Progress in rubella control initiated through measles elimination strategies:the Malaysian experience

Objective:To analyse the laboratory surveillance data from 2004 till 2008 to examine the changing trend of rubella cases in Malaysia.Methods:Samples for this study were either received through the measles case based surveillance program or were hospital cases received for sero-diagnosis of congenital rubella syndrome(CRS). Specific rubella IgM antibody test was carried out on all samples that were negative for measles IgM antibody and for sero-diagnosis of CRS.Results:Through the surveillance program for measles,the samples received for rubella had increased five fold from 365 in 2004 to 1 522 in 2007.Positive rubella cases detected had also increased from 4.1%in 2004 to 33.2%in 2007.The age group 11 to 20 years accounted for 73.6%of rubella cases confirmed in 2008,with a higher incidence among males than females.Positive rubella IgM was detected in 25 CRS cases during the 6 year period between January 2003 and December 2008.Conclusion:The measles elimination program had contributed to significant progress in the control of rubella,with the majority of rubella cases detected through this strategy.Since rubella is not notifiable in Malaysia,this integrated measles and rubella surveillance should be continued.However,to enhance the progress,specific targets should also be established in the national program to eliminate rubella and CRS.

Seroprevalence of toxoplasmosis and rubella in pregnant women attending antenatal private clinic at Ouagadougou,Burkina Faso

Objective:To evaluate the prevalence of toxoplasmosis and rubella among pregnant women at Ouagadougou in Burkina Faso.Methods:All patient sera were tested for rubella and toxoplasmosis anti-IgG using commercial ELISA kits(PlateliaTMRubella IgG and Platelia? Toxo IgG).The presence of anti-rubella and anti-toxoplasmosis tgM in serum samples was tested using commercial ELISA kits Platelia Rubella TgM and Platelia Toxo IgM.Results:Among all the pregnant women tested for toxoplasmosis and rubella,their prevalence were 20.3% and 77.0%,respectively.Pregnant women in the age group of 18-25 years showed the highest frequency of anti-toxoplasmosis（34.5%） and anti-rubella IgG（84.6%）.The prevalence of anti-toxoplasma and anti-rubella IgG decreased between 2006 and 2008 from 32.7%to 12.1%and 84.6% to 65.0%,respectively.There was no significant association between age and the mean titer of anti-toxoplasmosis IgG among pregnant women.Conclusions:The diagnosis of toxoplasmosis and rubella is necessary in pregnant women in Burkina Faso because of the low immunization coverage rate of rubella and the high level of exposure to these two infections which can be harmful to the newborn if contracted by women before the third trimester of pregnancy.

Clinical Trial of Measles and Rubella Combined Vaccine Produced by POLYVAC in Vietnam

A clinical trial of measles and rubella combined vaccine (MR: MRVAC) produced by POLYVAC was conducted in Vietnam in 2016. A total of 756 subjects were enrolled, and 504 were allocated to MRVAC and 252 to control MR vaccine groups. Paired sera were obtained in 733, and the number of subjects was 403 aged 1 - 2 years, 164 aged 2 - 18 years, and 166 aged 18 - 45 years. Antibodies against measles and rubella viruses were evaluated by EIA. Most subjects had been immunized with a single dose of Expanded Programme on Immunization (EPI) measles vaccine at 9 months of age. Only 41 of 403 subjects aged 1 - 2 years were negative for measles antibody before vaccination, and all became seroconverted. A serological response of more than a 2-fold increase against measles was noted in 214 (47%, 95% CI;42.4% - 51.6%) of 458 initially seropositive individuals immunized with MRVAC and 65 (28%, 95% CI;22.3% - 33.8%) of 234 in the control group, and geometric mean titer (GMT) after vaccination was 25.49-5.60 in MRVAC and 25.03-5.24 in control group. Seroconversion against rubella virus after immunization with MRVAC was noted in 267 (98.5%, 95% CI;97.1% - 100%) of 271 initially seronegative subjects, similar to that after immunization with control group. GMT after immunization with MRVAC was 24.88-5.11 significantly lower than that after immunization with control vaccine (25.59-5.80). Most subject ≥ 2 years of age had rubella antibody because of MR vaccination campaign and no significant serological response was observed in initially seronegatives. MRVAC was highly immunogenic and safe vaccine and the domestic production of MR vaccine would contribute to realizing the goal of eliminating measles and rubella.

Serum Antibody Titers of Measles and Rubella among Japanese Children

Background: The rubella outbreak in Japan has not yet been eliminated. In particular, an outbreak of congenital rubella syndrome has recently become a public health problem in Japan. The World Health Organization has set an elimination target of 2015 for measles in Japan. However, an outbreak of measles occurred in Japan between 2007 and 2008. Starting in April 2006, the measles and rubella vaccines were administered twice, once when a child reached 1 year old and once when the child was 5 - 6 years old (just before starting elementary school). Between October of 1978 and 2006, children were vaccinated only once for measles and rubella. Design: During the study enrollment period (2011-2013), the serum antibody titers of measles and rubella were measured in pediatric patients (n = 163) in the Tokyo Takanawa Hospital. Results: The prevalence rates of the two diseases indicated that only one vaccination was insufficient to protect against infection. Conclusions: Our studies have determined that it was important to vaccinate children twice for measles and rubella during early infancy.

Perinatal Outcome of Inadvertent Immunization with the Measles-Rubella Vaccine in Pregnant Mexican Women during the Campaign for the Eradication of Congenital Rubella in 2008

Objective: To investigate maternal and neonatal complications resulting from inadvertent immunization against rubella-measles during the first trimester of pregnancy. Methods: A prospective and descriptive study was carried out, including a total of 1,924 pregnant women, 175 (9.1%) of which were classified as non responding to infection by the rubella virus. They underwent clinical and ultrasonographic follow-up to dismiss maternal or fetal complications and complications at the time of delivery. The infant was checked to determine demographic, anthropometric, serological and clinical features at the time of birth. Results: No women had complications during the pregnancy, including exanthematic symptoms. 174/175 newborns were studied;one pregnancy was interrupted based on non-medical arguments. The findings in terms of the analyzed patients suggest a benign evolution after inadvertently immunizing the pregnant women, which support studies with similar results. No complications during the course of the pregnancy or phenotypic alterations of the infant at the time of birth are suggested.

Relationship between Self-Reported Vaccination History and Measles and Rubella Antibody Titers in Medical and Nursing Students

In hospitals, infection control for measles and rubella is important. Medical and nursing students as well as healthcare workers must have immunity against these diseases. Many countries have adopted requirements for healthcare workers’ documented vaccination history or laboratory tests as evidence of their immunity. Evaluating a written vaccination history is difficult in many cases. Therefore, we compared measles and rubella antibody titers with self-reported vaccination history and we evaluated the association between the history and measles and rubella antibody titers, using the medical and nursing students’ data. We analyzed 564 data for measles and 558 data for rubella. Vaccination history was requested to be completed as accurately as possible. Students with one or more measles or rubella vaccinations had high positive ratios of titer, and the ratio was significantly higher than that of the students without vaccinations. The positive ratio between the two-dose and one-dose vaccination groups was not significantly different for measles or rubella (measles: p = 0.534, rubella: p = 0.452). Although it should be requested that the history is complete by using other resources, such as referring to maternity passbooks or proof of vaccination, self-reported history may be useful to confirm immunity, even if there is a possibility that the history is not accurate.

Rubella Immunity among Pregnant Women in Bangui, Central African Republic

Sero-positivity rates of the rubella virus among pregnant women vary from country to country widely throughout the world. In the Central African Republic, rubella vaccination is not included in the national immunization schedule. Thus, we propose to evaluate the immune status of pregnant women. This was an analytical retrospective study that consulted the records of pregnant women received in prenatal consultations at the Bangui Community Hospital maternity ward from January to December 2020. Socio-demographic and laboratory data (IgM, IgG) were collected from January to June 2021. Chi2 test was used. A total of 289 pregnant women were analyzed. Women with an IgM+ response accounted for 4.15%. Those with an IgG+ were 14.87%. The distribution by age group shows that patients aged 20 - 24 and those aged 25 - 29 had a rubella profile suggesting persistent infection (p = 0.010). The average age of women included was 28 (±6) years. The average parity for the entire sample was 2.18 (1.93). At any age pregnant women were not significantly exposed to rubella infection (p = 0.96), (ORbrut = 1.03;CI95% = [0.32 - 3.34]). Both immunized and non-immunized individuals are similarly exposed [OR = 0.86;95% IC95% = 0.44 - 1.68] with no difference (p = 0.96). Rubella infection remains particularly severe when it occurs during pregnancy. It would be wise to seek immunity in all girls of childbearing age in order to rule out any risk of rubella embryopathy.

Incidence of rubella IgM antibodies in individuals with febrile rash illness attending clinics in Akwa Ibom State, Nigeria, 2006-2009

Background: Rubella is an infectious disease of public health importance because infection ac-quired during early pregnancy often results in foetal abnormalities that are classified as con-genital rubella syndrome (CRS). The burden of rubella infection in most developing countries is however not well documented because of lim-ited epidemiological data. Methods: Between 2006 and 2009, 781individuals with febrile rash illness seen in clinics in Akwa Ibom State were screened for rubella specific IgM antibodies using the ELISA technique. Statistical analysis was done using Graph prime version 5.3 statis-tical package at 95% confidence interval. The level of significance was established at P = 0.05 using Fisher’s exact two-tailed values. Results: Of 781 individuals screened for rubella specific IgM antibodies, 94 (12%) were found to be posi-tive. Incidence of 8.7% recorded in 2006 gradu-ally rose to 9.3% in 2007, 11.6% in 2008 and 14.3% in 2009. Those in the reproductive age group (> 16 years) were most affected (51.7%). However, this was not statistically significant (P = 0.228). Females (17.4%) were more suscepti-ble than males (6.2%) (P < 0.0001) an rural dwellers (12.8%) more susceptible than urban dwellers (10.5%) (P = 0.416). Conclusion: The study shows that the incidence of rubella in Akwa Ibom State, Nigeria is high. The lowest incidence was however found among individu-als below the reproductive age. Thus, the find-ings of this study can be used by policy makers to model the introduction of routine rubella vaccination into the country’ Expanded Program on Immunization Schedule (EPI).

Relatives of rubella virus in diverse mammals

Since 1814,when rubella was first described,the origins of the disease and its causative agent,rubella virus(Matonaviridae:Rubivirus),have remained unclear1.Here we describe ruhugu virus and rustrela virus in Africa and Europe,respectively,which are,to our knowledge,the first known relatives of rubella virus.Ruhugu virus,which is the closest relative of rubella virus,was found in apparently healthy cyclops leaf-nosed bats(Hipposideros cyclops)in Uganda.Rustrela virus,which is an outgroup to the clade that comprises rubella and ruhugu viruses,was found in acutely encephalitic placental and marsupial animals at a zoo in Germany and in wild yellow-necked field mice(Apodemus flavicollis)at and near the zoo.Ruhugu and rustrela viruses share an identical genomic architecture with rubella virus2,3.

Cloning and Sequence Analysis of Envelope Glycoprotein E1 Gene of Rubella Virus, JR23 Strain

To construct an expression vector containing the E1 glycoprotein gene of rubella virus for the study on the effect of mutation of the E1 gene glycoprotein and the analysis of phylogenetic differences of sequences, the gene encoding the E1 envelope glycoprotein was amplified from rubella virus, Jinan strain JR23, by RT-PCR and ligated into PMD-18T vector. The clones that carried the E1 gene were identified after amp r selection and analysis of restriction enzyme digestion. After sequencing this gene was analyzed by Danstar and Winstar programs, and the map of phylogenetic tree was drawn. The clone of E1 glycoprotein was thus constructed. It was found that the sequence differences between JR23 strain and the TCRB strain from Japan and those between JR23 strain and Thomas strain of England were rather small with difference values of 0.9% and 1.2% respectively. Yet those between JR23 strain and BRD2 strain from Beijing and those between JR23 strain and XG379 strain from Hong Kong were comparatively larger with difference values of 7.6% and 7.3% respectively. The sequence of JR23 strain with other strains was less than 3% except the NC strain (3.7%). It concludes that the construction of E1 glycoprotein gene offers an approach to study the relationship between structures and functions of E1 gene and its gene products. In the phylogenetic tree, it shows that there are significant differences in the sequences of rubella virus isolated in China, and this might be helpful to develop an effective subunit vaccine.

Resurgence of measles virus infection in an eliminated country, Sri Lanka

Objective:To describe the situation of measles in Sri Lanka from May to November,2023 and to define the role of virology laboratory towards case confirmation and epidemiological and genetic characterization of the outbreak.Methods:This retrospective study analyzed all samples tested for measles from 1st of May to 30th of November,2023 at National Measles Rubella Laboratory,Sri Lanka.According to the World Health Organization(WHO)algorithm,serum and oropharyngeal/nasopharyngeal swabs were tested with WHO recommended kits for anti-measles IgM and measles virus specific RNA,respectively.Selected RNA positive samples were sequenced at reference laboratory,India.Analysis of sequencing data and construction of phylogenetic tree were carried out at National Measles Rubella Laboratory.Data was analyzed using descriptive statistics.Results:Of the total 1132 serum samples and 497 oropharyngeal/nasopharyngeal swabs from 1326 patients,657(49.5%)patients were confirmed as measles by anti-measles IgM,measles virus specific RNA or both.Males(55.6%,n=365)and the age group from>20 to≤30 years(33.0%,n=217)predominated positive patients.All provinces reported measles positive cases.All samples sequenced(100%,n=42)were genotype D8 with 95.2%(n=40)bearing Victoria.Australia origin.Conclusions:We described resurgence of measles in an eliminated country,confirming the genotype to be D8,one of the two genotypes currently circulating globally.Further,the study strongly convinced the importance of a strengthened virological surveillance system in an eliminated country,despite its eliminated status.

Unilateral pulmonary artery stenosis and late-onset cataract in an adult： a case of suspected congenital rubella syndrome

Congenital rubella syndrome is characterized by the triad of deafness, cataract and cardiovascular mafformations. The great majority of the cases in the literature have been usually diagnosed in infancy and childhood because of various defects at birth. However, we report a rare case of suspected congenital rubella syndrome in an adult with unilateral pulmonary artery stenosis and late-onset cataract.

真实世界12岁以下儿童接种麻腮风联合减毒活疫苗后30天内单纯性热性惊厥发生风险分析

目的分析甘肃省12岁以下儿童接种麻腮风联合减毒活疫苗(MMR)后30 d内发生单纯性热性惊厥(SFS)特征。方法筛选甘肃省2021年1月1日至2023年12月31日电子病历库中诊断为“热性惊厥”个案,利用病例身份信息匹配甘肃省免疫规划信息系统中该病例的接种信息,采用观察性流行病学方法分析12岁以下儿童出现SFS的流行特征及接种MMR 30 d内SFS发生风险。结果共纳入10614例SFS儿童患者,12岁以下儿童SFS总体发生率为92.42/10万,其中12~24月龄儿童发生率最高,为297.67/10万,男性儿童发生SFS风险高于女性儿童(RR值为1.61,P<0.001)。接种MMR后30 d内发生SFS风险较未接种该疫苗的高(RR值为2.66,P<0.001)。接种第1剂次的发生率(27.98/10万)较第2剂次(18.48/10万)高,12~24月龄儿童在接种第1剂次MMR 6~14 d SFS发生风险较<12月、25月~6岁组高(RR值分别为4.06和2.64,P<0.001)。结论12~24月龄儿童在接种MMR后6~14 d SFS发生风险增加,以12~24月龄儿童最为常见,应高度关注高风险人群并加强对SFS监测。

Correlation Analysis of Rubella Incidence and Meteorological Variables Based on Chinese Medicine Theory of Yunqi

Objective: To analyze the correlations between the incidence of rubella and meteorological factors over the same period and previous periods including 1, 2, 3 and 4 year ago(defined according to Chinese medicine Yunqi theory of "pestilence occurring after 3 years") and establish the rubella-meteorological forecast models for Beijing area, China. Methods: Data regarding the incidence of rubella between 1990 and 2004 from Beijing Center for Disease Control and Prevention, and the meteorological variables including daily average temperatures, daily average wind speeds, average precipitations, average relative humidity, average vapor pressures and average low cloud covers between 1986 and 2004 were collected from the Beijing Meteorological Observatory. Descriptive statistics and back-propagation artificial neural network for forecast model’s establishment were adopted for data analysis. Results: The average temperature and relative humidity have a great contribution(100%) to the rubella morbidity. But the combination of other meteorological factors contributed to improve the accuracy of rubella-meteorological forecast models. The forecast accuracy could be improved by 76% through utilizing a combination of meteorological variables spanning from 3 years ago to the present rather than utilizing data from a single year or dating back to more earlier time than 3 years. Conclusions: There is a close relationship between the incidence of rubella and meteorological variables in current year and previous 3 years. This finding suggests that rubella prediction would benefit from consideration to previous climate changes.

27-Ald-triterpenoid saponins from Adina rubella

Four new triterpenoid saponins were isolated from the roots of Adina rubella Hance. They were characterized as adinaic acid 3 beta-O-[alpha-L-rhamnopyranosyl(1-->2)-beta-D-glucopyranosyl(1-->2)-beta-D-glucurono-pyranoside-6-O-methyl ester]-28-O-beta-D-glucopyranoside, adinaic acid 3 beta-O-[alpha-L-rhamnopyranosyl(1-->2)-beta-D-glucopyranosyl(1-->2)-beta-D-glucuronopyranoside-6-O-butyl ester]-28-O-beta-D-glucopyranoside, adinaic acid 3 beta-O-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyrnaosyl]-(28-->1)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranosyl ester, 27-hydroxyursolic acid 3 beta-O-[alpha-L-rhamnopyranosyl (1-->2)-beta-D-glucopyranosyl(1-->2)-beta-D-glucuronopyranoside-6-O-methyl ester]-28-O-beta-D-glycopyranoside. Their structures were elucidated by spectral methods, especially with the aid of 2D NMR techniques. Their complete assignments of the H-1 and C-13 NMR signals were carried out.

珠海市出国留学人员麻疹、风疹IgG抗体水平监测情况分析

目的 通过监测珠海市出国留学人员麻疹、风疹IgG抗体水平,提出成人、青少年麻疹、风疹疫苗接种建议,为卫生健康部门、口岸卫生检疫部门进一步强化麻疹、风疹防控工作提供科学依据。方法 整理珠海市2021年6月至2023年1月期间出国留学人员麻疹、风疹预防接种状况,检测该人群血清样本麻疹、风疹病毒IgG抗体水平,统计分析出国留学人员麻疹、风疹病毒IgG抗体总体状况及不同组别人群麻疹、风疹病毒IgG抗体水平差异。结果 314名调查对象中,麻疹、风疹IgG抗体总阳性率分别为69.11%、63.38%。15岁及以下、16~20岁、21~25岁、26~30岁、31~35岁、36岁及以上麻疹抗体阳性率分别为83.33%、72.84%、68.42%、66.67%、78.57%、50.00%,风疹抗体阳性率分别为66.67%、66.67%、61.40%、70.83%、57.14%、61.11%;不同性别之间麻疹、风疹IgG抗体阳性率差异无统计学意义(P>0.05);不同年龄分组人员在麻疹、风疹IgG抗体阳性率方面差异较小,无统计学意义(P>0.05);不同分属地人员麻疹、风疹IgG抗体阳性率差异无统计学意义(P>0.05)。结论 珠海地区留学人员麻疹、风疹抗体阳性率总体超过60%,36岁以上人群阳性率偏低,成年人可考虑加强接种麻腮风疫苗。

2019-2022年开封市健康人群麻疹、风疹和流行性腮腺炎抗体水平监测分析

目的了解开封市健康人群麻疹、风疹、流行性腮腺炎抗体水平,评价疫苗免疫效果,为科学防控及相关疾病传播风险评估提供依据。方法采用多阶段分层抽样的方法采集开封市4个监测点0~79岁共计1983名健康人群血清标本,利用ELISA方法分别对血清中麻疹、风疹、流行性腮腺炎IgG抗体进行检测。结果1983份血清样本中,麻疹、风疹、腮腺炎的抗体阳性率分别为90.97%、83.16%、90.42%。不同性别间麻疹、风疹、流行性腮腺炎抗体阳性率没有显著性差异(P>0.05)。不同年龄组、不同监测点间的抗体阳性率具有显著性差异(P<0.01)。不同免疫史及距末次疫苗接种不同时间的麻疹、风疹抗体阳性率具有显著性差异(P<0.01),流行性腮腺炎抗体阳性率无显著性差异(P>0.05),但3种抗体阳性率均随免疫剂次的增加而升高。结论开封市存在麻疹、风疹、流行性腮腺炎免疫规划薄弱环节,应关注8月龄幼儿首剂疫苗的及时接种,对育龄期妇女进行宣传教育,及时开展抗体水平监测,积极开展查漏补种工作。

2014—2021年平凉市疑似麻疹、风疹病例检测结果分析

目的:分析2014—2021年平凉市疑似麻疹、风疹病例血清学IgM抗体检测结果,以了解麻疹、风疹的流行特点,为麻疹、风疹的疫情监测提供实验室诊断依据,为进一步控制和消除麻疹、风疹提供可靠的参考依据。方法:对2014—2021年平凉市各县区报告的疑似麻疹、风疹病例采用酶联免疫捕获法(ELISA)进行血清学IgM抗体检测,对检测结果进行统计分析。结果:2014—2021年平凉市共检测646例疑似麻疹、风疹病例,检出麻疹IgM抗体阳性73例,阳性率11.30%;检出风疹IgM抗体阳性158例,阳性率24.46%。不同性别麻疹、风疹病例分布,差异无统计学意义(P>0.05)。2月份、4月份为麻疹高发季节,1月份和2月份风疹发病较多。麻疹发病多为1岁以下幼童,风疹发病多为青少年。无免疫史和免疫史不详的阳性病例占比较高。结论:加强疫情监测预警,进一步加强实验室麻疹、风疹IgM抗体检测,及时确证疑似病例,同时加强查漏补种和强化免疫工作。

先天性风疹综合征一例

通过收集先天性风疹综合征患儿及母亲的临床资料、实验室结果、流行病学资料,分析先天性风疹综合征患儿的病因、诊断及预防策略。结合文献复习,孕妇孕期容易感染风疹病毒,导致胎儿先天性风疹综合征的风险较高,孕期开展风疹病毒筛查非常重要,必要时行介入性产前诊断确诊,同时对育龄妇女开展病毒筛查及疫苗接种也很重要。

Serologic survey of cytomegalovirus and rubella virus in Tabriz,Iran

Objective:To determine the prevalence of rubella and cytomegalovirus(CMV)among women in Tabriz City,Iran in 2013.Methods:This study was carried out in numerous laboratories in city of Tabriz.In 2013,26618 women aged 18-35 years were enrolled in this study.Serum samples were analyzed with chemiluminescence apparatus and SPSS software was used to conduct the statistical analysis.Results:A total of 26618 individuals were examined(10598 cases for anti-CMV and 16020 cases for anti-rubella).About 98.9%and 1.1%samples were reported positive and negative for CMV immunoglobulin G(IgG),respectively.The positivity for anti-CMV immunoglobulin M(IgM)antibody was found in 0.75%samples,while 99.25%were negative for the anti-CMV IgM antibody.Anti-IgG against rubella seropositivity was found in 95.8%and rubella IgM seropositivity in 0.93%.Anti-IgG against rubella seronegativity was found in 4.2%and rubella IgM seronegativity in 99.07%.Conclusions:According to the results,primary and secondary infections are usually symptomless or inconspicuous,but they can cause serious fetal damage.Routine antenatal care should therefore include serological testing to check the immune status of the woman and to diagnose any fresh virus infections that may arise.