Subclinical rubella reinfection
during pregnancy followed
by transmission of virus to the fetus.
Aboudy Y, Fogel A, Barnea B, Mendelson E, Yosef L, Frank T, Shalev E.
Central Virology Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
We report a documented case of rubella
reinfection during pregnancy in a previously vaccinated woman with
residual antibody titre to rubella of 15 IU/ml. The reinfection occurred
following an exposure to rubella virus (contact with 6-year-old daughter with
clinical rubella) between the 7th and 10th week of pregnancy
which resulted in transmission of the
virus to the fetus. Umbilical cord blood drawn by cordocentesis was
found to be strongly positive for rubella IgM antibody. After termination of
the pregnancy rubella virus was isolated in cell culture from fetal tissues.
Congenital rubella after previous maternal immunity.
Das BD, Lakhani P, Kurtz JB, Hunter N, Watson BE, Cartwright KA, Caul EO,
Roome AP.
Department of Microbiology, Milton Keynes General Hospital.
Two mothers who had asymptomatic
rubella infection in pregnancy gave birth to severely affected infants. In
both, the presence of preexisting antibody was well documented, although it
could not be established whether it was the result of vaccine or natural
infection.
Postinfection and postvaccination antirubella immunity.
Kantoch M, Imbs D.
Out of 1670 pregnant women contacts examined for antibodies to rubella virus,
recent rubella infection was confirmed in 5.1% of subjects,
2.2% of which were symptomatic and
2.9% asymptomatic; 89.9% of tested women were seropositive. These
results closely resembled those, obtained in serological surveys, carried out
in Poland several times in the years 1969-82. Rubella antibodies were found in
over 90% of women in childbearing age, with HI antibody geometric mean titre
(GMT) 58.7-84.3 (depending on the epidemiologic situation). Especially high
GMT--of 122--was detected in women of the 30-34 year age group after the
rubella epidemic in 1980/81, which showed the highest rubella morbidity of 5-9
year-old children. Reactogenicity and immune response in 10-13 year-old
vaccinated girls were investigated. Seroconversion among seronegatives, among
subjects with low antibody level (less than 1:20) and among seropositives with
antibody titres 40 or higher before vaccination occurred in 99.8%, 60% and
12.8% of cases, respectively. HI antibody GMT after immunization was
132.6-135, similar to GMT induced by naturally acquired infection in the women
of 30-34 year age group after the rubella epidemic. The difference of GMT in
vaccinated girls with joint symptoms (152) and without postvaccinal reactions
(124) was statistically significant. Practical conclusions for rubella
diagnostic and vaccination programmes based on the analogies and differences
of antirubella immunity in infected pregnant women, in naturally infected
children and adults, and in vaccinated subjects are discussed.
Subclinical rubella reinfection in
vaccinated women with
rubella-specific IgM response during pregnancy and transmission of virus to
the fetus.
Forsgren M, Soren L.
This report concerns 2 cases of
documented rubella reinfection during pregnancy in previously vaccinated
women. The antibody response at reinfection comprised not only
anti-rubella IgG but also IgM. In the first case the reinfection occurred
between the 13th and 19th week of pregnancy and was followed by transmission
of virus to the fetus (anti-rubella IgM in cord blood and persisting antibody
activity). The child had no clinical signs of congenital rubella and is
normally developed without hearing impairment at 41/2 years of age. In the
second case the reinfection resulted from exposure in the 15th week of
pregnancy; there were neither serological nor clinical signs of congenital
rubella in the child. The reported case of fetal infection in spite of
previous rubella vaccination of the mother does not discourage the use of
rubella vaccine. Rubella vaccine induces long lasting immunity and protection
from viremia in the vast majority of individuals.
Seven cases of asymptomatic rubella
reinfection in early pregnancy are described. In each, there was a
history of exposure to a rubelliform illness and low levels of
rubella-specific IgM subsequently appeared in the serum.
Four of the women had been immunised,
after having been shown to be susceptible to rubella, one had been immunised
at school without previous antibody screening, and two were uncertain about
immunisation.
One pregnancy was terminated and rubella virus was not isolated from
the products of conception. Six pregnancies went to term and the infants
showed no evidence of intrauterine infection. In a further case it was
impossible to discriminate between reinfection and primary infection, and
termination of pregnancy was offered.
Subclinical rubella
reinfection in vaccinated women with rubella-specific IgM response
during pregnancy and transmission of virus to the fetus.
Forsgren M, Soren L.
This report concerns 2 cases of documented rubella reinfection during
pregnancy in previously vaccinated women. The antibody response at reinfection
comprised not only anti-rubella IgG but also IgM. In the first case the
reinfection occurred between the 13th and 19th week of pregnancy and was
followed by transmission of virus to the fetus (anti-rubella IgM in cord blood
and persisting antibody activity). The child had no clinical signs of
congenital rubella and is normally developed without hearing impairment at
41/2 years of age. In the second case the reinfection resulted from exposure
in the 15th week of pregnancy; there were neither serological nor clinical
signs of congenital rubella in the child. The reported case of fetal infection
in spite of previous rubella vaccination of the mother does not discourage the
use of rubella vaccine. Rubella vaccine induces long lasting immunity and
protection from viremia in the vast majority of individuals.
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