Resurgence of congenital rubella syndrome in the 1990s. Report on missed opportunities and failed prevention policies among women of childbearing age
S. H. Lee, D. P. Ewert, P. D. Frederick and L. Mascola
Division of Field Epidemiology, Centers for Disease Control, Los Angeles, CA.
OBJECTIVE--To assess previous missed opportunities for rubella screening
and vaccination of women delivering infants with congenital rubella
syndrome and to discuss prevention strategies. DESIGN--Descriptive analysis
of data collected through interviews and review of medical records.
POPULATION STUDIED--Twenty-one women who delivered infants with congenital
rubella syndrome in four Southern California counties from January 1, 1990,
through January 8, 1991. RESULTS--Twelve (57%) of the women had a total of
22 known missed opportunities for rubella screening or vaccination. Of the
22 missed opportunities, three (14%) were missed screenings at the time of
marriage, two (9%) were missed screenings during previous pregnancies, five
(23%) were missed screenings during induced abortions, and 12 (55%) were
missed opportunities for vaccination postpartum or after induced abortions.
Nine (43%) of the women had no known missed opportunities for rubella
screening or vaccination. Of 12 women educated in California, only four
(33%) were subject to the 1982 California school rubella immunization
requirement. CONCLUSIONS--Congenital rubella syndrome could have been
prevented in more than half of the infants born to these women if missed
opportunities for rubella testing and/or vaccination had not occurred.
Because premarital rubella testing and school immunization requirements do
not ensure that all women of childbearing age are immune to rubella,
physicians and hospitals should establish procedures for postpartum rubella
vaccination of susceptible women. Family planning and abortion clinics
should implement routine rubella testing and follow-up vaccination of
susceptible women.
