RESURGENCE OF RUBELLA IN PREGNANCY & CONGENITAL RUBELLA SYNDROME IN FRANCE IN 1993

Poster presented at the 3rd Scientific Meeting of European
Society of Chemotherapy, Paris, May 18th-20th, 1995 I. REBIERE, Réseau National de Santé Publique,
12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France
tél : 01 41 79 67 00

Introduction

After eight years of decline, the number of rubella infections in pregnancy and congenital rubella syndromes (CRS) have increased in France in 1993.

Methods

Surveillance for rubella during pregnancy and CRS is based on a laboratory network (Réseau Rénarub) and is effective since 1976. Demographic, clinical and biological data for all cases identified through the laboratories were obtained from the attending clinicians.

Results

In 1993, 78 cases (11/100 000 births) were laboratory-confirmed in pregnant women compared to a median of 38 cases during 1988-92 (fig.1).

Figure 1 : Incidence of rubella infections in pregnancy - France, 1976-1993

• Of the 78 women, 55 had a primo-infection, 5 had a reinfection and 18 couldn't be classified in primo or re infection.

• Of the 78 women, 16 had a termination of pregnancy and 60 continued with their pregnancy.

• Of the 60 women who continued with their pregnancy, 9 delivered an infant with birth-defects of CRS (1,3/100 000 births) compared to a median of 4 cases during 1988-92 (fig.2).

Figure 2 : Incidence of congenital rubella syndromes (CRS) with birth-defects - France, 1976-1993

Specific IgM antibodies were detected in 21 of the 57 infants tested.

Results (continuation)

The risk of birth-defects after rubella infection during the first trimester was 70% compared to 14% when infection occurred between the 12th and the 18th week of gestation. No birth-defect was observed after infection beyond the 18th week of gestation.

Thirty four percents of the pregnant women infected were parous. The vaccination status was known for 56 of the 78 pregnant women : 4 had been vaccinated.

Discussion-Conclusion

The risk of contracting rubella during pregnancy decreased substantially in France after the introduction of rubella vaccine in 1970 and MMR vaccine in 1986.

However, if circulation of the virus persists among young children and if women in childbearing age remain susceptible, periodic resurgences of rubella and CRS are to be expected. This has occurred in the United States in 1990-91 and in the United Kingdom in 1993 1,2.

Efforts have to be intensified to reach a vaccination coverage of 95% in children under the age of 6 years and to vaccinate young women. Because the unvaccinated male population is a potential reservoir of virus3, the introduction of a second dose of MMR vaccine in adolescents needs to be considered.

References :

1. CDC Rubella and Congenital Rubella Syndrome - United States, January 1, 1991 - May 7, 1994. MMWR,1994;43:391-401

2. RAMSAY M., GAY N. MILLER E et al. The epidemiology of measles in England and Wales : rational for the 1994 national vaccination campaign. CDR Review,1994;4:R141-6

3. BUISSON Y., NICAND E., EONO P et al. Epidémiologie de la rubéole chez l'adulte. La Lettre de l'Infectiologue,1995;10;39-44

We wish to thank the biologists who make this work possible :

Centre Hospitalier, Belley - Laboratoire, Ferney Voltaire - C.H.G., Hirson - Laboratoire Gambetta, Cannes - Centre Hospitalier Lenval, Nice - UER Médecine, Nice - Hôpital La Timone, Marseille - Laboratoire Constantini, Caen - C.H.U., Caen - SCP Lajoinie Caubel, Aurillac - Centre Hospitalier, La Rochelle -Centre Hospitalier, Ajaccio - C.H.U. Hôpital du Bocage, Dijon - Centre Hospitalier, Paimpol - C.H.U., Besançon - Laboratoire Boudet, Pacy-sur-Eure - Centre Hospitalier, Chartres - C.H.R., Brest - Centre Hospitalier, Bagnols-sur-Ceze - C.H.U. Gaston Doumergue, Nîmes - C.H.U. Rangueil, Toulouse -C.H.U. Purpan, Toulouse - Laboratoire Laspougeas, Mauvezin - Laboratoire A.R.A.Q., Bordeaux - LABM des Allées de Tourny, Bordeaux - Hôpital Pellegrin, Bordeaux - Centre Hospitalier, Beziers - Hôpital Lapeyronie, Montpellier - Hôpital Saint Charles, Montpellier - C.H.U. Pontchaillou, Rennes - Laboratoire Origet, Tours - C.H.U. Bretonneau, Tours - C.H.U. A. Michallon, Grenoble - Laboratoire Plantier, Bourgoin-Jallieu - Bureau d'Hygiène, Saint-Etienne - Laboratoire Puech, Saint-Etienne - C.H.U., Saint Priest en Jarez - Laboratoire Luitaud-Achard, Brioude - C.H.U. Hôtel Dieu, Nantes - Laboratoire Trichereau, Nantes - Centre Hospitalier, Gien - C.H.R., Orléans - Laboratoire Olivot-Mariotti, Agen - C.H.U., Angers - Centre Hospitalier, Avranches - Centre Hospitalier, Cherbourg - Hôpital Robert Debré, Reims - Laboratoire Médico-Biologique, Nancy -Maternité A. Pinard, Nancy - Laboratoire Valantin, Frouard - C.H.U. Brabois, Vandoeuvre-les-Nancy - SCP Laboratoire Roupert, Lazare et Scheppler, Metz - C.H.R., Thionville - Laboratoire Artus Goudaert Douchy, Cambrai - Laboratoire Dron Lavieville, Gravelines - Laboratoire Houriez Momal Brauge, Valenciennes - C.H.R., Lille - Hôtel-Dieu, Valenciennes - Centre Hospitalier, Compiègne - Centre Hospitalier, Alençon -LABM Collange, Méricourt - Laboratoire Valtille, Bruay en Artois - Hôpital Saint Jacques, Clermont-Ferrand - Laboratoire Fayet-Kasselis, Pau - Centre Hospitalier, Pau - Faculté de Médecine, Strasbourg - C.H.R. Louis Pasteur, Colmar - C.H.U. Debrousse, Lyon - Institut Pasteur, Lyon - Fondation Marcel Mérieux, Lyon - Université Claude Bernard, Lyon - Laboratoire Saysset, Echenoz la Meline - Hôtel Dieu, Paris - Hôpital Armées Val de Grâce, Paris - Hôpital Saint Louis, Paris - Hôpital Trousseau, Paris - G.H. Pitié-Salpétrière, Paris - Institut Alfred Fournier, Paris - Sainte-Anne, Paris - Institut Pasteur, Paris - Hôpital Lariboisière, Paris - Institut de Puériculture, Paris -Hôpital Saint-Vincent-de-Paul, Paris - Hôpital Notre-Dame-de-Bon-Secours, Paris - Hôpital Boucicaut, Paris - Hôpital Necker, Paris - Hôpital Claude Bernard, Paris - Hôpital Robert Debré, Paris - Laboratoire du Châtelet, Rouen - Hôpital Charles Nicolle, Rouen - Centre Hospitalier, Nemours - Laboratoire de la Noue de Bussy, Meaux Beauval - Centre Hospitalier, Abbeville - Hôpital Sud, Amiens - Centre Hospitalier, Albi - Laboratoire A et C Carayon, Mazamet - Laboratoire Couston-Bleunven, Albi - Laboratoire Odent-Fourcade, Gaillac - Laboratoire Bouhnik et Sarfati, Avignon -Laboratoire Meire Aimon Meire, Chatellerault - Cité Hospitalière, Poitiers - Hôpital Dupuytren, Limoges - Laboratoire Raby-Cheyroux, Limoges - Laboratoire Loiseau -Dehenry, Sens - Hôpital Ambroise Paré, Boulogne - Hôpital Antoine Béclère, Clamart - Hôpital Américain, Neuilly-sur-Seine - Centre Hospitalier, Aulnay sous Bois - Hôpital Avicenne, Bobigny - C.H.I., Montreuil-sous-Bois - C.H.U., Le Kremlin Bicêtre - Hôpital Saint Camille, Bry-sur-Marne - Hôpital Intercommunal, Creteil - C.H. Victor Dupouy, Argenteuil -Laboratoire Cerba, Cergy Pontoise - Hôpital René Dubois, Pontoise - Centre Hospitalier, Pointe-à-Pitre - Centre Hospitalier, Saint Denis de la Réunion - Centre Hospitalier, Saint-Laurent-du-Maroni - C.H.T de Mamao, Papeete.

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