Preliminary multiplex microarray IgG immunoassay for the diagnosis of toxoplasmosis and rubella

BACKGROUND During pregnancy, toxoplasmosis and rubella can cause serious damage to the mother and the foetus through vertical transmission. Early diagnosis enables implementation of health measures aimed at preventing vertical transmission and minimising damage caused by these diseases. OBJECTIVE Here, we report the development of a multiplex assay for simultaneous detection of IgG antibodies produced during toxoplasmosis and rubella infection. METHODS This assay is based on xMap technology. Initially, by singleplex assays, we evaluated the following antigens: one Toxoplasma gondii lysate; two antigenic extracts of T. gondii (TOX8131 and TOX8122); fragments of T. gondii antigens [SAG-1 (amino acids 45-198), GRA-7 (24-100), GRA-1 (57-149), ROP-4, and MIC-3 (234-306)]; two chimeric antigens composed of fragments of SAG-1, GRA-7, and P35 (CTOX and CTOXH); and fragments of Rubella virus antigens [E-1 (157-176, 213-239, 374-390), E-2 (31-105), and C (1-123)]. FINDINGS A multiplex assay to simultaneously diagnose toxoplasmosis and rubella was designed with the best-performing antigens in singleplex and multiplex assays, which included CTOXH, T. gondii lysate, TOX8131, E-1, and E-2. The multiplex assay showed 100% sensitivity and specificity for anti-T. gondii IgG detection and 95.6% sensitivity and 100% specificity for anti-R. virus IgG detection. MAIN CONCLUSIONS We found that, despite the difficulties related to developing multiplex systems, different types of antigens (extracts and recombinant proteins) can be used to develop high-performance diagnostic tests. The assay developed is suitable to screen for prior T. gondii and R. virus infections, because it is a rapid, high-throughput, low-cost alternative to the current standard diagnostic tools, which require multiple individual tests.

Evaluation of a Novel Array-Based Toxoplasma, Rubella, Cytomegalovirus, and Herpes Simplex Virus IgG Enzyme Linked Immunosorbent Assay and Its Comparison with Virion/Serion Enzyme Linked Immunosorbent Assays

BACKGROUND: The dramatic increase in use of the IgG test for toxoplasma, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV) [TORCH] has led to the requirement for a high-efficiency method that can be used in the clinical laboratory. This study aimed to compare the results of BGI-Array ELISA TORCH IgG (BGI-GBI, China) screening method to those of Virion/Serion TORCH IgG ELISA (Virion/Serion, Germany). METHODS: Serum specimens (n=400) submitted for routine IgG testing by Virion/Serion ELISA were also tested using the BGI-Array ELISA method. The agreements of these two kinds of method were analyzed by kappa-coefficients calculation. RESULTS: Following repeat testing, the BGI-Array ELISA TORCH IgG assays demonstrated agreements of 99.5% (398/400 specimens), 98% (392/400 specimens), 99% (396/400 specimens), and 99.5% (398/400 specimens), respectively. The BGI-Array ELISA IgG assays provided results comparable to Virion/Serion ELISA results, with kappa-coefficients showing near-perfect agreement for the HSV (kappa=0.87), rubella (kappa=0.92) and CMV (kappa=0.93) and substantial agreement for the toxoplasma (kappa=0.80) IgG assays. The use of the BGI-Array ELISA TORCH IgG assays could reduce the turnaround time (1.5 hr vs. 5 hr by Virion/Serion ELISA for 100 specimens) and were easy to use. CONCLUSIONS: BGI-Array ELISA TORCH IgG shows a good agreement with Virion/Serion ELISA methods and is suitable for clinical application.

Seroprevalencia de rubeola en Colombia: un analisis por cohorte de nacimiento / Soroprevalencia de rubeola em Colombia: analise por coorte de nascimento / Seroprevalence of rubella in Colombia: a birth-year cohort analysis

OBJETIVO : Estimar la seroprevalencia de rubéola y factores asociados. METODOS : Estudio de seroprevalencia poblacional con una muestra aleatoria de 2.124 individuos de seis a 64 años, representativa por edad, sexo y área en Medellín, Colombia, 2009. Se analizó la asociación de variables biológicas y socioeconómicas con la seroprotección para rubéola, según la cohorte del año de nacimiento antes (1954 a 1990) y después (1991 a 2003) del inicio de la vacunación universal. Se determinaron los títulos de IgG con pruebas de alta sensibilidad (AxSYM ® Rubella IgG – Laboratorio Abbott) y especificidad (VIDAS RUB IgG II ® – Laboratorio BioMerieux). Se estimaron proporciones y promedios ponderados derivados de un muestreo complejo incluyendo un factor de corrección por las diferencias en la participación por sexo. Se analizó la asociación de la protección por grupos de variables biológicas y sociales con un modelo de regresión logística, según la cohorte de nacimiento. RESULTADOS : Los títulos promedio de IgG fueron más altos en los nacidos antes del inicio de la vacunación (media 110 UI/ml; IC95% 100,5;120,2) que en los nacidos después (media 64 UI/ml; IC95% 54,4;72,8), p = 0,000. La proporción de protección fue creciente de 88,9% en los nacidos en 1990-1994, de 89,2% en 1995-1999 y de 92,1% en 2000 a 2003, posiblemente relacionado con la administración del refuerzo desde 1998. En los nacidos antes del inicio de la vacunación, la seroprotección estuvo asociada con el antecedente de contacto con casos (RD 2,6; IC95% 1,1;5,9), el estado de salud (RD 2,5; IC95% 1,05;6,0), el nivel de escolaridad (RD 0,2; IC95% 0,08;0,8) y los años de residencia del hogar en el barrio (RD 0,96; IC95% 0,98;1,0), luego de ajustar por todas las variables. En los nacidos después ...

OBJETIVO : Estimar a soroprevalência de rubéola e fatores associados. MÉTODOS : Estudo de soroprevalência em população a través de uma amostra aleatória de 2.124 indivíduos de seis a 64 anos, representativa por idade, sexo e área em Medellín, Colômbia, 2009. Foi analisada a associação de variáveis biológicas e socioeconômicas com a soroproteção para rubéola, de acordo com a coorte de nascimento antes (1954 a 1990) e depois (1991 a 2003) do inicio da vacinação universal. Foram determinados os títulos de IgG com testes de alta sensibilidade (AxSYM® Rubella IgG – Laboratório Abbott) e especificidade (VIDAS RUB IgG II® – Laboratório BioMerieux). Foram estimadas proporções e médias ponderadas derivadas de amostragem complexa incluindo um fator de correição pelas diferenças na participação por sexo. Foi analisada a associação da proteção por grupos de variáveis biológicas e sociais com um modelo de regressão logística, segundo a coorte de nascimento. RESULTADOS : As médias dos títulos de IgG foram maiores nos nascidos antes do inicio da vacinação (média 110UI/ml; IC95% 100,5;120,2) do que nos nascidos posteriormente (média 64 UI/ml; IC 95% 54,4;72,8), p = 0,000. A proporção de proteção foi crescente de 88,9% nos nascidos em 1990-1994, de 89,2% em 1995-1999 e de 92,1% em 2000 a 2003, provavelmente relacionado à administração do reforço desde 1998. A soroproteção esteve associada nos nascidos antes com o fato de ter contato com casos (RD 2,6; IC95% 1,1;5,9), o estado de saúde (RD 2,5; IC95% 1,05;6,0), o nível de escolaridade (RD 0,2; IC95% 0,08;0,8) e os anos morando no bairro (RD 0,96; IC95% 0,98;1,0), após ajuste por todas ...

OBJECTIVE : To estimate the seroprevalence of rubella and associated factors. METHODS : Population-based seroprevalence study in a random sample of 2,124 individuals, aged six to 64 years, representative by age, sex and area in Medellín, Colombia, 2009. Biological and socioeconomic variables were analyzed for their association with serum protection against rubella, according to birth-year cohort; those born before (1954-1990) and after (1991-2003) the introduction of universal immunization. Titer of IgG antibodies against the rubella virus was detected using a high sensitivity (AxSYM®Rubella IgG – Abbott Laboratories) and a high specificity test (VIDAS RUB IgG II®– BioMerieux Laboratories). Proportions and weighted averages derived from a complex sample, including a correction factor for differences in gender participation, were estimated. Association with protection for groups of biological and social variables according to birth cohort was analyzed using a logistic regression model. RESULTS : Titers of IgG antibodies were higher in those born before (mean 110 UI/ml, 95%CI 100.5;120.2) compared to those born after (mean 64 UI/ml; 95%CI 54.4;72.8; p = 0.000) the introduction of mass immunization. The proportion of protection increased from 88.9% in those born 1990-1994, to 89.2% in those born 1995-1999 and to 92.1% in those born between 2000 and 2003, possibly due to boosters being administered from 1998 onwards. In those born before the introduction of the immunization, seroprotection was associated with previous contact with cases (OR 2.6; 95%CI 1.1;5.9), self- perceived health status (OR 2.5; 95%CI 1.05;6.0), educational level (OR 0.2; 95%CI 0.08;0.8) and years of residence in the neighborhood (RD 0,96; 95%CI 0.98;1.0) after adjusting for all variables. In those born after, serum protection was associated with effective sleep time (OR 1,4; 95%CI 1.09;1.8) and self-perceived health status (OR 5.5; 95%CI ...

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%.

Prevalence of toxoplasmosis, cytomegalovirus and rubella IgG antibodies in hatay women and children / Prevalencia de los anticuerpos IgG contra la toxoplasmosis, el citomegalovirus y la rubéola en mujeres y niños de hatay

OBJECTIVE: Toxoplasmosis, cytomegalovirus and rubella may cause congenital infections. The aim of this study is to investigate toxoplasmosis, cytomegalovirus and rubella IgG antibodies in women and children who were admitted to the Hatay Women and Children Hospital between January 1 and December 31, 2009. METHODS: Levels of IgG antibodies for toxoplasmosis, cytomegalovirus and rubella established with chemiluminescence immunoassay (Architect i2000, Abbott, USA) method were evaluated, retrospectively. RESULTS: The results were obtained from 1103 cases. Seropositivity of IgG antibodies for toxoplasmosis (n = 743), cytomegalovirus (n = 929) and rubella (n = 746) were 59.9%, 98.9% and 93.6%, respectively. CONCLUSION: Routine serological screening should be recommended in women of childbearing age. Seronegative subjects should be vaccinated for rubella and educated for protection from toxoplasmosis.

OBJETIVO: La toxoplasmosis, el citomegalovirus y la rubéola pueden causar infecciones congénitas. El objetivo de este estudio es investigar los anticuerpos IgG contra la toxoplasmosis, el citomegalovirus y la rubéola en las mujeres y ninos ingresados en el Hospital de Hatay para Mujeres y Niños, entre el 1ero de enero y el 31 de diciembre de 2009. MÉTODOS: Los niveles de anticuerpos IgG de la toxoplasmosis, el citomegalovirus, y la rubéola establecidos mediante el método de inmunoensayos por quimioluminiscencia (Architect i2000, Abbott, USA), fueron evaluados retrospectivamente. RESULTADOS: Los resultados se obtuvieron de 1103 casos. La seropositividad de anticuerpos de IgG para la toxoplasmosis (n = 743), el citomegalovirus (n = 929) y la rubéola (n = 746) fue de 59.9%, 98.9% y 93.6%, respectivamente. CONCLUSIÓN: Deben recomendarse tamizajes serológicos de rutina para las mujeres en ead de maternidad. Los sujetos seronegativos deben ser vacunados contra la rubéola y educados para protegerse contra la toxoplasmosis.

Seroprevalencia de IgG contra Rubeola en mujeres entre 10-49 años, en Cartagena, Colombia / The seroprevalence IgG antibodies against rubella (German measles) in 10-49 year-old women from Cartagena, Colombia

Objetivo Determinar la seroprevalencia de Inmunoglobulina G (IgG) contra Virus de la Rubéola (VR) en Cartagena y si las metas de cobertura en inmunización contra VR han sido alcanzadas. Métodos Se desarrolló un estudio transversal, durante 2009. Se incluyeron mujeres entre 10-49 años de edad. Los individuos fueron seleccionados aleatoriamente. Las variables socio-demográficas fueron registradas por entrevista directa. La IgG contra VR fue detectada mediante ELISA. Para analizar diferencias entre grupos se emplearon la prueba exacta de Fisher y X2. Se aplicó un modelo de regresión logística para correlacionar variables. Resultados Se analizaron 1 528 muestras. El 93 por ciento (n=1 422) de la población fue seropositiva. Las mujeres entre 10-14 años reportaron un menor nivel de seropositividad en relación con el resto de la población. Las diferencias entre proporciones de seroprevalencia fueron estadísticamente significativas en los rangos de edad (p<0,001) y la ocupación (p=0,042). Las mujeres entre 10-14 años reportaron riesgo elevado para seronegatividad (OR=0,27, p<0,001). Conclusiones Las metas de seroprevalencia contra VR no han sido alcanzadas en Cartagena y nuevos casos de Rubéola o Síndrome de Rubéola Congénita podrían presentarse en el Distrito. Estos hallazgos revelan que no hubo progreso significativo desde 2006, cuando el porcentaje de cobertura en vacunación contra VR oscilaba entre 90-95 por ciento. El alto riesgo en el grupo de 10-14 años sugiere falencias en la administración de las dosis iniciales en el esquema de vacunación.

Objective Determining immunoglobulin G (IgG) against the rubella virus (RV) causing German measles in Cartagena and whether vaccination goals against German measles have been achieved. Methods A cross-sectional study was carried out during 2009; females aged 10-49 years were included. Selection was randomised. Socio-demographic variables were recorded in face-to-face interviews. IgG against RV was detected by ELISA. X2 and Fisher's exact tests were used for comparing variables. A logistic regression model was used for correlating data. Results A total of 1,528 serum samples were analysed; 93 percent (n=1,422) were seropositive. The lowest seropositivity was reported in girls aged 10-14. Differences regarding seroprevalence percentages were statistically significant between age ranges (p<0.001) and employment (p=0.042). A high risk of seronegativity was reported for girls aged 10-14 (OR=0.27; p<0.001). Conclusions Seroprevalence goals against RV had not been reached in Cartagena and new cases of rubella (German measles) or congenital rubella (German measles)syndrome are still possible in the area. These findings revealed that no significant progress had been made since 2006 when German measles vaccine coverage was 90 percent-95 percent. High risk in girls aged 10-14 suggests that the local immunisation programme fails in MMR vaccine administration.

Soroprevalência da rubéola na população urbana e rural de Guaratinguetá / Seroprevalence of rubella in urban and rural populations, Guaratinguetá

OBJETIVO: Determinar a prevalência de anticorpos para a rubéola na população de 15 a 39 anos no município de Guaratinguetá, São Paulo, SP. MÉTODOS: Neste estudo, 996 amostras foram colhidas após consentimento informado e esclarecido entre homens e mulheres na faixa etária de 15 a 39 anos. Os anticorpos da classe IgG foram detectados por ELISA usando kit comercial Rubenostika IgGII (Organon Teknika AS, Holland). As faixas etárias foram estratificadas em três categorias: 15-19 anos; 20-29 anos e 30-39 anos. As análises estatísticas foram realizadas pelo software MINITAB versão 14.0 (Minitab Inc, EUA). RESULTADOS: A proporção de soros reagentes para anticorpos da classe IgG nas faixas etárias estudadas foram: 92,7 por cento positivos de 15-19 anos; 82,4 por cento de 20 a 29 anos e 90,7 por cento de 30-39 anos com diferença significativa na proporção de soropositivos pela faixa etária ( p < 0,001 ). A variação de intensidade da resposta anticórpica foi calculada e os resultados mostram que há diferença significativa (p = 0,002) entre as médias das três faixas etárias estudadas. Em relação à área rural e urbana, a média da relação DO/CO para cada faixa etária, observa-se que há uma tendência significativa de médias menores na zona rural. O mesmo ocorre quando são calculadas as proporções de soropositivos. CONCLUSÃO: Os resultados obtidos mostraram que o percentual e indivíduos com anticorpos da classe IgG contra a rubéola na faixa etária de 20-29 anos foi abaixo aquela observada em faixas etárias inferiores ou superiores. Além disso, a diferença da soropositividade entre a zona urbana e rural traduz uma suscetibilidade com potencial de manter a circulação do vírus nesta região.

OBJECTIVE: To investigate seroprevalence of rubella antibodies in a 15 to 39 year old population in the municipal district of Guaratinguetá. METHODS: The 996 samples studied were collected in urban and rural zones, after informed and elucidated consent from men and women stratified by age (15 -39 years). Rubella IgG antibodies were detected by ELISA using the commercial kit Rubenostika IgGII (Organon Teknika THE, Holland). Age groups were stratified in 3 categories: 15-19; 20-29 and 30-39 years of age. Statistical analyses were accomplished with the software MINITAB version 14.0 (Minitab Inc, USA). RESULTS: The proportion of seropositives for antibodies of the IgG class were: 92.7. percent positive for 15-19 years; 82.4 percent for 20 to 29 years and 90.7 percent for 30-39 years, with a significant difference in the seropositive proportions by age group (p <0.001). Variation of intensity of antibody response was calculated and results show a significant difference (p = 0.002) between means of the 3 age groups studied. In relation to rural and urban zone average of the ratio DO/CO for each age group, a significant tendency towards a lower average was observed in the rural zone. The same was true when the seropositive proportions were calculated. CONCLUSION: Results showed that the percentage and individuals with antibodies of the IgG class against rubella in the 20-29 year age group was lower than that in the younger and older age groups. Furthermore, the difference between seropositivity in the urban and rural zones discloses susceptibility with a potential for continued circulation of the virus in this zone.

Freqüência de sarampo, rubéola, dengue e eritema infeccioso entre casos suspeitos de sarampo e rubéola no estado de Pernambuco, no período de 2001 a 2004 / Frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and rubella in the State of Pernambuco between 2001 and 2004

O estudo teve como objetivo verificar a freqüência de sarampo, rubéola, dengue e eritema infeccioso entre casos suspeitos de sarampo e rubéola, no estado de Pernambuco, Brasil. Foram testadas 1.161 amostras de soro coletadas no período de 2001 a 2004, para as quatro viroses, utilizando-se ensaios imunoenzimáticos para detecção de anticorpos IgM. Desse total, 276 (23,8 por cento) amostras foram positivas para uma das quatro viroses analisadas. Foram detectados 196 (16,9 por cento) casos positivos para dengue, 38 (3,3 por cento) para eritema infeccioso (parvovírus B19), 32 (2,8 por cento) para rubéola e 10 (0,9 por cento) para sarampo. Entre os casos suspeitos de sarampo e rubéola, a infecção pelo vírus dengue foi a mais freqüente, seguida pelo parvovírus B19. A semelhança de manifestações clínicas entre as doenças exantemáticas contribui para dificultar o diagnóstico de sarampo, rubéola, dengue e eritema infeccioso, quando observados apenas os critérios clínicos. Deve-se salientar que os quatro testes utilizados foram insuficientes para diagnosticar 76,2 por cento das doenças febris exantemáticas notificadas. Este é o primeiro estudo que evidencia a circulação de parvovírus B19 humano em Pernambuco.

This study had the aim of investigating the frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and/or rubella in the state of Pernambuco, Brazil. A total of 1,161 serum samples collected between 2001 and 2004 were tested for these four viral diseases, using enzyme immunoassays to detect IgM antibodies. Out of this total, 276 (23.8 percent) samples were positive for one of the four viral diseases analyzed. There were 196 positive cases (16.9 percent) for dengue, 38 (3.3 percent) for erythema infectiosum (parvovirus B19), 32 (2.8 percent) for rubella and 10 (0.9 percent) for measles. Among the suspected cases of measles and rubella, dengue infection was the most frequent, followed by parvovirus B19. The similarity of the clinical manifestations among rash diseases contributes towards making it difficult to diagnose measles, rubella, dengue and erythema infectiosum on clinical grounds alone. It must be emphasized that the four tests used were insufficient for diagnosing 76.2 percent of the febrile and rash diseases notified. This is the first study bringing evidence of human parvovirus B19 circulation in Pernambuco.

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.

A rubella serosurvey in postpartum women in the three regions of Peru

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...

Cytomegalovirus and rubella infection in children and pregnant mothers--a hospital based study.

Cytomegaloviruses (CMV) are ubiquitous and species-specific. Humans are believed to be the only reservoir of this virus and transmission occurs by direct or indirect person-to-person contact. Vertical transmission can lead to serious congenital infections. Rubella virus causes serious disease after vertical transmission but mostly remain subclinical or cause a trivial infection that may remain unrecognized. The objective of our study was to find the prevalence of CMV and rubella infection in the vulnerable section of our population attending GTB hospital. GroupI included pregnant women with bad obstetric history (BOH) (n=1115); GroupII normal pregnant women (n=500); Group III pediatric age group (n==585) and Group IV others with varied illness (n=100). Serologically IgM antibodies against CMV and rubella were detected using commercially available Elisa kit. The percentage prevalence in groupI was (11%) and (3.6%); groupII was (4%) and (0); groupIII was (12%) and (3%); group IV was (5%) and (1%) against CMV and rubella respectively. No apparent seasonal variation was observed in the pattern of infection. Also, overall infection rates were at a much lower rate as compared to other studies. Therefore the detection of IgM antibodies in early pregnancy is an important tool to identify active infection and to provide obstetric management to avoid the risk of congenital transmission of infection. This in turn may lead to a rethinking of current immunization strategies and appropriate modifications for the prevention of vertical infection.

Prevalência de anticorpos IgG para rubéola em gestantes do Hospital São Lucas da PUCRS, Porto Alegre / Prevalence of rubella IgG antibodies in pregnant womem of São Lucas Hospital of PUCRS, Porto Alegre, Brasil

Objetivos: determinar a prevalência de imunoglobulina IgG para o vírus da rubéolaem gestantes acompanhadas no Hospital São Lucas da PUCRS, Porto Alegre, Brasil. Métodos: foi realizado um estudo transversal no período de abril a junho de 2004. Foram selecionadas 577 pacientes do ambulatório de pré-natal de baixo risco e do centro obstétrico. Os anticorpos IgG para rubéola foram pesquisados, no sangue das gestantes, por uma técnica de imunoensaio disponível comercialmente. Resultados: a prevalência dos anticorpos para rubéola nas 577 pacientes estudadas foi de 95% (IC95%:93%-97%). Conclusões: este estudo permite conhecer a prevalência da imunidade contra o vírus da rubéola em gestantes, ajudando a lidar com um problema brasileiro de saúde pública subestimado, que é a síndrome da rubéola congênita. Novas pesquisas são necessárias em outras áreas do país, pois a prevalência de imunidade pode variar de acordo com a regiões estudadas e nortear medidas de saúde pública que previnam surtos de rubéola.

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.

Rubella prevalence and its transmission in children.

Rubella is a major cause of birth defects among the TORCH group of agents causing congenital anomalies. Almost all the symptomatic infected infants have long-term neurological sequelae & many asymptomatic infants also develop deafness or psychomotor retardation later in life. In India need for rubella prevention & control is being recognized. Before formulating any kind of rubella vaccination policies, data on the burden of disease is important. Hence the prevalence of rubella in children and their transmission was evaluated. Paired sera of 146 babies with suspected intra uterine infection and their mothers from lower socioeconomic strata was tested for IgM antibodies by commercially available Enzyme immunoassay (EIA) kits. Congenital Rubella Syndrome (CRS) was confirmed in babies presenting with rubella compatible defects with positive IgM antibodies against rubella. It was seen that out of 146-paired samples evaluated, 15-paired samples (10.27%) were positive for IgM antibodies. The transmission rate of rubella virus from mother to child when the mother was infected was around 55.55% according to this study. CRS prevalence of 10.27% among symptomatic infants is significant as a large majority of rubella infection remains undetected and hence the actual burden of the disease may be higher. Since the disease is preventable by an effective vaccination, strategies for rubella immunization should be developed and enhanced.

Rubella antibodies in normal pregnant women at Srinagarind Hospital, Khon Kaen, Thailand.

BACKGROUND: Rubella infection in pregnant women, especially in the first trimester, can result in serious neonatal morbidity and mortality. To stem a series of rubella outbreaks in Thailand (in 1967, 1974 and 1978), the Ministry of Public Health launched the National Expanded Program on Immunization (EPI) in 1986. The Mump-Measles and Rubella (MMR) vaccine was given to all graduated primary school girls. OBJECTIVE: To determine the immune status to rubella in healthy pregnant women visiting the Antenatal Care Clinic (ANC) at Srinagarind University Hospital. DESIGN: Descriptive study. SETTING: Antenatal Care Clinic at Srinagarind Hospital. MATERIAL AND METHOD: Between January15 and May 17, 2004, 150 normal pregnant women (between 15 and 40 years of age) were included. After a complete history was taken and a physical examination performed, informed consent was signed; serum was collected for testing for rubella antibodies at the same time as routine prenatal check up in normal pregnant women including CBC, red blood cell indices, Rh blood group, VDRL, HBs Ag, andAntiHIV The ELISA technique was used to detect maternal rubella IgG antibodies. OUTCOME MEASURE: Rubella IgG antibody level. RESULTS: Three-quarters (112/150) of the pregnant women had immunity to rubella, 7% (11 cases) were indeterminate and 18% (27 cases) had no immunity. CONCLUSION: The cost of screening for rubella IgG antibodies was 150 baht using the HAI technique and 350 baht/case using the ELISA technique. The latter is more available but twice as expensive, so repeating rubella immunization for all high school females would be more cost effective and provide more certain protection.

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).