Perception of rubella risk in pregnancy: an epidemiological survey on a sample of pregnant women
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Ann Ig 2019; 31 (Suppl 1): 65-71 doi:10.7416/ai.2019.2278
Perception of rubella risk in pregnancy: an epidemiological
survey on a sample of pregnant women
A. Facciolà1, R. Squeri2, C. Genovese3, V. Alessi3, V. La Fauci2
Key words: Rubella, Pregnancy, Risk factor, Congenital Rubella Syndrome
Parole chiave: Rosolia, Gravidanza, Fattore di rischio, Sindrome della Rosolia Congenita
Abstract
Background. Rubella is a common exanthematous viral disease all over the world. The disease can be
prevented by administering a safe and effective vaccine, and in Italy it is subject to reporting obligations. A
national plan for the elimination of measles and congenital rubella (in Italian “PNEMoRC”) was approved
in 2003 and updated in 2010. This plan originally aimed at reducing the susceptible target population
(women in fertile age, 15-49 years old) to below 5% and at eliminating the congenital form of rubella by
2015, a goal which has not been achieved yet.
Study design. Our research work was focused on a convenience sample of pregnant women attending the
antenatal classes at the two main hospitals in Messina, Sicily (Italy).
Methods. After we obtained an informed consent, we administered to 200 Italian and foreign pregnant
women an anonymous questionnaire reporting socio-demographic characteristics, type of gynaecological
assistance and information received about Rubella serological status
Results. The mean age was 30.6 years ± 5.45. The majority of these women were married, at work and with
a high educational level. Most of them (75.3%) reported to be assisted by a private gynaecologist, while only
24.7% used a public facility. A remarkable percentage (62.8%) of these women reported to be serologically
negative at the anti-rubella antibodies test, but, only 7.5% of them reported to have passed the anti-rubella
antibody test before the conception.
Conclusions. Our results clearly show that we are still far from achieving the elimination of rubella risk
in pregnancy. We are facing a cultural gap perhaps also due to a generalized loss of “historical memory”
about the impact that infectious diseases have had in the past in terms of mortality and morbidity. In fact,
alongside the considerable drop in vaccination coverage in the recent years, our research also reveals a
reduced focus on pre-conceptional testing and limited awareness of associated risks. Furthermore, we
correlated the serological status with the sociodemographic characteristics of these women and found a
statistically significant correlation with their age and their educational level (P
66 A. Facciolà et al.
Introduction socio-demographic characteristics, in order
to verify the probability of achievement of
Rubella is an exanthematous viral the “PNEMoRC” objective of eliminating
infection that affects mainly children congenital rubella within 15 years from its
and remains subclinical in up to 50% of implementation.
cases (1). When the virus is contracted
during pregnancy, especially during the
first three months, it can be transmitted to Materials and methods
the foetus resulting in a syndrome known
as Congenital Rubella Syndrome (CRS). 1. Data collection
In Italy, this disease has been subject to After we obtained aindividual informed
a reporting obligation since 1970 and it consent, we administered anonymous face
can be prevented by administering a safe to face questionnaires to a convenience
and effective vaccine. Under the Global sample of 200 pregnant women attending
Vaccine Action Plan, measles and rubella the antenatal classes at the two main
are targeted for elimination in five World hospitals in Messina, Sicily (Italy). The
Health Organization (WHO) Regions by research was conducted for a period of two
2020 (2). According to the last WHO Global months (from 1st May to 30th June 2018).
Measles and Rubella Update (November The chosen hospitals were housing the two
2018), 9,499 rubella cases were notified in main birth centres in the city. Particularly,
the first ten months of 2018 worldwide (3). we investigated the socio-demographic
In Italy, while many cases of measles have characteristics of the women, such as
been consistently reported since 2013 with age, age of first pregnancy, marital status,
a severe outbreak in 2017 (4), rubella cases education level and profession, the type of
have decreased after early 2013. However, gynaecological assistance received and the
between January 2005 and February 2018, Rubella serological status.
88 cases of congenital rubella were reported,
80 of which confirmed and 8 probable (5). 2. Statistical analysis
In Italy, a national plan for the elimination Statistical data processing was performed
of measles and congenital rubella (in Italian using version 10 of StatSoft® software.
“PNEMoRC”) was approved in 2003 and Descriptive statistics were used to calculate
aimed at eliminating these viral diseases by percentages. Pearson’s correlation tests
2007 (6). As in 2007 the goal was not reached, were performed to assess the relationship
on March 23, 2011 a new “PNEMoRc” 2010- between socio-demographic characteristics
2015 plan was approved (7). and rubella serological status.
The Italian Behavioral Risk Factor
Surveillance System (in Italian: “PASSI”)
showed that - in the period 2009-2012 - Results
34% of women in childbearing age had an
unknown rubella immune status and 2% had 90.3% of the 200 women enrolled were
a negative rubella test (8). of Italian nationality, while 9.7% were of
The aim of this paper is to investigate the foreign nationality, especially from East
awareness of a sample of Italian and foreign Europe and Sri Lanka. The mean age was
pregnant women about the risk of rubella 30.6 ± 5.45 years for the Italian and 29 ±
during pregnancy, assessing their attention to 6.32 years for the foreign women. 89.3% of
pre-conception prevention and knowledge of the Italian and all the foreign women were
their serological status, correlating with their at their first pregnancy (mean age at firstSurvey on congenital rubella risk 67 Figure 1 - Socio-demographic characteristics of the enrolled pregnant women (A = marital status; B = scholarization level; C = employment)
68 A. Facciolà et al. Figure 2 - Rates of rubella serological status declared by the enrolled pregnant women pregnancy 29.9 years). The data concerning women (P
Survey on congenital rubella risk 69
that the most important sociodemographic All these findings testify about the
variables that were more correlated to their decreasing interest in the importance of
stated serological positivity were age and infectious diseases and their prevention that
cultural level. Particularly, the more “at risk” has spread over the last few decades. As
were the oldest women, with a low cultural a result, we witnessed a decrease in both
level, probably due to a reduced knowledge the awareness about these diseases and the
about the potential risk represented by related prevention, as shown in particular
rubella infection in pregnancy. by the remarkable decrease of vaccination
The very high percentage of women coverage and the following outbreaks of
declaring a negative serological status for vaccine-preventable infectious diseases
this infection and the extremely low rate occurred in recent years.
of preconception tests suggested that these Our study demonstrated that the
women were paying very little attention to perception of the rubella risk in pregnancy
the prevention of congenital rubella. This by women is extremely poor. Today we
result is in sharp contrast with some of our are witnessing a significant “cultural gap”
previous sero-epidemiological research, in regarding prevention that requires, on the
which women susceptible to rubella were one hand, a cultural growth of the population
much fewer compared to those in the present and, on the other, more awareness on the part
paper. Particularly, in a study of 2012, 85.8% of all healthcare workers about vaccinations
of the women enrolled (aged 15–45 years) and the rubella issue (17, 18, 19).
had an anti-rubella antibody titer, but, when
asked about the serological positivity, only
70.4% declared to be positive, while 55.2% Declarations of interest: There are no conflicts of
reported to have conducted a pre-conception interest.
rubella screening (10). Therefore, in the
current study, we observed a decrease both
in the positivity rate and in the level of Riassunto
awareness. The latter aspect is highlighted,
especially, by the big difference between La percezione del rischio della rosolia in gravidan-
za: indagine conoscitiva su un campione di donne
the two studies in terms of pre-conception
incinte
rubella screening adherence. Moreover, in
a subsequent study conducted in 2014 in a Premessa. La rosolia è una malattia esantematica
group of immigrant women, the serological di origine virale comune in tutto il mondo. In Italia, la
positivity was 82.2%; 67% of them said malattia è soggetta a notifica obbligatoria e può essere
to have neither knowledge of rubella as prevenuta grazie alla somministrazione di un vaccino
a disease nor of the potential harm to the efficace e sicuro. Nel 2003 è stato approvato il Piano
Nazionale di Eliminazione del Morbillo e della Rosolia
foetus, 12% stated they knew very little Congenita (PNEMoRC), che è stato aggiornato nel 2010.
and 21% reported they had been informed Il Piano aveva lo scopo di ridurre la popolazione target
about rubella and the related vaccination by suscettibile (donne in età fertile, di età compresa tra
centers for health and social services (13). 15 e 49 anni) al di sotto del 5% ed eliminare la forma
However, in the current study, the situation congenita della malattia entro il 2015.
is worse than before, because all of the Disegno dello studio. La ricerca è stata effettuata su
un campione di convenienza di donne in gravidanza che
immigrant women declared to be negative frequentavano i corsi preparto presso i due principali
to the rubella antibodies test, none of them ospedali della città di Messina, in Sicilia.
were unaware of TORCH agents and rubella Metodi. Dopo aver ottenuto il consenso informato,
and, lastly, none of them had the rubella test abbiamo somministrato un questionario anonimo a 200
before pregnancy. donne italiane e straniere. Il questionario conteneva do-70 A. Facciolà et al.
mande inerenti le loro caratteristiche socio-demografiche, 4. Palamara MA, Visalli G, Picerno I, et al. Measles
il tipo di assistenza ginecologica ricevuta e informazioni outbreak from February to August 2017 in Mes-
sullo stato sierologico della rosolia. sina, Italy. J Prev Med Hyg 2018; 59(1): E8-E13.
Risultati. L’età media delle donne in studio era di doi: 10.15167/2421-4248/jpmh2018.59.1.853.
30,6 anni ± 5,45. La maggior parte di esse era sposata, 5. Epicentro. Rosolia Congenita e in Gravidanza
lavoratrice e con un alto livello di istruzione. Il 75,3% ha News. 2018. Rapporto semestrale n. 8, marzo
dichiarato di essere assistita da un ginecologo privato; il 2018. Available on: http://www.epicentro.iss.it/
resto (24,7%) era seguita presso una struttura pubblica.
rosolia/bollettino/Rosolia_congenita_news_nu-
Una percentuale elevata (62,8%) ha, inoltre, dichiarato
mero%208%20IT.pdf [Last accessed: 2019, Feb
di essere risultata negativa alla ricerca degli anticorpi
22].
anti-rosolia. Infine, solo una piccolissima percentuale
di esse (7,5%) ha dichiarato di aver effettuato la ricerca 6. Ministero della Salute. Piano nazionale per
in epoca preconcezionale. l’eliminazione del morbillo e della rosolia
Conclusioni. I nostri risultati evidenziano chiaramente congenita (PNEMoRC) 2003-2007. 2003.
che siamo ancora lontani dal raggiungimento dell’eli- Available on: http://www.governo.it/backoffice/
minazione del rischio rappresentato dalla rosolia in allegati/20894-1712.pdf
gravidanza. Ci troviamo di fronte ad un vuoto culturale 7. Ministero della Salute. Italy. Piano nazio-
forse dovuto, tra l’altro, alla perdita di “memoria storica” nale per l’eliminazione del morbillo e della
sull’impatto che le malattie infettive hanno avuto in pas- rosolia congenita (PNEMoRC) 2010-2015.
sato sulla morbosità e sulla mortalità. La nostra ricerca 2011. Available on: http://www.salute.gov.it/
rivela anche una notevole riduzione nell’attenzione data imgs/C_17_pubblicazioni_1519_allegato.pdf
all’analisi preconcezionale e nella consapevolezza dei [Last accessed: 2019, Feb 22].
rischi associati, evidenziata anche dal considerevole calo 8. Istituto Superiore di Sanità. Progressi delle
delle coperture vaccinali verificatosi negli ultimi anni. Aziende Sanitarie per la Salute in Italia: la
Inoltre, correlando lo stato sierologico dichiarato dalle sorveglianza Passi (PASSI). 2012. Available
donne con le loro caratteristiche socio-demografiche, on: http://www.epicentro.iss.it/passi/dati/Vac-
abbiamo evidenziato una correlazione statisticamente
cinazioneAntirosolia.asp [Last accessed: 2019,
significativa con l’età e con il titolo di studio (PSurvey on congenital rubella risk 71
14. Olajide OM, Aminu M, Randawa AJ, Adejo DS. 17. Squeri R, Genovese C, Trimarchi G, Palamara
Seroprevalence of rubella specific IgM and IgG MAR, La Fauci V. An evaluation of attitude to-
antibodies among pregnant women seen in a ward vaccines among healthcare workers of a Uni-
tertiary hospital in Nigeria. Int J Womens Health versity Hospital in Southern Italy. Ann Ig. 2017;
2015; 7: 75-83. doi: 10.2147/IJWH.S68667. 29(6): 595-06. doi: 10.7416/ai.2017.2188.
15. Alvarado-Esquivel C, Hernandez-Tinoco J, 18. Squeri R, Riso R, Facciolà A, et al. Management
Sanchez-Anguiano LF, et al. Rubella immune of two influenza vaccination campaign in health
status in pregnant women in a northern Mexican care workers of a university hospital in the south
City. J Clin Med Res 2016; 8(9): 656-61. doi: Italy. Ann Ig. 2017; 29(3): 223-31. doi: 10.7416/
10.14740/jocmr2635w. ai.2017.2150.
16. Rapporto annuale sull’evento nascita in Italia- 19. Squeri R, Genovese C, Palamara MAR, Tri-
CeDAP. 2015. Available on: http://www.salute. marchi G, La Fauci V.“Clean care is safer
gov.it/portale/documentazione/p6_2_2_1. care”: correct handwashing in the prevention of
jsp?lingua=italiano&id=2766 [Last accessed: healthcare associated infections. Ann Ig 2016;
2019, Feb 22]. 28(6): 409-15. doi:10.7416/ai.2016.2123
Corresponding author: Prof. Vincenza La Fauci, orcid.org/0000-0002-5038-8811.
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U.
Policlinico “G. Martino”, Biological tour 1° Floor, Via Consolare Valeria, 98125 Messina, Italy
e-mail: vlafauci@unime.itYou can also read
