/prevenção & controle , Síndrome da Rubéola Congênita/transmissãoAssuntos
Rubéola (Sarampo Alemão) , Prevalência , Vacinação , África , América , Ásia , Europa (Continente) , Região do Mediterrâneo , Ilhas do Pacífico , Rubéola (Sarampo Alemão) , Síndrome da Rubéola Congênita , Prevalência , Vacinação , América , Sudeste Asiático , Europa (Continente) , Região do Mediterrâneo , Ilhas do PacíficoRESUMO
This review describes the advocacy efforts to mobilize resources for the campaign to vaccinate men and women aged 9-39 years, with a goal of eliminating rubella and congenital rubella syndrome in Guatemala. The country's investment in health has been historically low (0.9% of gross domestic product), and there has been a wide gap between the availability of economic resources and the need for economic resources for the immunization campaign. The review contains a summary of the investment made, the results of advocacy and resource mobilization, the vaccination coverage attained, and the campaign's impact on the disease.
Assuntos
Vacinação em Massa , Vacina contra Rubéola/administração & dosagem , Vacina contra Rubéola/imunologia , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Adolescente , Adulto , Criança , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Análise Custo-Benefício , Feminino , Guatemala/epidemiologia , Política de Saúde , Humanos , Masculino , Vacinação em Massa/economia , Rubéola (Sarampo Alemão)/economia , Vacina contra Rubéola/economia , Fatores Socioeconômicos , Organização Mundial da Saúde , Adulto JovemRESUMO
The circulation of wild measles virus was interrupted in Venezuela in February 2007 after the catch-up vaccination (1994) and monitoring (1998) and in response to the measles outbreak in 2001. Traditionally, the routine coverage with measles-mumps-rubella vaccine does not exceed 85%. In February 2006, a measles outbreak started by importation in the State Miranda; this extended to 7 states and lasted 50 weeks with an intermediate period of 17 weeks without reported cases. New cases were reported in the States Guarico and Amazon. The pattern of circulation of the silent period was determined through the use of retrospective search for measles; this showed that 57% of suspected cases did not enter the surveillance system. Molecular epidemiology made it possible to identify B3 as only genotype, which also circulated in Spain. The epidemiological and clinical characteristics of measles have been modified; these determine outbreaks identified late, of slow expansion, silent, and with limited case-fatality, compared with classical outbreaks. The outbreak spread by that behavior was not recognized and the classical control measures did not result. The beginning of a broader and intense vaccination was delayed, partly by weaknesses in the sensitivity of the system. It is crucial to recognize the new behavior of measles and the effectiveness of the classical control measures, and especially to establish criteria for interruption of the circulation to control an outbreak in this stage of elimination.
Assuntos
Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/prevenção & controle , Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Sarampo/epidemiologia , Sarampo/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/história , Emigrantes e Imigrantes , História do Século XX , História do Século XXI , Humanos , Lactente , Vacinação em Massa , Vigilância da População , Viagem , Venezuela/epidemiologia , Adulto JovemRESUMO
Costa Rica introduced the measles-mumps-rubella (MMR) vaccine in 1986. The Ministry of Health adopted the goal of eliminating endemic measles in 1991 by achieving and maintaining high vaccine coverage through routine delivery, mass campaigns and outreach activities, and the strengthening of expanded program on immunization (EPI) surveillance. Measles and rubella immunization strategies shifted susceptibility to older age groups, leading to the introduction of MMR2 in 1992, administered at age 7 years. In 2000, the goal of accelerated rubella control and congenital rubella syndrome prevention was established, and a nationwide vaccination campaign targeting men and women aged 15-39 was implemented to immunize the population of reproductive age. The last endemic case of measles was confirmed in 1999, and at the end of 2001 Costa Rica reported the last endemic cases of rubella and congenital rubella syndrome. Imported cases of measles and rubella were detected in 2003 and 2005, with no secondary cases detected. In 2008, Costa Rica established a National Committee of Experts, supported by technical teams, to collect the evidence required to verify the interruption of endemic transmission of the measles and rubella viruses. The evidence includes information on trends and epidemiologic analysis, molecular epidemiology, population immunity, the quality of surveillance, and the sustainability of the EPI program.
Assuntos
Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Sarampo/epidemiologia , Sarampo/prevenção & controle , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controle , Adolescente , Adulto , Pré-Escolar , Controle de Doenças Transmissíveis/história , Controle de Doenças Transmissíveis/métodos , Costa Rica/epidemiologia , Surtos de Doenças , Suscetibilidade a Doenças , Emigrantes e Imigrantes , Doenças Endêmicas , Feminino , História do Século XX , História do Século XXI , Humanos , Incidência , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vigilância da População , Viagem , Adulto JovemRESUMO
BACKGROUND: Due to the significant teratogenicity of rubella virus and the use of a live-attentuated vaccine, pregnancy is a contraindication of receipt of rubella vaccine (RCV). Data collected from several countries that have observed susceptible women who had received RCV during pregnancy documented that no infant with congenital rubella syndrome (CRS) has been born, so the risk is theoretical. As part of the regional initiative to eliminate rubella and CRS in the Americas, one of the key strategies was the vaccination of women of childbearing age. The implementation of mass vaccination campaigns targeting women of childbearing age in Argentina, Brazil, Costa Rica, Ecuador, El Salvador, and Paraguay provided an opportunity to further increase the body of knowledge on the safety of rubella vaccine if an unknowingly pregnant woman is vaccinated in early pregnancy. METHODS: Using a standard protocol, women who were unknowingly pregnant or become pregnant ≤ 30 days after receiving RCV were evaluated to determine immunity status (eg, susceptible, immune, and unknown) at the time of vaccination. Susceptible pregnant women were observed to determine the outcome of the pregnancy. For pregnancies that resulted in live births, serum samples were obtained from the newborn for rubella immunoglobulin (Ig) M antibody testing. If the newborn's serum sample was IgM positive, the infant was evaluated for manifestations of CRS. RESULTS: During the period 2001-2008, 48748253 women of childbearing age were vaccinated in the region of the Americas, 39542253 (81%) of whom were vaccinated in the 6 selected countries. Of these women, 30139 (0.07%) were pregnant or became pregnant ≤1 month after receiving vaccine and were followed up. On the basis of serological evaluation, 2894 (10%) women were classified as susceptible at the time of vaccination; of their pregnancies, 1980 (90%) resulted in a live birth. Sera from 70 (3.5%) of these infants were rubella IgM antibody positive, but none of the infants had features of CRS as a result of rubella vaccination. The maximum theoretical risk for CRS following rubella vaccination of susceptible pregnant women was 0.2%. Conclusions. The results of these studies from 6 select countries provides additional evidence showing an absence of risk of CRS associated with administering rubella vaccine shortly before or during pregnancy.
Assuntos
Vacinação em Massa , Vacina contra Rubéola/administração & dosagem , Vacina contra Rubéola/imunologia , Rubéola (Sarampo Alemão)/prevenção & controle , Controle de Doenças Transmissíveis , Costa Rica/epidemiologia , Feminino , Feto/efeitos dos fármacos , Humanos , Imunoglobulina M/sangue , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Fatores de Risco , Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/etiologia , Vacina contra Rubéola/efeitos adversos , América do Sul/epidemiologia , Vacinas AtenuadasRESUMO
BACKGROUND: Rubella during pregnancy can cause serious fetal abnormalities and death. Peru has had integrated measles/rubella surveillance since 2000 but did not implement congenital rubella syndrome (CRS) surveillance until 2004, in accordance with the Pan American Health Organization recommendations for rubella elimination. The article describes the experience from the CRS sentinel surveillance system in Peru. METHODS: Peru has maintained a national sentinel surveillance system for reporting confirmed and suspected CRS cases since 2004. A surveillance protocol was implemented with standardized case definitions and instruments in the selected sentinel sites. Each sentinel site completes their case investigations and report forms and sends the reports to the Health Region Epidemiology Department, which forwards the data to the national Epidemiology Department. CRS surveillance data were analyzed for the period 2004-2007. RESULTS: During the period 2004-2007, 16 health facilities, which are located in 9 of the 33 health regions, representing the 3 main geographical areas (coast, mountain, and jungle), were included as sentinel sites for the CRS surveillance. A total of 2061 suspected CRS cases were reported to the system. Of these, 11 were classified as CRS and 23 as congenital rubella infection. Factors significantly associated with rubella vertical transmission were: (1) in the mother, maternal history of rash during pregnancy (odds ratio [OR], 12.0; 95% confidence interval [CI], 3.8-37.8); (2) and in the infant, pigmentary retinopathy (OR, 18.4; 95% CI, 3.2-104.6), purpura (OR, 14.7; 95% CI, 2.8-78.3), and developmental delay (OR, 4.4; 95% CI, 1.75-11.1). CONCLUSIONS: The surveillance system has been able to identify rubella vertical transmission, reinforcing the evidence that rubella was a public health problem in Peru. This system may serve as a platform to implement surveillance for other congenital infections in Peru.
Assuntos
Síndrome da Rubéola Congênita/epidemiologia , Síndrome da Rubéola Congênita/prevenção & controle , Controle de Doenças Transmissíveis , Feminino , Humanos , Recém-Nascido , Razão de Chances , Peru/epidemiologia , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controleRESUMO
BACKGROUND: Brazil conducted mass immunization of women of childbearing age in 2001 and 2002. Surveillance was initiated for vaccination of women during pregnancy to monitor the effects of rubella vaccination on fetal outcomes. METHODS: Women vaccinated while pregnant or prior to conception were reported to the surveillance system. Susceptibility to rubella infection was determined by anti-rubella immunoglobulin (Ig) M and IgG immunoassays. Susceptible women were observed through delivery. Live-born infants were tested for anti-rubella IgM antibody; IgM-seropositive newborns were tested for viral shedding and observed for 12 months for signs of congenital rubella syndrome. Incidence of congenital rubella infection was calculated using data from 7 states. RESULTS: A total of 22 708 cases of rubella vaccination during pregnancy or prior to conception were reported nationwide, 20,536 (90%) of which were from 7 of 27 states in Brazil. Of these, 2332 women were susceptible to rubella infection at vaccination. Sixty-seven (4.1%) of 1647 newborns had rubella IgM antibody (incidence rate, 4.1 congenital infections per 100 susceptible women vaccinated during pregnancy [95% confidence interval, 3.2-5.1]). None of the infants infected with rubella vaccine virus was born with congenital rubella syndrome. CONCLUSIONS: As rubella elimination goals are adopted worldwide, evidence of rubella vaccine safety aids in planning and implementation of mass adult immunization.
Assuntos
Vacina contra Rubéola/administração & dosagem , Vacina contra Rubéola/imunologia , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Criança , Controle de Doenças Transmissíveis , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Vacinação em Massa , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez , Vacina contra Rubéola/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: The Region of the Americas eliminated measles in 2002 through high first-dose routine measles vaccine coverage and vaccination campaigns every 4-6 years; a second routine dose at school entry was added in some countries. The impact of this second routine dose on measles elimination was evaluated. METHODS: Data on socioeconomic factors, demographic characteristics, vaccination coverage, and the estimated proportion of children (<15 years of age) susceptible to measles were compiled. Countries were grouped using propensity score methods, and Kaplan-Meier curves were used to compare time to measles elimination between countries with a 1-dose schedule and those with a 2-dose schedule. RESULTS: One-dose (n = 14) and 2-dose (n = 7) countries did not differ with respect to median routine first-dose measles vaccine coverage, median coverage for 3 measles campaigns, or estimated percentage of susceptible children after routine first vaccination dose and campaigns. Compared with 1-dose countries, 2-dose countries had higher median gross national income per capita (P = .002), percentage of population living in urban areas (P = .04), and female literacy (P = .01), as well as lower infant mortality (P = .007); however, no differences in time to elimination were found. CONCLUSIONS: One-dose and 2-dose countries had similar times to measles elimination despite socioeconomic differences between their populations. A second routine dose might not have hastened measles elimination, because threshold immunity needed to eliminate measles was achieved with high first routine dose coverage and vaccination campaigns. Further research will be needed to determine the applicability of these findings to other regions.
Assuntos
Vacina contra Sarampo/administração & dosagem , Vacina contra Sarampo/imunologia , Sarampo/prevenção & controle , Adolescente , América Central/epidemiologia , Criança , Controle de Doenças Transmissíveis , Suscetibilidade a Doenças , Esquema de Medicação , Humanos , Sarampo/epidemiologia , Programas Nacionais de Saúde , Fatores de Risco , Fatores Socioeconômicos , América do Sul/epidemiologia , VacinaçãoRESUMO
Rubella virus infection is typically diagnosed by the identification of rubella virus-specific immunoglobulin M (IgM) antibodies in serum, but approximately 50% of serum samples from rubella cases collected on the day of rash onset are negative for rubella virus-specific IgM. The ability to detect IgM in sera and oral fluids was compared with the ability to detect rubella virus RNA in oral fluids by reverse transcription-PCR (RT-PCR) by using paired samples taken within the first 4 days after rash onset from suspected rubella cases during an outbreak in Perú. Sera were tested for IgM by both indirect and capture enzyme immunoassays (EIAs), and oral fluids were tested for IgM by a capture EIA. Tests for IgM in serum were more sensitive for the confirmation of rubella than the test for IgM in oral fluid during the 4 days after rash onset. RT-PCR confirmed more suspected cases than serum IgM tests on days 1 and 2 after rash onset. The methods confirmed approximately the same number of cases on days 3 and 4 after rash onset. However, a few cases were detected by serum IgM tests but not by RT-PCR even on the day of rash onset. Nine RT-PCR-positive oral fluid specimens were shown to contain rubella virus sequences of genotype 1C. In summary, RT-PCR testing of oral fluid confirmed more rubella cases than IgM testing of either serum or oral fluid samples collected in the first 2 days after rash onset; the maximum number of confirmations of rubella cases was obtained by combining RT-PCR and serology testing.
Assuntos
Surtos de Doenças , Imunoglobulina M/análise , Imunoglobulina M/sangue , Boca/química , RNA Viral/análise , Rubéola (Sarampo Alemão)/diagnóstico , Rubéola (Sarampo Alemão)/epidemiologia , Soro/química , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Dados de Sequência Molecular , Boca/imunologia , Boca/virologia , Peru/epidemiologia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Vírus da Rubéola/genética , Vírus da Rubéola/imunologia , Sensibilidade e Especificidade , Análise de Sequência de DNA , Soro/imunologia , Soro/virologia , Fatores de TempoRESUMO
Esta publicación recoge los afiches utilizados por los Estados Miembros de la Organización Panamericana de la Salud (OPS) para la eliminación del sarampión y la rubéola en la Región de las Américas. Los afiches compilados aquí ofrecen un boceto del sistema visual e iconográfico que fue desarrollado para informar, persuadir, dar conocimientos y motivar a los pueblos de las Américas a mantenerse fieles a su compromiso de eliminar estas dos enfermedades, promoviendo así la equidad. Desde una perspectiva histórica, estos afiches ofrecen mucho más de lo que reflejan las percepciones, sesgos y actitudes de la cultura, sociedad y tiempo en que fueron creados. En ellos se unen el arte, la cultura, la ciencia, la religión y los valores en pro de la salud.
Assuntos
Humanos , Controle de Doenças Transmissíveis/métodos , Imunoterapia , Sarampo , Rubéola (Sarampo Alemão) , Síndrome da Rubéola Congênita , AméricaRESUMO
[Preface]. Some 100 years ago, public health regularly began to include graphic arts among its armamentarium in the fight against diseases. It was an era of devastating epidemics and endemic infectious diseases, as health workers began to organize coordinated media campaigns that sought to mobilize the community and enlist its participation through striking posters, illustrated pamphlets, films, and other graphic materials. In its classical book, Rats, lice, and history, published in 1934, Hans Zinsser wrote: “infectious diseases are one of humankind’s great tragedies. They permanently struggle to exist through different ways of life.” This battle has sparked the imagination and creativity of many a graphic artist, who have variously depicted this ongoing saga in the course of time. / Es para mí un privilegio presentar Imágenes que inspiran: la movilización de las Américas para eliminar el sarampión y la rubéola, publicación que recoge los afiches utilizados por los Estados Miembros de la Organización Panamericana de la Salud (OPS) para la eliminación del sarampión y la rubéola en la Región de las Américas. Los afiches compilados aquí ofrecen un boceto del sistema visual e iconográfico que fue desarrollado para informar, persuadir, dar reconocimiento y motivar a los pueblos de las Américas a mantenerse fieles a su compromiso de eliminar estas dos enfermedades, promoviendo así la equidad. Desde una perspectiva histórica, estos afiches ofrecen mucho más de lo que originalmente se propusieron: son espejos que reflejan las percepciones, sesgos y actitudes de la cultura, sociedad y tiempo en que fueron creados. En ellos se unen el arte, la cultura, la ciencia, la religión y los valores en pro de la salud.
Assuntos
Doenças Transmissíveis , Imunoterapia , Sarampo , Rubéola (Sarampo Alemão) , Síndrome da Rubéola Congênita , América , Controle de Doenças Transmissíveis , Imunoterapia , Sarampo , Rubéola (Sarampo Alemão) , Síndrome da Rubéola CongênitaRESUMO
Measles is one of the most infectious diseases. Before the introduction of the measles vaccine, nearly all children contracted measles. By the end of the 1980s, most countries of the world had incorporated the measles vaccine into their routine vaccination programs. Globally, some 345,000 deaths due to measles still occur every year. Eradication of measles would play an important role in improving child survival. The goal to eradicate measles from the Americas was set by the Pan-American Sanitary Conference in 1994. Progress to date has been remarkable. Measles is no longer an endemic disease in the Americas and interruption of transmission has been documented in most countries. As of December 2007, 5 years have elapsed since the detection of the last endemic case in Venezuela in November 2002. This experience demonstrates that interruption of measles transmission can be achieved and sustained over a long period of time. Global eradication should be feasible if the appropriate strategies are implemented. Even in a new paradigm in which eradication is not followed by the discontinuation of vaccination, eradication of measles should be a good investment to avoid expensive epidemics and save those children that would potentially die due to infection with the measles virus. It is not only a dream to think that we will see a world free of measles by the year 2015.
Assuntos
Saúde Global , Sarampo/prevenção & controle , Sarampo/transmissão , Humanos , Programas de Imunização/métodos , Programas de Imunização/tendências , América Latina/epidemiologia , Sarampo/epidemiologia , Vacina contra Sarampo/uso terapêutico , América do Sul/epidemiologiaRESUMO
OBJECTIVE: To determine the proportion of postpartum women aged 15-49 in Peru who are susceptible to rubella, in order to help address strategies to eliminate rubella and to prevent congenital rubella syndrome (CRS) in the country. METHODS: A cross-sectional survey was conducted during March and April 2003 in six main regional hospitals, in the three geographic regions (coast, mountain, and jungle) of Peru. For the postpartum women who provided written informed consent, a questionnaire was administered and a blood specimen was collected. Sera were tested for rubella immunoglobulin G (IgG) antibody, using a commercial enzyme-linked immunosorbent serologic assay (ELISA) kit. Univariate, bivariate, and multivariate analyses were carried out to assess risk factors for susceptibility. RESULTS: In total, 1 236 postpartum women were enrolled. The overall proportion of IgG-antibody negative women was 12.8% (95% confidence interval (CI): 10.9%-14.6%). Bivariate analysis found the following variables associated with susceptibility: living in the jungle region (odds ratio (OR) = 1.65; 95% CI: 1.13-2.42); age < 19 years (OR = 2.02; 95% CI: 1.35-3.03); being a housewife (OR = 1.69; 95% CI: 1.12-2.55); and having < or = 11 years of education (OR = 2.12; 95% CI :1.20-3.75). Multivariate analysis found the following variables were associated with susceptibility: living in the jungle region (OR = 1.67; 95% CI: 1.13-2.46); age < 19 years (OR = 1.62; 95% CI: 1.07-2.47); having < 4 children born alive (OR = 1.85; 95% CI: 1.00-3.40); and having < or = 11 years of education (OR = 2.07; 95% CI: 1.16-3.71). CONCLUSIONS: The proportion of postpartum women at the study sites who were found to be susceptible to rubella was 12.8%, placing Peru among the countries facing a moderate level of risk for the occurrence of CRS cases. The findings suggest the need to also provide the rubella vaccine to other population groups, especially women of childbearing age.
Assuntos
Síndrome da Rubéola Congênita/prevenção & controle , Rubéola (Sarampo Alemão)/epidemiologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Intervalos de Confiança , Estudos Transversais , Coleta de Dados , Interpretação Estatística de Dados , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Consentimento Livre e Esclarecido , Pessoa de Meia-Idade , Razão de Chances , Peru , Período Pós-Parto , Gravidez , Fatores de Risco , Rubéola (Sarampo Alemão)/imunologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vírus da Rubéola/imunologia , Estudos Soroepidemiológicos , Fatores SocioeconômicosRESUMO
Most persons with rubella virus-specific immunoglobulin M (IgM)- or IgG-positive sera tested positive (98% [n = 178] and 99% [n = 221], respectively) using paired filter paper dried blood spot (DBS) samples, provided that DBS indeterminate results were called positive. For persons with IgM- or IgG-negative sera, 97% and 98%, respectively, were negative using DBS.
Assuntos
Anticorpos Antivirais/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Vírus da Rubéola/imunologia , Rubéola (Sarampo Alemão)/diagnóstico , Anticorpos Antivirais/imunologia , Coleta de Amostras Sanguíneas , Surtos de Doenças , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Peru/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/imunologia , Rubéola (Sarampo Alemão)/virologia , Sensibilidade e Especificidade , Testes SorológicosRESUMO
BACKGROUND: Costa Rica implemented a nationwide measles-rubella vaccination campaign among men and women (15-39 years old) in May 2001. A protocol was developed to follow-up the vaccinated women who were unknowingly pregnant, to determine the risk of congenital rubella syndrome (CRS) or congenital rubella infection only associated with the administration of the rubella vaccine RA27/3 during pregnancy. METHODS: To classify the prevaccination maternal immune status, a serum sample was taken at the initial evaluation to detect IgM and IgG rubella antibodies (enzyme-linked immunosorbent assay). All pregnancies were followed up and all newborns were evaluated. A cord serum sample of their children was taken at birth. We calculated odds ratio, OR (95% confidence interval, 95% CI) associated with miscarriage, stillbirth, prematurity, low birth weight, and the presence of defects compatible with CRS. RESULTS: The prevaccination immune status was established in 797 women and 1191 mother and child pairs were analyzed. Adjusted OR for miscarriage (OR = 0.60, 95% CI = 0.26-1.39), stillbirth (OR = 1.32, 95% CI = 0.10-16.81), prematurity (OR = 0.25, 95% CI = 0.03-2.39), low birth weight (OR = 0.25, 95% CI = 0.03-2.23) and defects compatible with CRS (OR = 1.09, 95% CI = 0.34-3.54) showed no association between immune and susceptible maternal status. There were no cases of CRS and no children were IgM positive. CONCLUSIONS: No adverse pregnancy outcome such as miscarriages or CRS was documented in women who were vaccinated and unknowingly pregnant. These results support RA27/3 rubella vaccine safety.
Assuntos
Feto/efeitos dos fármacos , Resultado da Gravidez/epidemiologia , Vacina contra Rubéola/efeitos adversos , Vacina contra Rubéola/imunologia , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/imunologia , Adolescente , Adulto , Costa Rica/epidemiologia , Bases de Dados Factuais , Ensaio de Imunoadsorção Enzimática , Feminino , Feto/virologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Recém-Nascido , Masculino , Vacinação em Massa , Gravidez/imunologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/imunologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vacina contra Rubéola/administração & dosagemRESUMO
OBJECTIVE: To determine the proportion of postpartum women aged 15-49 in Peru who are susceptible to rubella, in order to help address strategies to eliminate rubella and to prevent congenital rubella syndrome (CRS) in the country. METHODS: A cross-sectional survey was conducted during March and April 2003 in six main regional hospitals, in the three geographic regions (coast, mountain, and jungle) of Peru. For the postpartum women who provided written informed consent, a questionnaire was administered and a blood specimen was collected. Sera were tested for rubella immunoglobulin G (IgG) antibody, using a commercial enzyme-linked immunosorbent serologic assay (ELISA) kit. Univariate, bivariate, and multivariate analyses were carried out to assess risk factors for susceptibility. RESULTS: In total, 1 236 postpartum women were enrolled. The overall proportion of IgG-antibody negative women was 12.8 percent (95 percent confidence interval (CI): 10.9 percent-14.6 percent). Bivariate analysis found the following variables associated with susceptibility: living in the jungle region (odds ratio (OR) = 1.65; 95 percent CI: 1.13-2.42); age < 19 years (OR = 2.02; 95 percent CI: 1.35-3.03); being a housewife (OR = 1.69; 95 percent CI: 1.12-2.55); and having < 11 years of education (OR = 2.12; 95 percent CI :1.20-3.75). Multivariate analysis found the following variables were associated with susceptibility: living in the jungle region (OR = 1.67; 95 percent CI: 1.13-2.46); age < 19 years (OR = 1.62; 95 percent CI: 1.07-2.47); having < 4 children born alive (OR = 1.85; 95 percent CI: 1.00- 3.40); and having < 11 years of education (OR = 2.07; 95 percent CI: 1.16-3.71). CONCLUSIONS: The proportion of postpartum women at the study sites who were found to be susceptible to rubella was 12.8 percent, placing Peru among the countries facing a moderate level of risk for the occurrence of CRS cases. The findings suggest the need to also provide...
OBJETIVO: Determinar la proporción de mujeres recién paridas de 15-49 años de edad susceptibles a la rubéola en Perú, a fin de contribuir a establecer estrategias para eliminar la rubéola y evitar el síndrome de rubéola congénita (SRC) en el país. MÉTODOS: Se realizó un estudio transversal en marzo y abril de 2003 en seis hospitales regionales principales de tres regiones geográficas (costa, sierra y selva) de Perú. A las mujeres recién paridas que dieron su consentimiento informado por escrito se les aplicó un cuestionario y se les tomó una muestra de sangre. La detección serológica de anticuerpos de la clase IgG contra rubéola se realizó mediante un ensayo inmunoenzimático comercial tipo ELISA. Se realizaron análisis con una, dos y múltiples variables para evaluar los factores de riesgo de ser susceptible a la enfermedad. RESULTADOS: En total participaron 1 236 mujeres recién paridas. La proporción de mujeres negativas a anticuerpos IgG contra rubéola fue de 12,8 por ciento (intervalo de confianza de 95 por ciento [IC95 por ciento]: 10,9 por ciento a 14,6 por ciento). Según el análisis bifactorial, las variables asociadas con la vulnerabilidad a la enfermedad fueron: vivir en la región de la selva (razón de posibilidades [odds ratio, OR] = 1,65; IC95 por ciento: 1,13 a 2,42); tener menor de 19 años de edad (OR = 2,02; IC95 por ciento: 1,35 a 3,03); ser ama de casa (OR = 1,69; IC95 por ciento: 1,12 a 2,55); y tener 11 años o menos de educación (OR = 2,12; IC95 por ciento: 1,20 a 3,75). Las variables asociadas con la vulnerabilidad a la enfermedad según el análisis multifactorial fueron: vivir en la región de la selva (OR = 1,67; IC95 por ciento: 1,13 a 2,46); tener menos de 19 años de edad (OR = 1,62; IC95 por ciento: 1,07 a 2,47); tener menos de 4 niños nacidos vivos (OR = 1,85; IC95 por ciento: 1,00 a 3,40); y tener 11 años o menos de educación (OR = 2,07; IC95 por ciento: 1,16 a 3,71). CONCLUSIONES: En la zona estudiada, la proporción...
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Síndrome da Rubéola Congênita/prevenção & controle , Rubéola (Sarampo Alemão)/epidemiologia , Anticorpos Antivirais/sangue , Intervalos de Confiança , Estudos Transversais , Coleta de Dados , Interpretação Estatística de Dados , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Imunoglobulina G/sangue , Consentimento Livre e Esclarecido , Razão de Chances , Peru , Período Pós-Parto , Fatores de Risco , Vírus da Rubéola/imunologia , Rubéola (Sarampo Alemão)/imunologia , Rubéola (Sarampo Alemão)/prevenção & controle , Estudos Soroepidemiológicos , Fatores SocioeconômicosRESUMO
BACKGROUND: The epidemiology of rubella in Costa Rica changed during recent decades, shifting the susceptible groups to the reproductive age. This study estimates the burden of congenital rubella syndrome (CRS) from 1996 to 2001 in this country. METHODS: Three methods to calculate CRS incidence were used. A retrospective search ("Observed cases") was conducted using hospital discharge records of children born from 1996 to 2001 with selected codes of ICD9 and ICD10 consistent with CRS and children <3 months of age with a positive serologic test for rubella IgM antibody at the National Children's Hospital (NCH). Cases were classified as either suspected, compatible or confirmed CRS and congenital rubella infection. "Expected" incidence of CRS was calculated using reported cases of rubella (women 15-45 years of age) and fertility rates, assuming CRS probability of 0.9 during the first trimester of pregnancy and 0.5 of asymptomatic rubella cases. "Estimated" CRS cases were calculated using incidence rates reported from modeling analysis during epidemic and endemic years. RESULTS: Of the 577 discharge charts reviewed and the 66 children reported as rubella IgM(+), 40 compatible CRS cases, 45 confirmed, and 4 with congenital rubella infection cases were identified. The range of annual incidence rate of CRS (per 1000 live births) was as follows: "Observed" = 0.00-0.33, "Expected" = 0.00-0.35 and "Estimated" = 0.5-1.5. Compared with the estimated number of CRS cases, only 27.2% of CRS cases were detected from the retrospective search and 10.1% would be expected when calculated using rubella reported cases. CONCLUSIONS: The under-detection of CRS cases using rubella reported cases in women of reproductive age and retrospective search of CRS reinforces the importance of suspecting CRS in the presence of a single compatible manifestation. Laboratory confirmation is indispensable to implement CRS elimination strategies and should be done in every suspected case.