Rubella virus infection and associated factors among pregnant women attending the antenatal care clinics of public hospitals in Hawassa City, Southern Ethiopia: a cross-sectional study

Rubella seroprevalence among pregnant women in the region of Rabat, Morocco: a cross-sectional study

OBJECTIVES

The aim of the present research is to update data on the seroprevalence of rubella and to identify the associated risk factors among pregnant women in the Rabat region of Morocco in order to take immediate action to monitor the virus.

DESIGN

A cross-sectional study.

SETTING

The study was conducted at Ibn Sina University Hospital and at referral healthcare centres in the region of Rabat.

PARTICIPANTS

A total of 502 pregnant women (mean age 29.7±6.3 years, range 17-44 years) attending the maternity department during 8 months were selected for serological testing.

OUTCOME MEASURES

A structured questionnaire was used to obtain sociodemographic, reproductive and clinical characteristics after obtaining written informed consent. Venous blood samples were collected to determine rubella-specific IgG antibodies using an automated chemiluminescent microparticle immunoassay (ARCHITECT i1000SR and i2000SR, Abbott Diagnostics).

RESULTS

Antirubella IgG antibodies (≥10 IU/mL) were found in 408 (85.9%) pregnant women examined. The rate of susceptibility to rubella virus infection among pregnant women was found to be 14.1%. These protective rates were found to differ significantly between uneducated pregnant women (80.9%) and those with university-level education (95.5%) (p=0.02). Pregnant women in the 17-24, 25-34 and 35-44 years age groups accounted for 92.5%, 85.2% and 82.8%, respectively (p=0.015). Also, IgG seropositivity status was found to differ significantly between multiparous (83.3%) and primiparous (92.5%) pregnant women (p=0.01). None of the other characteristics was significantly associated with rubella infections.

CONCLUSION

Vaccination programmes need to be updated to ensure that campaigns reach their specified goals. Thus, implementing an effective, large-scale screening programme for congenital rubella infection in different regions of Morocco is highly recommended. On the other hand, seronegative pregnant women should be given special preventive care and health education about rubella transmission and congenital rubella syndrome sequelae.

Seroprevalence of rubella virus infection among antenatal care clients of Halaba Town public health facilities, southern Ethiopia

Rubella virus infection during pregnancy has several effects on the developing fetus. However, little is known about the epidemiology of the infection in Ethiopia. A cross-sectional study was conducted to assess the seroprevalence of rubella virus infection on consecutive 299 pregnant women attending antenatal care clinics in public health facilities in Halaba Town, Southern Ethiopia. Structured questionnaires were used to collect information on socio-demographic and reproductive characteristics. Venous blood samples were collected, and sera were tested for anti-rubella IgM and IgG using the enzyme-linked immunosorbent assay. Anti-rubella IgG and IgM were detected in 265 (88.6%) and 15 (5.0%) of 299 participants, respectively. Pregnant women in their first trimester [crude odds ratio (cOR) = 4.26; 95% CI (1.47, 12.4)] were at increased risk of having anti-rubella IgM compared to those in their second and third trimesters. Urban residents [cOR = 4.06; 95% CI (1.94, 8.47)] were with a higher percentage of IgG positivity compared to rural residents. Anti-rubella IgG positivity was higher in housewives [cOR = 2.94; 95% CI (1.07, 8.04)] compared to self-employed women. Our findings showed a high prevalence of rubella virus exposure, and considerable percentages of recent infection and susceptible women to contracting the infection, emphasizing the importance of congenital rubella syndrome in the research area.

Modeling the Dynamics of Rubella Disease with Vertical Transmission

Rubella is a highly contagious and serious human disease caused by the rubella virus. It affects everyone around the world, but it is especially common in pregnant women and children. In particular, when pregnant women are infected with the rubella virus, it causes Congenital Rubella Syndrome (it transmit vertically from mother to fetus, which causes that the new born baby to inherit birth defect disease). In order to prevent this viral disease, children must receive an MMR (measles, mumps and rubella) vaccine twice. If children receive two doses of the vaccine, then they develop long life immunity (protected against rubella). Based on the biological behavior of rubella disease, the SVPEIRS (susceptible, vaccinated, protected, exposed, infected, recovered) deterministic mathematical model of rubella disease dynamics is proposed. From the perspective of the qualitative behavior of the model, it is bounded in the invariant region and all the solutions of the compartment are positive. In addition, the equilibrium points and the stability of the equilibrium points (local and global) are also analyzed. The basic reproductive number is determined using a next-generation matrix. The results of the sensitivity analysis show that rubella is spread in a community if the values of contact rate, vertical transmission (neonatal infection) rate, exposure rate and rate of waning out of the first vaccinating dose are increase by keeping other parameters constant. On the other hand, increasing the first and second vaccination rate and treatment rate can help to control rubella in the community. Numerical simulation results show that due to the lack of protection for women before pregnancy, the number of infections increases with the birth of infected children, and the two doses of vaccine play a significant role in reducing and eliminating rubella. Therefore, to eliminate rubella in the community, healthcare and policymakers must pay attention to these parameters.

Epidemiological Pattern of Rubella in Africa: A Review of Selected Sub-Saharan African Countries

Rubella, (German measles) is vaccine-preventable and a viral disease of public health importance. It presents with mild febrile rash illness, attendant congenital sequel and foetal death. This paper seeks to do a review of the epidemiology of rubella in selected sub-Saharan African countries. This is a review of literatures involving data triangulation of rubella surveillance data. World Health Organization (WHO)rubella surveillance data (2015-2018) available online was used to present the seasonal/time-variation. Data was extracted from the site into Microsoft Excel over three months period (October-December, 2018). Univariate data analysis was done using SPSS-23 and data were presented with appropriate tables and charts to show the trend. Epidemiologic findings showed that periodicity of rubella varies across countries in Africa with seasonal variation across the four sub-regions. In the West Africa sub-region, sharp increases occurred in reported cases in January with peaks in March-April. In Nigeria, a West African country, available data showed that seasonal peak occurs in the first four months (Jan-April) of the year with most of the burden among those below fifteen years of age, affects both sexes and incidence cuts across both rural and urban areas. However, in the Central sub-region, spikes generally occur between February and March with troughs in September to November. In the East sub-region, dual peaks occur in March-April and in September-October; in the South sub-region, unique annual seasonality with few cases reported in January-June each year. The peak incidence of rubella has been observed to be a function of the seasonal peaks/variation in Africa. Therefore, the knowledge of this seasonal variation can be leveraged upon by Governments to control the disease through scaling up of awareness creation and surveillance during the identified peaks and beyond.

Seroepidemiology study of Cytomegalovirus and Rubella in pregnant women in Luanda, Angola: geospatial distribution and its association with socio-demographic and clinical-obstetric determinants

Background

Both CMV and Rubella virus infections are associated with the risk of vertical transmission, fetal death or congenital malformations. In Angola, there are no reports of CMV and Rubella studies. Therefore, our objectives were to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the risk of primary infection during pregnancy and evaluate the socio-demographic risk factors associated with both infections.

Methods

A prospective cross-sectional study was conducted from August 2016 to May 2017. Specific anti-CMV and anti-Rubella antibodies were quantified by electrochemiluminescence and demographic and clinical data were collected using standardized questionnaire. Bivariate and multivariate logistic regression analysis were used to quantify the effect of clinical and obstetric risk factors on virus seroprevalence.

Results

We recruited 396 pregnant women aged from 15 to 47. Among them, 335 (84.6%) were immune to both CMV and Rubella virus infections, while 8 (2.0%) had active CMV infection and 4 (1.0%) active RV infection but none had an active dual infection. Five women (1.2%) were susceptible to only CMV infection, 43 (10.9%) to only RV infection, and 1 (0.3) to both infections. Multivariate analysis showed a significant association between Rubella virus infection and number of previous births and suffering spontaneous abortion.

Conclusions

Overall, this study showed that there is a high prevalence of anti-CMV and anti-Rubella antibodies in pregnant women in Luanda. It also showed that a small but important proportion of pregnant women, about 11%, are at risk of primary infection with rubella during pregnancy. This emphasizes the need for vaccination.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07087-x.

The Burden of Likely Rubella Infection among Healthy Pregnant Women in Abakaliki, Ebonyi State, Nigeria

The first 140 days of pregnancy are critical as regards rubella virus infection because of the likelihood of a poor pregnancy outcome. This study was undertaken to investigate the likelihood of exposure to poor pregnancy outcomes due to seroprevalence of rubella among selected pregnant women attending Mile Four Hospital, Abakaliki, Ebonyi State, Nigeria. The seroprevalence of rubella immunoglobulin M (IgM) antibodies was investigated among pregnant women. A total of 187 sera samples collected from the women were screened for rubella virus IgM antibody using the enzyme-linked immunosorbent assay (ELISA). The results obtained were analyzed using SPSS. The chi square test was performed at a $P$ value of 0.05 significance and at a 95% confidence interval. Of the 187 pregnant women, 35 (18.72%) were positive for the rubella virus. Pregnant women within 26–30 years of age had the highest prevalence (26.15%), while those aged 35–40 years had the least prevalence. Married women had the highest prevalence (20.0%), followed by singles (16.67%) and widows (15.38%), while divorced pregnant women recorded the least prevalence (9.20%). Pregnant women with no formal education were more predisposed to rubella virus (22.22%) infection compared to their educated counterparts. Occupationally, full-time housewives had the highest prevalence (24.26%). The infection rates seemed to wane as pregnancy advanced. The first trimester had the highest prevalence (21.88%), followed by the second trimester (18.84%) and the third trimester (17.44%). Pregnant women living in urban areas had higher IgM seroprevalence (20.18%) than those in rural areas (16.67%). Furthermore, grand multigravidas were more infected (22.73%) than primigravidas (14.52%) and multigravidas (20.39%). The seroprevalence of rubella in this study was high, and it calls for general surveillance and mass immunization of children and females of childbearing age in the area to help reduce the incidence of congenital rubella syndrome.

Serological Markers of Viral Infections (Rubella Virus, Human Cytomegalovirus and Arboviruses) among Symptomatic Pregnant Women in Rural and Urban Areas of Mwanza, Tanzania

Viral infections have been associated with poor pregnancy outcomes. We investigated the magnitude of rubella virus (RV), dengue virus (DENV), Zika virus (ZIKV) and human cytomegalovirus (HCMV) among symptomatic pregnant women in rural and urban areas of Mwanza. A cross-sectional study was conducted between July 2017 and April 2018 in Mwanza. A rapid immunochromatographic test was done to detect ZIKV IgM and IgG as well as DENV IgM and IgG antibodies. A multiplex_RT-PCR was also done to detect the viral RNA genome. Enzyme immunoassays were done to detect RV and HCMV. Out of 171 participants, 1 (0.6%) was found to be seropositive for ZIKV_IgM antibodies, while 5 (2.9%) were ZIKV_IgG seropositive. DENV seropositivity was 9 (5.3%) and 3 (1.8%) for IgM and IgG, respectively, with all being PCR negative. Two participants (1.2%) were RV_IgM seropositive. 100% were HCMV_IgG seropositive and none was HCMV_IgM seropositive. Among 70 women with high HCMV_IgG titters, 10 (14.3%) had a low avidity index, indicating recent infections. Residing in rural areas (p = 0.044) and advanced age (p = 0.024) independently predicted ZIKV/DENV seropositivity. A substantial proportion of pregnant women had markers for viral infections. There is a need for introducing routine screening and monitoring pregnancy outcomes of positive cases to establish the relationship of these viruses and adverse pregnancy outcomes in endemic areas.

Rubella seroprevalence among mothers and incidence of congenital rubella three years after rubella vaccine introduction in Vietnam

Following a rubella outbreak in 2011, Vietnam implemented a mass measles-rubella vaccination campaign for children aged 1–14 years in 2014–2015, further expanding the target age to 16–17 years in 2016; routine vaccination was introduced in 2014. However, there was concern that a substantial proportion of women of child-bearing age were still susceptible to rubella, with the fear of congenital rubella emergence. Thus, we conducted a prospective cohort study in Nha Trang, Vietnam, from 2017–2018 to investigate pregnant women’s susceptibility to rubella infection, the incidence of congenital rubella infection, and factors associated with susceptibility. Cord blood was tested for rubella-specific immunoglobulin M (IgM) and IgG; neonatal saliva and cord blood specimens were examined for rubella-RNA. We analyzed 2013 mother-baby pairs. No baby was rubella-IgM or rubella-RNA positive. Overall, 20.4% of mothers were seronegative (95% confidence interval, 18.6%–22.1%). The seronegativity was significantly low among mothers aged <35 years. We found that maternal age groups of 20–24 and 25–29 years, and the lack of self-reported vaccination history were significantly associated with seronegativity. Many pregnant women who were not covered by the vaccination campaign are still at risk of rubella infection.

Seroprevalence of rubella virus among pregnant women: A 4-year registered-based study from family medicine and obstetric clinics in Saudi Arabia

OBJECTIVES

This study aimed to determine rubella virus infectivity and immune status in pregnant females who visited the family medicine and obstetrics clinics at a large hospital in Saudi Arabia, and to identify the possible predictors of rubella susceptibility.

METHODS

This registered-based, cross-sectional study included pregnant, aged between 18 and 50 years old, who presented for the first antenatal visit between 2017 and 2020. Data on sociodemographic, antenatal characteristics and serological results were collected. Chi-Squared or Fisher's Exact test and t tests were used for bivariate analysis followed by the multivariable logistic regression model.

RESULTS

A total of 4328 pregnant were included in the study. Seroprevalence of rubella immunity was 76.41%. Positive rubella IgM antibody was identified in 1.21% of those who performed the test (17/1409). Odds of susceptibility were decreased with an increase in age (OR = 0.96, 95% CI = 0.95-0.97) and in non-Saudis' (OR = 0.44, 95% CI = 0.36-0.54).

CONCLUSIONS

Approximately 24% of pregnant were susceptible to rubella virus infections in this study. Screening females of child-bearing age and reimmunisation of susceptible cases before pregnancy are suggested. Further studies to investigate the impact of applying this policy in premarital screening are recommended.

Related factor of igg rubella-specific in couples of childbearing age in bolaang mongondow district

OBJECTIVE

This study aims to determine the determinant factors associated with the amount of Specific Rubella IgG levels in women of childbearing age.

METHODS

The study design used observational analytic with cross-sectional, while sample was women of childbearing age who were in Maelang Health Center, as well as fulfilling the specified inclusion criteria 125 samples.

RESULTS

There was no significant relationship between age (p=0.097), type of work (p=0.302), education (p=0.160), income (p=0.099) and parity (p=0.314) with immunological status rubella, and significant is history of miscarriage (p=0.027). Multivariate analysis showed history of miscarriage was dominant factor in immunological status of rubella (p=0.027; OR=5.469).

CONCLUSION

It is expected that health workers in study area increase counseling about the danger of rubella virus either at posyandu or subdistrict level musrembang activities and government is expected to support and provide latest innovations.

Rubella seroprevalence using residual samples from the South African measles surveillance program: a cross-sectional analytic study

Introduction: South Africa is yet to introduce rubella-containing vaccines (RCV) into its routine immunization schedule. Selecting the target population when introducing RCV should take into account the ages of susceptible individuals in the population. We aimed to determine the seroprevalence of antibodies to rubella and characterize immunity gaps among individuals of all ages in South Africa. Methods: We tested for rubella immunoglobulin G (IgG) antibodies with a commercial enzyme-linked immunosorbent assay. We used residual samples collected from 2016 through 2018 as part of the national measles surveillance program. We only tested samples that were negative for measles and rubella immunoglobulin M (IgM) and explored the association between rubella susceptibility (IgG negative) and predictor variables (year of sample collection, age, sex, and province of residence) using logistic regression analysis. Results: We obtained results for 6057 records. Rubella susceptibility was highest among Individuals aged zero to 11 months (81.9%), followed by children 1 to 5 years old (71.5%), 6 to 10 y old (40.9%) and 11 to 15 y old (31.25) while the smallest proportion of susceptible individuals was among those 16 to 49 y old (19.9%). Females were less likely to be susceptible to rubella compared to males (OR = 0.79 (95%CI: 0.71-0.87), P < .001) in unadjusted analysis but this effect was not observed after adjusting for age and province. In multivariable logistic regression, age (OR = 6.24 (4.52-8.63), P < .001) and province of residence (OR = 0.97 (95%CI: 0.95-0.99), P = .01) were associated with rubella susceptibility. Conclusion: In the absence of rubella vaccination in the Expanded Program on Immunization in South Africa, the bulk of individuals susceptible to rubella are children under 16 y old. About 20% of individuals 16 to 49 y old are susceptible to rubella. This susceptibility gap must be born in mind during RCV introduction.

Sero-prevalence of rubella among pregnant women in Sub-Saharan Africa: a meta-analysis

Background: Rubella continues to be a leading cause of vaccine-preventable congenital birth defects and permanent organ damage, especially in developing countries. For women who are infected with the rubella virus (RV) before conception or during the first trimester of pregnancy, the unborn child has up to a 90% probability of developing congenital rubella syndrome. There are limited data on the seroprevalence of the rubella virus among pregnant women in Sub-Saharan Africa. Therefore, the aim of this study was done to determine the pooled seroprevalence of rubella among pregnant women in Sub-Saharan Africa. Methods: The PRISMA guidelines protocol was followed to write the systematic review and meta-analysis. Published studies were searched in Medline, PubMed, Google scholar, advance google and Cochrane Library. The search terms on the databases are: "rubella"OR "rubeo*", "rubella"AND"seroepidemiology", "seroprevalen *" OR "prevalen*", "seroprevalen *" OR "seroimmun*", "rubella antibod*"AND "pregnan*", "seroprevalen *" AND "sub-Saharan Africa".The heterogeneity of studies was weighed using Cochran's Q test and I² test statistics. Publication bias was assessed by using Egger's and Begg's test. Results: Twenty-eight studies were included in this meta-analysis. The pooled seroprevalence of anti-RV IgG among pregnant women in Sub-Saharan African was 89.0% (95%CI: 84.6-92.3), and the pooled prevalence of anti-RV IgM among pregnant women in Sub-Saharan Africa was 5.1% (95%CI: 2.6-9.9). Conclusion: This meta-analysis showed that seronegativity and acute infection with RV among pregnant women in sub-Saharan Africa is high compared to other studies and the WHO threshold among women of child-bearing age. This finding calls for primary health care providers to make the community aware of this rubella-susceptible group and its healthcare burden, with the desired outcome that sub-Saharan Africa countries would introduce an implementation strategy for rubella vaccination of pregnant women and women of child-bearing age.

Risk Factors for Rubella Transmission in Kuyu District, Ethiopia, 2018: A Case-Control Study

Background

Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus. Despite increased episodes of rubella epidemics (127 outbreaks in 2009–2015), rubella national vaccination is not yet introduced in Ethiopia. In January 2018, an increase of fever and rash cases was reported in Kuyu District of Oromia. We investigated the outbreak to confirm rubella, determine risk factors, and guide interventions.

Methods

We identified rubella cases from health centers and conducted a case-control study (1 case : 2 controls) with 150 participants, from March 12 to 15, 2018. Cases were people who presented with fever and rash or laboratory-confirmed cases. Controls were age matched (<15 yrs) with neighbors selected purposively. We interviewed parents by a structured questionnaire and observed the housing condition. Variables include sex, age, vaccination status, family size, contact history, housing condition, and travel history. Simple logistic regression was used to select the candidate variable at a P value <0.25. We identified risk factors at P < 0.05 with AOR and 95% CI by multivariate logistic regression.

Results

We identified 50 cases (with no death), and out of them, seven (14%) were confirmed cases (rubella IgM positive). The mean age of the cases was 6 ± 3 years and of the controls was 8 ± 4 years. Family size >5 (AOR = 2.4; 95% CI: 1.5–4.11), not well-ventilated living room (AOR = 4.7; 95% CI: 3.43–8.12), history of contact with rash people (AOR = 2.2; 95% CI: 1.6 3.5), no history of diarrhea in the last 14 days (AOR = 0.8; 95% CI: 0.6–0.9), and no history of vitamin A supplementation (AOR = 2.9; 95% CI: 1.7–2.6) were significant factors for rubella infection.

Conclusions

We identified rubella outbreak in the rural area. Crowded living condition, large family size, not receiving vitamin A in the last 6 months, and contact with people with symptoms of rubella were factors that drove the outbreak, while not having diarrhea in the last 14 days was the protective factor. We recommended the introduction of rubella immunization national programs and advocated the policy on rubella vaccine and strengthening surveillance for congenital rubella syndrome and rubella.

Rubella virus infections and immune status among pregnant women before the introduction of rubella vaccine in Amhara Regional State, Ethiopia

BACKGROUND

Rubella and its associated congenital anomalies have been greatly reduced in most developed countries through use of the rubella vaccine. However, the magnitude of the problem is underestimated and there are no well-established rubella/congenital rubella syndrome prevention and control strategies in many developing countries, including Ethiopia. The aim of this study was to determine the prevalence of rubella virus infections among pregnant women and their immune status before the introduction of rubella vaccine in Amhara Regional State, Ethiopia.

METHODS

A prospective cross-sectional study was conducted among pregnant women in Dessie, Felege-Hiwot, and University of Gondar referral hospitals, from December 2015 to February 2017. After obtaining written informed consent, socio-demographic data, reproductive history, clinical manifestations, and the possible risk factors for rubella virus infections were collected using a structured questionnaire. The laboratory analysis of rubella-specific antibodies was done using an enzyme-linked immunoassay method on venous blood samples. Data were entered and analyzed using IBM SPSS Statistics version 20. Binary logistic regression was used to determine the strength of association between the dependent variables and covariates.

RESULTS

A total of 600 pregnant women were included in the study. Their mean age was 26.4±5years (range 16-40 years). The overall seroprevalence of rubella infection was 89%. Of the total study participants, 9.5% were positive for rubella-specific IgM antibody, which indicates acute/recent rubella virus infection. In contrast, 79.5% of them had protective levels of rubella-specific IgG antibody and were immune as a result of previous wild-type rubella infection. However, 11% of the pregnant women were negative for both rubella-specific antibodies; these women represent the susceptible group.

CONCLUSIONS

A large number of pregnant women had acute/recent rubella virus infections at the time of data collection, indicating that the virus is endemic in the study area. More than a tenth of pregnant women were found to be susceptible to acquiring the infection in future pregnancies, with the possible risk of rubella-associated congenital anomalies. Hence screening of all women of child-bearing age before conception and during pregnancy might reduce the devastating effects of the virus on the developing fetus.