Evaluación de la seroprotección contra sarampión, rubéola y hepatitis B en niños menores de cinco años del Perú, 2011 / Evaluation of the seroprotection against measles, rubella and hepatitis B in children under 5 years of age in Peru, 2011

Objetivos. Estimar la prevalencia de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años del Perú. Materiales y métodos. Se realizó una encuesta nacional basada en la aplicación de un cuestionario y obtención de muestra de sangre capilar en papel de filtro para el estudio de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años. Se utilizó un muestreo probabilístico, estratificado y multietápico con inferencia a nivel nacional y siete ámbitos de estudio: Lima metropolitana, resto de costa urbana, costa rural, sierra urbana, sierra rural, selva urbana y selva rural. Las muestras de sangre capilar fueron procesadas siguiendo protocolos estandarizados para la determinación de anticuerpos mediante técnica de ELISA utilizando reactivos comerciales. Resultados. Se encontró una prevalencia nacional de 91,6% (IC95%: 90,6-92,7%), 91,3% (IC 95%: 90,3-92,4%) y 95,9% (IC 95%: 95,0-96,8%) para anticuerpos contra sarampión, rubéola y hepatitis B respectivamente. No se evidenció diferencias significativas de las prevalencias entre los diferentes ámbitos de estudio y en los diferentes estratos socioeconómicos de los conglomerados. Conclusiones. En niños de 1 a 4 años se ha estimado una prevalencia nacional de anticuerpos contra sarampión y rubéola entre 90-93%, mientras que para anticuerpos contra hepatitis B (anti-HBsAg) entre 95-97%.

Objectives. To estimate the prevalence of antibodies against measles, rubella and hepatitis B in children aged between 1 and 4 years in Peru. Materials and methods. A national survey was conducted based on a questionnaire and capillary blood sample taken on filter paper in order to study antibodies against measles, rubella and hepatitis B in children from 1 to 4 years of age. A stratified, multistage, probability sampling design was used to be representative at the national level and at level of seven ambits, including the Metropolitan Lima Area, the rest of the urban coast, the rural coast, the urban highlands, the rural highlands, the urban jungle and the rural jungle. The capillary blood samples were processed according to the standardized protocols for detection of antibodies using the ELISA technique and commercial reagents. Results. The survey showed a national prevalence of antibodies against measles, rubella and hepatitis B of 91.6% (CI 95%: 90.6%; 92.7%), 91.3% (CI 95%: 90.3%; 92.4%) and 95.9% (CI 95%: 95.0%; 96.8%) respectively. There was no evidence of significant differences in the prevalence among the ambits of study or among the socioeconomic strata of the conglomerates for any of the three types of antibodies. Conclusions. In children from 1 to 4 years of age, the national prevalence of antibodies against measles and Rubella was between 90-93%, while the prevalence of antibodies against Hepatitis B (anti-HBsAg) was between 95-97%.

Campanha nacional de vacinação contra rubéola: perfil epidemiológico das gestantes vacinadas inadvertidamente com a dupla viral no estado do Pará em 2008 / National campaign of vaccination against rubella: epidemiological profile of pregnant women inadvertently vaccinated with the viral double in the state of Pará in 2008

Introdução: em relação à população não vacinada no Brasil, definiu-se a necessidade de realizar, no ano de 2008, uma campanha nacional de vacinação contra rubéola para homens e mulheres de 20 a 39 anos, o Plano de Vacinação para Eliminação da Rubéola. A despeito da segurança imputada à vacina, manteve-se a recomendação de não vacinar mulheres grávidas. Aquelas que, por desconhecimento ou qualquer razão, recebessem a vacina anti-rubéola até a 12ª semana de gestação, ou que engravidassem até 30 dias após o recebimento da vacina, foram notificadas e acompanhadas durante a gestação. Objetivo: descrever as características epidemiológicas das gestantes vacinadas inadvertidamente (GVI) contra rubéola, que foram notificadas no estado do Pará, no período de agosto a dezembro de 2008, segundo faixa etária, idade gestacional, situação imunológica, regionais e municípios. Material e Métodos: estudo epidemiológico descritivo transversal, utilizando-se as informações do banco de dados secundários das GVI durante a Campanha de Eliminação da Rubéola no estado do Pará em 2008. As variáveis foram coletadas do banco de dados secundário construído com o Epi Info 6.0, a partir das fichas de notificação de GVI contra rubéola. A classificação imunológica das GVI foi obtida a partir dos resultados da pesquisa de anticorpos específicos para rubéola pelo método ELISA (IgG e IgM), realizado pelo LACEN-PA.

Congenital rubella syndrome after rubella vaccination in 1-4 weeks periconceptional period.

OBJECTIVE: To examine weather exposure to rubella vaccine during 1-4 wk periconceptional period can cause congenital rubella syndrome (CRS). METHODS: This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wk pre or post conception. Time of conception was determined by last menstrual period (LMP) and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody titers in cord blood samples. RESULTS: A total of 60 pregnant women with the median gestational age of 38 weeks were studied. The mean maternal age was 22 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects (fever, lymphadenopathy, arthritis, arthralgia). None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3100grs and 6.7% of them were premature. No signs of CRS were found in the neonates based on systemic physical exam at birth and one month later. Mean value of cord blood anti rubella IgG titere was 148/28+/-67/26 lu/ml. cord blood anti rubella IgM was negative in all of the neonates. CONCLUSION: In this study inadvertent rubella vaccination 1-4 wk before and after conception did not cause CRS in neonates and according to all reasearches pregnancy termination is not indicated in these cases.

Knowledge and practice of students of Ain Shams university in measles and rubella [MR] catch up campaign

The ministry of health in Egypt implemented Measles Rubella [MR] campaign in 2008 based on the recommendation of the WHO for supplementary immunization activities to eliminate measles by 2010. The targeted age was 10 to 20 years. Egypt had an epidemic of rubella in spring of 2007. This campaign is unique in Egypt as it is the first national vaccination campaign targeting university students. This study aimed at reporting the practice of vaccination among medical and non medical students in the MR vaccination campaign, to assess the knowledge about the vaccination, side effects and contraindications. Also to explore the compliance to vaccination and causes of refusal of vaccine uptake. The study was done in two stages, first stage during the vaccination sessions. Medical and non medical students were given a questionnaire to assess their knowledge about the campaign and the vaccine. The second stage was done after the end of the campaign to assess the compliance of medical students to vaccination. Vaccination posters inside the university were the main source of knowledge about the campaign as reported by 73.3% of students followed by friends 56% and TV ads 40.7%. Lack of knowledge about adverse effects, and contraindication was high [80.5% and 68.8% respectively]. The mean knowledge score percent of students was 26.5% and was higher among medical than non medical. Overall compliance with vaccination among medical students was [64.8%] which was significantly higher among females compared to males [81.5% versus 52.1% respectively]. Non compliant students had a significant higher mean age. Almost half of non compliant students reported refusal of vaccination due to insufficient information about the vaccine [43.3%]. A successful vaccination campaign was conducted at Am Shams University yet there were insufficient health education messages to support it

Measles and rubella antibody status in children after treatment for acute lymphoblastic leukemia

OBJETIVO: Avaliar a história vacinal e a situação da proteção vacinal contra sarampo e rubéola em crianças portadoras de leucemia linfóide aguda após o término do tratamento. MÉTODOS: O estado imunológico contra o sarampo e a rubéola foi avaliado pela técnica ELISA em 22 crianças com leucemia linfóide aguda após o término do tratamento. RESULTADOS: Dos 22 pacientes, 20 haviam recebido previamente duas doses da vacina do sarampo, e 18 deles, uma dose da vacina da rubéola. Soropositivos para sarampo e rubéola resultaram em 65 e 88,9 por cento, respectivamente, sem correlação com idade do paciente, agressividade do tratamento ou tempo decorrido entre final do tratamento e coleta da amostra. CONCLUSÃO: Detectamos falha na proteção vacinal contra sarampo e rubéola em 35 e 11,1 por cento dos casos, respectivamente. Recomendamos, ao final do tratamento para leucemia linfóide aguda, aplicar reforço da vacina contra sarampo, avaliar o estado imunológico contra rubéola e, se necessário, revacinar o paciente.

OBJECTIVE: To assess the vaccination history and the status of vaccine-induced protection from measles and rubella in children after treatment for acute lymphoblastic leukemia. METHODS: Measles and rubella immunological status was assessed by the ELISA technique for 22 children previously treated for acute lymphoblastic leukemia. RESULTS: From the total of 22 patients, 20 had been given two doses of measles vaccine and 18 had had one dose of rubella vaccine. The percentage of patients seropositive for measles and rubella were 65 and 88.9 percent, respectively, with no correlation with age of patient, aggression of treatment or the time passed between the end of treatment and sample collection. CONCLUSIONS: We detected that vaccination had failed against measles and rubella in 35 and 11.1 percent of cases, respectively. We recommend that a measles booster be given after the completion of treatment for acute lymphoblastic leukemia and that rubella immunity status should be assessed at this point, with revaccination performed when necessary.

Immune status of health care personnel & post vaccination analysis of immunity against rubella in an eye hospital.

BACKGROUND & OBJECTIVES: Congenital rubella syndrome (CRS) accounts for a significant amount of mortality and morbidity in India. Rubella vaccination is not included in our national immunization programme. Occupational exposure of the health care personnel to rubella infection is well known. This study aims to assess the serological status of health care workers against rubella virus in Aravind Eye Care System, Madurai and to follow the immune response in the seronegative individuals after vaccination. METHODS: A total of 500 female and 81 male workers were enrolled in the study. Blood sample was collected for the analysis of rubella specific IgM and IgG antibodies. The seronegative individuals were vaccinated with monovalent rubella vaccine, RA 27/3. The post-vaccination samples were analysed for the antibody levels and their avidity using enzyme immunoassay. RESULTS: Of the 581 volunteers, 493 were seropositive with good protective immunity and 22 had both IgM and IgG antibodies. Sixty six volunteers (59 females and 7 males) were found to be seronegative to rubella. The seroconversion was observed in all the sixty vaccinated individuals, as seen by the appearance of anti-rubella IgG antibodies by fourth week, reaching the peak protective levels (>20 IU/ml) by third month. There was also a progressive increase in the avidity after vaccination. INTERPRETATION & CONCLUSION: Nearly 11.4 per cent of the health care workers were found to be seronegative for rubella virus and after vaccination, these volunteers developed a good protective immunity, thereby reducing the risk of contracting the hospital based rubella infection. Therefore, rubella vaccination may be instituted in hospitals for the benefit of health care workers.

Seroepidemiological profile of pregnant women after inadvertent rubella vaccination in the state of Rio de Janeiro, Brazil, 2001-2002

OBJETIVOS: Analizar el estado serológico de mujeres embarazadas tras haber recibido inadvertidamente la vacuna antirrubeólica, en el estado de Rio de Janeiro, Brasil. MÉTODOS: Se realizó un estudio transversal de mujeres embarazadas de 15 a 29 años de edad que fueron vacunadas contra la rubéola y el sarampión entre noviembre de 2001 y marzo de 2002 y que no sabían que estaban embarazadas en ese momento o que concibieron en el transcurso de los siguientes 30 días. Se les aplicaron las pruebas detectoras de inmunoglobulina M (IgM) e inmunoglobulina G (IgG) contra el virus de la rubéola y se les clasificó de inmunes si se obtenían resultados negativos a IgM y positivos a IgG al aplicar las pruebas en un lapso no mayor de 30 días después de la vacunación; de susceptibles si se obtenía un resultado positivo a IgM después de la vacunación, o indefinido si se obtenían resultados negativos a IgM y positivos a IgG tras un intervalo mayor de 30 días entre la vacunación y la aplicación de las pruebas serológicas. RESULTADOS: De 2 292 mujeres, 288 (12,6%) se mostraron susceptibles; 316 (13,8%) se mostraron inmunes; 1 576 (68,8%) tuvieron resultados indefinidos; 8 (0,3%) tuvieron resultados ilegibles y 104 (4,5%) no tuvieron seguimiento. La seropositividad a IgM, según el intervalo transcurrido entre la vacunación y la aplicación de las pruebas serológicas, fue de 16,1% (< 30 días), 15,4% (31–60 días), y 14,2% (61–90 días). En lo respectivo a la edad de las personas a las que se dirigió la campaña, se encontró que el grupo de 20 a 24 años tenía la mayor proporción de personas susceptibles a la rubéola (14,8%) y representaba a 42,4% (122/288) de todas las mujeres susceptibles. En 75% de las embarazadas susceptibles, la edad gestacional fue de 5 semanas o menos en el momento de la vacunación. CONCLUSIONES: Se justificó la vacunación poblacional de todas las mujeres en edad fecunda sobre la base de datos epidemiológicos y serológicos. Durante el seguimiento de las embarazadas no se observó ningún caso de síndrome de rubéola congénita ocasionado por la vacuna antirrubeólica. No obstante, el porcentaje de infección congénita observado refuerza la recomendación de que se evite vacunar a mujeres embarazadas y de que estas procuren no concebir durante un mes como mínimo después de la vacunación antirrubeólica.

Desarrollo de anticuerpos y frecuencia de eventos temporalmente asociados a las vacunas contra el sarampión y rubéola en personal de salud universitario de Jalisco / Antibody development and frequency of events temporarily with measles and rubella vaccines among university health personnel in Jalisco

Objetivo: Evaluar el estado inmune y la seroconversión o respuesta anamnésica posterior a inmunización con vacuna de sarampión-rubéola (SR) y eventos temporalmente asociados, en personal de salud universitario. Materiales y métodos: Estudio prospectivo, longitudinal y comparativo de mayo a junio de 2000 en 120 adultos sanos de un Hospital de la Universidad Autónoma de Guadalajara. Previo consentimiento informado se aplicó la vacuna SR de sarampión (Schwarz) y rubéola (RA 27/3). Se realizó seguimiento telefónico semanal para identificar eventos locales y sistémicos temporalmente asociados a la vacunación (30 días posteriores a su aplicación, no atribuibles a otro proceso mórbido). Se tomó suero antes y seis semanas después de la vacunación. Los anticuerpos (IgG) contra sarampión y rubéola fueron cuantificados por análisis inmunoenzimático (Enzygnost®, Dade Behring) con puntos de corte de > 300mUI/mL y > 8UI/mL, respectivamente. Análisis: media, desviación estándar (DS), Prueba t de Student pareada (significancia de P < 0.05). Resultados: Se logró seguimiento en 105/120 (87.5%) durante seis semanas. El 87.4% fue personal de salud y 44.6% varones. Rango de edad 17-71 años (mediana = 21). En la historia clínica hubo antecedente de posible sarampión en 57.1%. Se obtuvo suero pareado en 75 casos. La proporción de voluntarios con anticuerpos para sarampión y rubéola antes (90.7 y 94.7%) y después (100 y 100%) de la vacuna se incrementó de manera significativa (P < 0.001). Dolor, calor, rubor e induración en el sitio de inyección se presentó en 4/105 (~4%). Fiebre, exantema, artralgias y artritis en 9/105 (~9%). Conclusiones: La proporción de susceptibles a sarampión fue alta si tomamos en consideración la potencialidad de transmisión del virus de sarampión a la población que atenderían durante el período de contagiosidad (3-5 días). La respuesta de inmunidad postvacunal fue óptima. La vacunación en personal de salud debe ser prioritaria.

Objective: To evaluate the seroprevalence, seroconversion, anamnesic response and events temporally associated with immune status pre and post immunization with measles and rubella vaccine in health personnel from a public University in Guadalajara, Mexico. Material and methods: We carried out a prospective, longitudinal and comparative study from May to June 2000 among 120 healthy volunteers. Informed consent was obtained from all participants. We administered measles (Schwarz) and rubella (RA 27/3) vaccines. Weekly phone calls during six weeks were recorded from each volunteer to assess local and systemic events temporally associated with immunization non attributable to any other disease. Serum samples were obtained before and after vaccination in 75 volunteers. Antibodies against measles and rubella were measured by an enzyme immunoassay kit (Behring) with cut-off points of ³300mUI/mL and ³8UI/mL respectively. Statistical analysis included mean, standard deviation and paired Student's t-test (P < 0.05). Results: 105/120 participants (87.5%) were followed during 6 weeks. 87.4% were health personnel and 44.6% were males. The age range was 17-71 years (median = 21). We found a prior history of measles in 57.1%. Local events included pain, heat, redness and induration and were reported by 4/105. Systemic events such as fever, exanthema, pain in joints and arthritis was reported by 9/105. The proportion of study subjects with protective antibodies against measles and rubella prior to vaccination was 90.7 and 94.7% respectively. Both groups reached 100% after vaccination. Conclusions: The proportion of non-immune health personnel was low and similar to other reports. However, the potential spread of measles and rubella virus from a non-immunized infected health care provider could be amplified by the number of patients seen daily during the peak period of 3-5 days. The vaccination of health personnel should be encouraged.

Tendencias de la inmunidad a la rubéola en mujeres de edad fértil y pre-escolares en Costa Rica, 1969-1996 / Tendencies of the immunity to the rubella in women of fertile age and pre-scholastic in Costa Rica, 1969-1996

Objetivo: Determinar las tendencias de la inmunidad a la rubéola en pre-escolares y mujeres de edad fértil desde 1969 hasta 1996 en Costa Rica. Métodos: Se determinó el nivel de anticuerpos a rubéola en una sub-muestra de sueros en custodia recolectados durante la Encuesta Nacional de Nutrición de 1996. La muestra (EE=5 por ciento, confianza 95 por ciento) incluyó pre-escolares de 1 a <7 años (n=259) y mujeres de 15-45 años n=381). Los sueros se procesaron mediante la técnica de ELISA, considerando susceptibles los títulos IgG <10 UI/ml. Mediante el empleo de datos reportados por encuestas de seroprevalencia realizadas en 1969, 1973, 1980, 1985 y los resultados del 1996 se analizaron los cambios en el nivel de susceptibilidad a la rubéola en mujeres de 15 a 39 años y pre-escolares. Resultados: En 1996, un 36.5 por ciento de mujeres 15 a 45 años) y 7.3 por ciento de pre-escolares eran susceptibles a la rubéola. Las diferencias de susceptibilidad entre zona urbana y rural no fueron estadísticamente significativas en pre-escolares (8.0 por ciento, IC95 por ciento=4.3-12,4 vrs 6.2 por ciento, IC95 por ciento=2.1-11.3), ni en las mujeres de edad fértil (31.6 por ciento, IC95 por ciento=25.6-37.6 vrs 44.2 por ciento, IC95 por ciento=36.1-52.4). Entre 1969 y 1996 el porcentaje de susceptibles a rubéola en pre-escolares se redujo de 86.3 por ciento (IC95 por ciento=84.5-88.1) a 7.3 por ciento (IC95 por ciento=4.2-10.8), pero un mujeres de 15-39 años se elevó de 23.8 por ciento (IC95 por ciento=20.7-26.9) a 36.5 por ciento (IC95 por ciento=31.5-41.5). Conclusiones: Los patrones de inmunidad a la rubéola en Costa Rica cambiaron significativamente desde la introducción de la vacuna SRP en el esquema de vacunación infantil en 1986, desplazando la susceptibilidad a las mujeres de edad fértil. Palabras clave: Rubéola, seroprevalencia, inmunización, pre-escolares, edad fértil, Síndrome de rubéola congénita).

Identification of seronegative pregnant women eligible for immunization against rubella

To estimate the frequency of Rubella seropositivity among pregnant women and thereby getting an estimate of seronegative women who should eventually be immunized against Rubella. A blood sample of 100 consecutive pregnant women coming for their first antenatal check-up at Shifa International Hospital, Islamabad, was collected in the year 2002. Enzyme-Linked immunosorbent assay [ELISA] technique was used to detect IgG antibodies against Rubella. Out of 100 pregnant women 61[61%] were positive for rubella [IgG antibodies] in the first trimester of pregnancy. Mean age of the study participants was 27 ' 3.27 years. Twenty-five [25%] women were primigravida, while 75 [75%] were multigravida. Majority of the women were housewives belonging to middle and lower middle socioeconomic class. We found 61% women had positive Rubella antibodies during first antenatal visit. Nearly 40% who were negative should be immunized against rubella, preferably before conception

Estado inmunitario de 4 grupos de edad de población chilena contra sarampión y rubeola / Immune status against measles and rubella among chilean subjects of different ages

Background: Results of clinical and epidemiological studies confirm that no cases of measles have occurred in Chile since 1993. However, since covering of vaccination programs do not exceed 95 percent, an immunological surveillance for this disease is warranted. Aim: To know the immune status against measles and rubella in the Chilean population. Material and methods: A serological census of a representative sample of communities with high (90 percent or more) or low immunization coverings was performed. Four sub samples along the country were selected: 122 children aged 18 months of age (stratum A), 1,276 children attending the first year of basic school (stratum B), 899 teenagers in their last high school year (stratum C) and 399 women attending a family planning clinic (stratum D). IgG antibodies against measles and rubella were measured using ELISA and hemagglutination inhibition techniques, respectively. Results: Antibodies against measles and rubella were found in 96 percent and 94 percent of study subjects. No differences in these titres were found between different strata or communities with high or low vaccination covering. There is a high percentage of positive antibodies against measles among children of 18 months of age and a high percentage of antibodies against rubella among teenagers and women in family planning. Only 3 percent of the sample had not received any vaccine at the moment of the study. Conclusions: The high prevalence of antibodies against rubella allows to conclude that it is not necessary to consider this antigen in the next vaccination campaign. Due to the high prevalence of antibodies against measles, only the population older than 20 years old should be affected by the disease if this virus enters the country

Soroconversäo da vacina tríplice viral em crianças de 9 e 15 meses de idade / Soroconversion of the MMR vaccine in childrens at 9 and 15 month

A resposta sorológica à vacina tríplice viral foi avaliada em 109 crianças de nove meses de idade, sem história prévia de vacinaçäo contra sarampo, e em 98 crianças de 15 meses de idade, que comprovadamente receberam a vacina monovalente contra o sarampo aos nove meses. A vacina trivalente utilizada continha as seguintes cepas de vírus do sarampo, cepa Urabe Am9 de vírus da caxumba e cepa Wistar RA 27/3 de vírus da rubéola. Um número significantemente maior de crianças do grupo de 15 meses de idade apresentava anticorpos pré-vacinais contra sarampo e caxumba. As taxas de soroconversäo para o sarampo, caxumba e rubéola foram elevadas em ambos os grupos, nä havendo diferenças estatisticamente significantes entre os mesmos. Os títulos de anticorpos pós-vacinais contra a rubéola foram significantemente mais elevados no grupo de crianças de 15 meses de idade. Nenhum evento adverso sério imputável à vacinaçäo foi ibservado.

Catarata congênita bilateral: estudo comparativo dos achados clínicos observados em dois grupos pertencentes a níveis sócio-econômicos distintos em Pernambuco / Bilateral congenital cataract: a comparative study of the clinical findings in two groups of diferent socio-economic classes in Pernambuco (Brazil)

Os autores revisaram os prontuários médicos de 2 grupos de pacientes pertencentes a níveis sócio-econômicos distintos no período de agosto de 1992 a março de 1994 totalizando 42 casos portadores de catarata congênita. Foram selecionados para este estudo 22 pacientes afetados bilateralmente, tendo sido realizado uma análise comparativa dos resultados visuais obtidos pós-facectomia, instituiçäo da terapêutica da ambliopia e estimulaçäo visual precoce

Immune response to measles, mumps & rubella vaccine at 9, 12 & 15 months of age.

Seroconversion rates to measles, mumps and rubella (MMR) in children given MMR vaccine at 9, 12 and 15 months of age were assessed so as to recommend the optimum age for vaccination. A total of 164 infants were recruited, of whom 123 completed the study. Sera were tested pre-immunization and 4 wk after MMR vaccine, for the presence and titres of antibodies by the haemagglutination inhibition (HI) test and by enzyme-linked immunosorbant assay (ELISA). The pre-immunization results showed that levels of maternal antibody detectable by HI had disappeared by 9 months in all infants in the case of measles, but not in the case of mumps or rubella. Evidence for subclinical infection with the three viruses was found in 19 to 31 per cent of infants by 15 months of age. The responses to measles antigen by both HI test and ELISA were better (> 95%) at 12 or 15 months than at 9 months (80%). Vaccine failure was low at 12 or 15 months. The response to mumps antigen by HI antigen was also higher (92%) at 12 months than at 9 months (75%). Vaccine failure was less frequent at 12 months than at 9 months. The ELISA was found to be unreliable for mumps virus antibody testing. Rubella vaccine evoked good seroresponse (> 92%) at 9, 12 and 15 months, both by HI test and ELISA. Thus a better response to the MMR vaccine was obtained at or after 12 months of age than earlier. Hence, a dose of MMR may be given optimally at 12 months for children not previously immunized with measles vaccine. For those already given measles vaccine, the MMR may be given at 12 or 15 months.

Prevalence of anti-rubella antibodies in Hazara division

Two hundred and twenty five school going girls belonging to three districts of Hazara Division, Pakistan were sampled for rubella antibodies. Age range selected was 5 to 15 years. IgG was positive in 78.22% of cases and IgM in 24.44% of cases. The antibodies pattern and prevalence was the same in all the three districts. A clear increase of IgG was.seen up to the age of 11 years but between 12 and 15 years of age the increase of IgG was not very significant. This study reveals high prevalence of IgG [78.22%] up to the age of 15 years but still a very high figure of about 21.74% of girls remained susceptible to rubella at a critical period of child-bearing age [i.e. 15 years]. This is in contrast to the susceptible subjects of 1.1-4.2%in developed countries