Hardelid, P.; (2008) The seroepidemiology of rubella in pregnant women in North Thames. Doctoral thesis , University of London.

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Abstract

Congenital rubella infection is a significant cause of birth defects worldwide. In the UK, vaccination programmes, introduced initially in 1970, have been successful in preventing congenital rubella cases and interrupting virus circulation. Previous studies have shown that women with a non-British background are more likely to be susceptible to rubella in pregnancy. London, with a large migrant population and suboptimal vaccination uptake is at particular risk of outbreaks. This thesis presents results of a rubella serosurvey in pregnant women in the North Thames area, using 18882 newborn dried blood spot samples to estimate maternally derived rubella IgG antibody level as a proxy for maternal levels, and investigate maternal age, Strategic Health Authority of residence and country of birth as risk factors for rubella seronegative status. Data on maternal country of birth was available through linkage to birth registration data, and latent class mixture models were used to identify samples which were seronegative for rubella IgG. Results of a study to validate two commercial enzyme-linked immunosorbent assays for use on dried blood spot sample are also presented. Overall, 2.7% of pregnant women were estimated to be rubella seronegative (95% CI 2.4% to 3.0%). Non-UK born women were significantly more likely to be seronegative to rubella for women born in South Asia, Sub-Saharan Africa and the Americas the adjusted odds ratios of rubella seronegative status were 4.96, 4.19 and 3.42 (95% CI 3.76 to 6.52, 3.11 to 5.64 and 2.13 to 5.52 respectively). Women aged less than 20 years were significantly more likely to be seronegative than women in their thirties (adjusted odds ratio 2.53, 95% CI 1.72 to 3.72). Application of latent class mixture regression models to estimate the independent effect of maternal characteristics on rubella antibody level is also demonstrated. These results highlight the continued risk to migrant women of rubella infection in pregnancy.

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