Rubella virus vaccine associated arthropathy in postpartum immunizedwomen: influence of preimmunization serologic status on development of jointmanifestations
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Rubella virus vaccine associated arthropathy in postpartum immunized
women: influence of preimmunization serologic status on development of joint
manifestations
Rubella virus vaccine associated arthropathy
in postpartum immunized women: influence of preimmunization serologic status on
development of joint manifestations.
Mitchell LA, Tingle AJ, Grace M, Middleton P, Chalmers AC.
Department of Pathology, Faculty of Medicine, University of British Columbia,
Vancouver, Canada. lmitchel@interchange.ubc.ca
OBJECTIVE: To measure preimmunization rubella virus (RV)-specific IgG levels
and to relate these to the development of acute and chronic (persistent or
recurrent) joint manifestations following rubella vaccination. METHODS:
Specific IgG was determined by whole RV enzyme immunoassays (EIA) (Abbott
Rubazyme and M33, an in-house method), immunoblot, neutralization domain
peptide (BCH-178c) EIA, and neutralization bioassay in prevaccine samples of
268 RV seronegative women (Abbott absorbance < 0.999 units) who had received
monovalent live attenuated RA27/3 strain RV vaccine in a clinical trial that
recorded joint manifestations. RESULTS: Of rubella vaccinated women tested for
prevaccine antibodies, 21.7% were actually positive (> or = 10 IU/ml) by M33
EIA, 33.2% had Abbott values > or = 0.250 units, and 47.6% had RV
protein-specific antibody (immunoblot), while only 17.6% were positive (> or
= 10 IU/ml) by neutralization domain peptide EIA and 12.7% had neutralization
titers > or = 1:8. Seropositivity by the various methods was compared to
recorded occurrence of acute and chronic arthropathy (arthralgia and/or
arthritis) after RV vaccination. Relative to women who had no joint
manifestations, prevaccine seropositivity rates for subjects with acute
arthropathy were significantly (p < 0.05) lower in the Abbott test (<
0.250 units), BCH-178c peptide EIA, and neutralization bioassay, while those
who also developed chronic arthropathy had significantly lower prevaccine
seropositivity rates for the Abbott (< 0.250 units) and M33 EIA and
neutralization bioassay. CONCLUSION: Results suggest that risk for arthropathy
following RA27/3 rubella vaccination may be higher in women who have very low
prevaccine levels of antibody, particularly in assays measuring functional
(neutralizing) antibodies.
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