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Are many women immunized against rubella unnecessarily?

Published online by Cambridge University Press:  25 March 2010

P. P. Mortimer ,
J. M. B. Edwards ,
A. D. Porter ,
R. S. Tedder ,
J. E. Mace  and
A. Hutchinson
P. P. Mortimer
Affiliation:
Virus Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT
J. M. B. Edwards
Affiliation:
Virus Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT
A. D. Porter
Affiliation:
Virus Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT
R. S. Tedder
Affiliation:
Department of Virology, The Middlesex Hospital Medical School, Mortimer Street, London W1P 7PN
J. E. Mace
Affiliation:
Department of Virology, The Middlesex Hospital Medical School, Mortimer Street, London W1P 7PN
A. Hutchinson
Affiliation:
Lintonville Medical Group, Ashington, Northumberland
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Summary

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Radial haemolysis (RH) was used to test sera for immunity to rubella from 1317 patients attending a general practice. One hundred and forty-one (10·7%) were treated as susceptible and offered an attenuated virus vaccine (RA 27/3). Pre-immunization sera from 43% of these patients were reactive at low levels in RH (< 15 international units rubella antibody per ml).

Pre- (S1) and post- (S2) immunization sera from 66 vaccinees were studied in detail. Antibody was detected by RH, haemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA), and the specific IgM response was measured by a solid-phase M-antibody capture radioimmunoassay (MACRIA). The vaccine-induced IgM response was only detected if the S1 serum was non-reactive by all tests for rubella antibody. It was weaker than that seen following wild virus infection. It could be detected reliably for six weeks, and in most cases for nine weeks, after immunization. In contrast, patients with S1 specimens reactive by RH, HI or ELISA never showed an IgM response in the S2 specimen despite ‘significant’ antibody rises often being present.

It was considered that an IgM response to RA 27/3 was the best indicator of pre-immunization susceptibility to rubella. The failure of many vaccinees to make an IgM response implied that a significant proportion were already immune. It is suggested that the threshold for a report of immunity to rubella could be lowered from 15 i.u. antibody per ml and so fewer women immunized without vaccine being withheld from those who need it.

Type
Research Article
Information
Journal of Hygiene , Volume 87 , Issue 1 , August 1981 , pp. 131 - 138
Copyright
Copyright © Cambridge University Press 1981

References

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