Background: Elimination of congenital rubella syndrome depends not only on effective childhood immunization
but also on the identification and immunization of rubella susceptible women. We assessed
rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum
immunization with measles, mumps and rubella (MMR) vaccine.
Methods: Cross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain)
between January 2008 and December 2013. Antenatal serological screening for rubella was performed
in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended
following birth. We evaluated rubella serological response to MMR vaccination in mothers who
complied with the recommendations.
Results: A total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD
5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in
2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined
with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than
women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI
1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more
likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubellasusceptible
women, with the highest proportion being immigrant women compared with women born
in Spain. After vaccination, all women showed rubella immunity.
Conclusions: The higher rubella susceptibility found in the three youngest age groups and in immigrant
women highlights the relevance of antenatal screening, in order to ensure identification and postpartum
immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing
age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella
and other vaccine-preventable diseases.