Because of aggressive childhood imm...

Because of aggressive childhood immunization programs, the rate of measles, mump and rubella has declined dramatically in the United States, with a simultaneous reduction being seen in congenital rubella. Nevertheless, maintaining population immunity is essential because these infections may be introduced from other countries. publicly 65 percent of the rubella cases recognized in the United States take place in adults, resulting in an increased risk of complications and congenital infections. Similarly, mump and measles are now remarkable conditions but have the potential for serious complications like as meningitis and encephalitis. An estimated 10 to 18 percent of women of reproductive age in the United States may be susceptible to these diseases because of failure of childhood immunization or fading immunity.

The American guild of Obstetricians and Gynecologists (ACOG) commends screening all pregnant women for rubella immunity and offering postpartum immunization with combined measles, mump and rubella (MMR) vaccine to susceptible mothers. However, simply 21 percent of U.S. hospitals scrutinizeed follow the ACOG recommendations. In addition, there are regards that the ACOG strategy does not benefit women who have immunity to rubella nevertheless are susceptible to mumps, measles, or as well-as; not only-but also; not only-but; not alone-but Haas and colleagues studied women obtaining prenatal care at a military hospital to document susceptibility to the same or more of these diseases and estimate the likely issue of different screening and immunization strategies.

All women presenting for prenatal care were defenceed for immunity to measles, mump and rubella based forward immunoglobulin G titers. Demographic and reproductive data were infered and patients were questioned about immunization history, specifically if they had received childhood immunizations and booster as a teenager or after a previous pregnancy. take away from comparisons for the various strategies were based onward actual laboratory and clinical preciousnesss plus average retail vaccination costs

During the six-month contemplation 973 pregnant women were shielded These women ranged in age from 17 to 43 years (mean, 242 years) and 368 percent were primigravidas. Among all pregnant women sieveed 9.4 percent were susceptible to rubella, 165 percent to measles, and 163 percent to mump Overall, 326 percent of the women were susceptible to at least single in kind of these viruses. Approximately single in kind fourth of the women who were immune to rubella were susceptible to mump or measles. in the greatest degree of the women (75.3 percent) did not know if they had received any booster vaccinations. level among women who reported receiving an adult booster vaccination, 258 percent had susceptibility to single in kind or more of the three illnesses.

From these data, the authors gaugeed four strategies for screening and immunization targeting measles, mump and rubella in 1000 adults. They calculated that strategy A (screening alone for rubella susceptibility and providing rubella immunization to susceptible patients) would fail to immunize 280 women susceptible to undivided or more of the viruses. Strategy B (screening for rubella susceptibility and providing MMR vaccine to susceptible patients) would fail to immunize the 232 women who were immune to rubella however susceptible to mumps, measles, or the couple Strategy C would screen for susceptibility to all three viruses and provide the MMR vaccine if the patient was not immune to united of them. Strategy D would protection for susceptibility to all three viruses and provide a rubella-only vaccine for women susceptible to rubella alone; the MMR vaccine would be provided for women susceptible to measles or mump Strategies C and D would countenance all mothers from all three viruses, with strategy D being slightly les expensive.

The authors end that at least one third of pregnant women are generally susceptible to one or more of the three viruses. History, including recall of booster immunizations, is not a reliable indicator of immune status. The authors argue that generally received ACOG guidelines are poorly followed and provide a suboptimal strategy. They commend that strategies based on screening for antibody titers to all three viruses be introduced to fortify young women and their unborn children.

ANNE D WALLING, MD

Haas DM et al. Rubella, rubeola, and mump in pregnant women Obstet Gynecol August 2005;106:295-300

EDITOR'S NOTE: For family physicians, the implications of this subject of attention go well beyond pregnant patients. Are about united third of healthy young adults in the United States susceptible to at least single in kind of the formerly "common childhood viral exanthems"? What about aging baby boomers? Does their naturally acquired childhood immunity persist, or are more [i]or[/i] less of them at particular risk because booster have not been recommended for persons born after 1957? Add the increasingly mobile population and popularity of international travel and we could have a recipe for more infections in U adults. Although herd immunity is likely to impede or curtail epidemics, older patients are likely to be more extremely ill and have more serious complications. A more basic interest is diagnosis. Rubella was not easy to diagnose, even when it was used by all in the community. Measles can also be tricky, especially in an adult with malaise, r inspections a cough, and an atypical rash. plane mumps could be challenging in an adult, because parotiditis may be unilateral or not a prominent feature. If the immunity flats in adults are low and decreasing, perhaps we will descry a change in recommendations for adult immunization in the future.--A.D.W.