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Are many women immunized against rubella unnecessarily?

  • P. P. Mortimer (a1), J. M. B. Edwards (a1), A. D. Porter (a1), R. S. Tedder (a2), J. E. Mace (a2) and A. Hutchinson (a3)...

Summary

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.

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References

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Banatvala, J. E., O'Shea, S., Best, J. M., Nicholls, M. W. N. & Cooper, K. (1981). Transmission of RA 27/3 rubella vaccine strain to products of conceptions. Lancet i, 392.
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CMO (1976)4. Chief Medical Officer, Department of Health and Social Security.
Harris, R. E., Smith, K. O., Gehle, W. D. & Dupuy, J. (1980). Rubella immunity: comparison of haemagglutination inhibition and radioimmunoassay antibody methods. Obstetrics and Gynaecology 55, 603–7.
Kurtz, J. B., Mortimer, P. P., Mortimer, P. R., Morgan-Capner, P., Shafi, M. S. & White, G. B. B. (1980). Rubella antibody measured by radial haemolysis. Characteristics and performance of a simple screening method for use in diagnostic laboratories. Journal of Hygiene 84, 213–22.
IPAC (1981). Rubella prevention: recommendation of the Immunization Practices Advisory Committee, Centers for Disease Control. Morbidity and Mortality Weekly Report 30, 3747.
Mortimer, P. P., Tedder, R. S., Hambling, M. H., Shafi, M. S., Burkhardt, F. & Schilt, U. (1981). Antibody capture radioimmunoassay for anti-rubella IgM. Journal of Hygiene 86, 139–53.
Pattison, J. R. & Mace, J. E. (1973). Rubella screening tests. Journal of Clinical Pathology 26, 161.

Are many women immunized against rubella unnecessarily?

  • P. P. Mortimer (a1), J. M. B. Edwards (a1), A. D. Porter (a1), R. S. Tedder (a2), J. E. Mace (a2) and A. Hutchinson (a3)...

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