Data on susceptibility, assessed through serological testing or personal history, were analyzed with respect to several demographic and HIV-related characteristics. Following exclusion of 93 women with rubella status reported as unknown, 1146 pregnancies with a live birth were analyzed. Overall, between 2001 and 2009, 303 women (26.4%) were reported as susceptible. Among the 843 nonsusceptible women, 163 (19.3%) were reported as previously vaccinated, with a significant increase during the study period in the proportion of vaccinated women, from 3.4% in 2001 to 25.0% in 2009 (χ2 for trend: P < .001). During the same period, the proportion of susceptible women decreased significantly, from 26.9% in 2001 (36.2% in 2002) to 18.8% in 2009 (P = .002). The general characteristics of susceptible and nonsusceptible women are reported in Table 1. Rubella susceptibility was not associated with any particular HIV-related or demographic characteristic, but appeared to be significantly associated with susceptibility to Toxoplasma infection (odds ratio [OR]: 3.10, 95% confidence interval [CI]: 2.24–4.29, P < .001) and with susceptibility to cytomegalovirus (CMV) infection (OR, 6.90; 95% CI, 5.06–9.14; P < .001), with a borderline-significance association (P = .063) with a negative history of sexually transmitted infections [STI] (OR, 1.49; 95% CI, .98–2.29). View this table: In this windowIn a new windowTable 1. Characteristics Of Pregnant Women With and Without Rubella Susceptibility Overall, among 1011 children with available information on birth defects, no cases of CRS were observed. The overall birth defect rate (3.4%; 95% CI, 2.3–4.5) was similar to other studies on HIV infection [4, 5]. Only 2 women (.19%) were positive for rubella IgM antibodies during pregnancy (at 16 and 30 wk of pregnancies, respectively). In both cases, children had no birth defects or functional abnormalities. In our cohort, which collects, based on HIV seroprevalence data [6], no less than 40% of deliveries in HIV-infected women in Italy, about 20% of HIV-infected pregnant women appear to be currently susceptible to rubella infection. This proportion is high compared with other studies on rubella seroprevalence in Italy [7] and suggests higher susceptibility rate and lower frequency of vaccination among women with HIV. It is unknown to what extent concerns about using a live attenuated vaccine in women with HIV may be responsible for the low frequency of vaccination observed. However, in our sample, only a limited proportion of women had low CD4 count or clinically relevant immunosuppression that may have prevented vaccination. The significant reduction in the rate of susceptibility during the last decade, coupled with the concurrent significant increase in the proportion of vaccinated women, is encouraging and suggests that a further decline in rubella susceptibility can be obtained in this population using appropriate vaccination strategies. Our data also suggest that susceptibility to rubella is associated to susceptibility to other infections that may be responsible for congenital syndromes or newborn infections (Toxoplasma, CMV, or sexually transmitted infection), and as such reinforce the need for an appropriate preconception counseling and care in this particular population. Next SectionAcknowledgments The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy Project coordinators: M. Floridia, M. Ravizza, E. Tamburrini. Investigators: M. Ravizza, E. Tamburrini, F. Mori, P. Ortolani, E.R. dalle Nogare, G. Sterrantino, M. Meli, S. Polemi, J. Nocentini, M. Baldini, G. Montorzi, M. Mazzetti, B. Borchi, F. Vichi, E. Pinter, E. Anzalone, R. Marocco, C. Mastroianni, V.S. Mercurio, A. Carocci, E. Grilli, A. Maccabruni, B. Mariani, A. Moretti, G. Natalini, G. Guaraldi, K. Luzi, G. Nardini, C. Stentarelli, A. Degli Antoni, A. Molinari, P. Rogasi, M.P. Crisalli, A. Donisi, M. Piepoli, V. Cerri, A. Viganò, V. Giacomet, V. Fabiano, S. Stucchi, C. Cerini, G. Placido, M. D'Alessandro, A. Vivarelli, P. Castelli, F. Savalli, V. Portelli, F. Sabbatini, D. Francisci, S. Alberico, G. Maso, M. Tropea, A. Meloni, D. Gariel, C. Cuboni, F. Ortu, P. Piano, A. Citernesi, I. Vicini, E. Periti, A. Spinillo, M. Roccio, A. Vimercati, E. Bassi, B. Guerra, F. Cervi, E. Tridapalli, G. Brighi, M. Stella, G. Faldella, C. Puccetti, M. Sansone, P. Martinelli, A. Agangi, C. Tibaldi, L. Trentini, S. Marini, G. Masuelli, I. Cetin, A. Crepaldi, M.L. Muggiasca, E. Ferrazzi, C. Giaquinto, M. Fiscon, R. Rinaldi, E. Rubino, A. Bucceri, R. Matrone, G. Scaravelli, G. Anzidei, C. Fundarò, O. Genovese, C. Cafforio, C. Pinnetti, G. Liuzzi, V. Tozzi, P. Massetti, M. Anceschi, A.M. Casadei, F. Montella, A.F. Cavaliere, V. Finelli, C. Riva, L. Lazier, M. Cellini, S. Garetto, G. Castelli Gattinara, A.M. Marconi, S. Foina, S. Dalzero, M. Moneta, F. Di Lorenzo, C. Polizzi, A. Mattei, M.F. Pirillo, R. Amici, C.M. Galluzzo, S. Donnini, S. Baroncelli, M. Floridia. Pharmacokinetics: M. Regazzi, P. Villani, M. Cusato. Advisory Board: A. Cerioli, M. De Martino, P. Mastroiacovo, M. Moroni, F. Parazzini, E. Tamburrini, S. Vella. SIGO-HIV Group National Coordinators: P. Martinelli, M. Ravizza. We thank all the women who participated in the study, Cosimo Polizzi and Alessandra Mattei for technical support to the project, and Maria Cristina Rota and Pierpaolo Mastroiacovo for their help in discussing the manuscript and the data. Financial support. This work was supported by the Italian National Program on Research on AIDS (public grants 39C/A, 31D55, and 31D56); and the Italian Medicines Agency (AIFA; public research grants). No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI). Potential conflicts of interest. All authors: no conflicts. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. Previous Section References 1.↵Duszak RS. Congenital rubella syndrome-major review. Optometry 2009;80:36-43. Medline2.↵Nardone A, Tischer A, Andrews N, et al. Comparison of rubella seroepidemiology in 17 countries: Progress towards international disease control targets. Bull World Health Organ 2008;86:118-25. CrossRefMedlineWeb of Science3.↵Floridia M, Ravizza M, Tamburrini E, et al. Diagnosis of HIV infection in pregnancy: Data from a national cohort of pregnant women with HIV in Italy. Epidemiol Infect 2006;134:1120-7. Medline4.↵Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy Registry international Interim Report for 1 January 1989 – 31 January 2010. Wilmington, NC: Registry Coordinating Center; 2010. Available at: www.APRegistry.com. Accessed 19 November 2010. 5.↵Townsend C, Willey B, Cortina-Borja M, Peckham C, Tookey P. Antiretroviral therapy and congenital abnormalities in infants born to HIV-infected women in the UK and Ireland, 1990–2007. AIDS 2009;23:519-24. CrossRefMedlineWeb of Science6.↵Girardi E, Vanacore P, Costa F, et al. Trends in HIV prevalence among pregnant women in Italy, 1994 to 2002. J Acquir Immune Defic Syndr 2006;41:361-4. CrossRefMedlineWeb of Science7.↵Rota MC, Bella A, Gabutti G, et al. Rubella seroprofile of the Italian population: An 8-year comparison. Epidemiol Infect 2007;135:555-62. Medline« Previous | Next Article » Table of Contents This Article Clin Infect Dis. (2011) 52 (7): 960-962. doi: 10.1093/cid/cir040 ExtractFree » Full Text (HTML)Free Full Text (PDF)Free - Classifications CORRESPONDENCE - ServicesAlert me when cited Alert me if corrected Alert me if commented Find similar articles No Web of Science related articles Similar articles in PubMed Add to my archive Download citation Request Permissions + Citing ArticlesNo citing articlesCiting articles via CrossRefNo Scopus citing articlesNo Web of Science citing articlesCiting articles via Google Scholar + Google ScholarArticles by Floridia, M.Articles by Tamburrini, E.Search for related content + PubMedPubMed citationArticles by Floridia, M.Articles by Pinnetti, C.Articles by Ravizza, M.Articles by Tibaldi, C.Articles by Sansone, M.Articles by Fiscon, M.Articles by Guaraldi, G.Articles by Guerra, B.Articles by Alberico, S.Articles by Spinillo, A.Articles by Castelli, P.Articles by Dalzero, S.Articles by Cavaliere, A. F.Articles by Tamburrini, E. + Related ContentNo related web pages - ShareCiteULikeConnoteaDeliciousFacebookGoogle+MendeleyTwitterWhat's this? Navigate This Article Top Acknowledgments References Search this journal: Advanced »Current Issue August 1, 2012 55 (3) Alert me to new issues Published on behalf of Infectious Diseases Society of America HIV Medicine Association Society Members: For your free access to this journal, log in via the IDSA members area. Impact Factor: 9.154 Editor-in-Chief Sherwood L. Gorbach, M.D. View full editorial board Contact the Editorial Office IDSA Conflict of Interest policy Archival Material Browse the archive Supplement archive Cover archive For Authors Instructions to Authors ICMJE Form Submit Now! OUP Services for Authors Rights & Permissions Self-archiving Policy For Reviewers CME Information Conflict of Interest disclosure form For the Media Press Room Alerting Services Email table of contents CiteTrack XML RSS feed MostMost ReadMost CitedMost Read Measurement of Airborne Influenza Virus in a Hospital Emergency Department The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America Smallpox Vaccination: A Review, Part II. Adverse Events Shining Light on "Dark Winter" Tularemia with Vesicular Skin Lesions May Be Mistaken for Infection with Herpes Viruses » View all Most Read articles Most CitedPharmacokinetic/Pharmacodynamic Parameters: Rationale for Antibacterial Dosing of Mice and MenDefining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants: An International ConsensusInvolvement of Panton-Valentine Leukocidin--Producing Staphylococcus aureus in Primary Skin Infections and PneumoniaNosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance StudyPractice Guidelines for the Management of Community-Acquired Pneumonia in Adults» View all Most Cited articles
Floridia, M., Pinnetti, C., Ravizza, M., Tibaldi, C., Sansone, M., Fiscon, M., Guaraldi, G., Guerra, B., Alberico, S., Spinillo, A., Castelli, P., Dalzero, S., Cavaliere, A., Tamburrini, E., Rubella susceptibility profile in pregnant women with HIV, <<Clinical infectious diseases : an official publication of the Infectious Diseases Society of America>>, 2011; 52 (7): 960-962. [doi:10.1093/cid/cir040] [http://hdl.handle.net/10807/25023]
Rubella susceptibility profile in pregnant women with HIV
Pinnetti, Carmela;Tamburrini, Enrica
2011
Abstract
Data on susceptibility, assessed through serological testing or personal history, were analyzed with respect to several demographic and HIV-related characteristics. Following exclusion of 93 women with rubella status reported as unknown, 1146 pregnancies with a live birth were analyzed. Overall, between 2001 and 2009, 303 women (26.4%) were reported as susceptible. Among the 843 nonsusceptible women, 163 (19.3%) were reported as previously vaccinated, with a significant increase during the study period in the proportion of vaccinated women, from 3.4% in 2001 to 25.0% in 2009 (χ2 for trend: P < .001). During the same period, the proportion of susceptible women decreased significantly, from 26.9% in 2001 (36.2% in 2002) to 18.8% in 2009 (P = .002). The general characteristics of susceptible and nonsusceptible women are reported in Table 1. Rubella susceptibility was not associated with any particular HIV-related or demographic characteristic, but appeared to be significantly associated with susceptibility to Toxoplasma infection (odds ratio [OR]: 3.10, 95% confidence interval [CI]: 2.24–4.29, P < .001) and with susceptibility to cytomegalovirus (CMV) infection (OR, 6.90; 95% CI, 5.06–9.14; P < .001), with a borderline-significance association (P = .063) with a negative history of sexually transmitted infections [STI] (OR, 1.49; 95% CI, .98–2.29). View this table: In this windowIn a new windowTable 1. Characteristics Of Pregnant Women With and Without Rubella Susceptibility Overall, among 1011 children with available information on birth defects, no cases of CRS were observed. The overall birth defect rate (3.4%; 95% CI, 2.3–4.5) was similar to other studies on HIV infection [4, 5]. Only 2 women (.19%) were positive for rubella IgM antibodies during pregnancy (at 16 and 30 wk of pregnancies, respectively). In both cases, children had no birth defects or functional abnormalities. In our cohort, which collects, based on HIV seroprevalence data [6], no less than 40% of deliveries in HIV-infected women in Italy, about 20% of HIV-infected pregnant women appear to be currently susceptible to rubella infection. This proportion is high compared with other studies on rubella seroprevalence in Italy [7] and suggests higher susceptibility rate and lower frequency of vaccination among women with HIV. It is unknown to what extent concerns about using a live attenuated vaccine in women with HIV may be responsible for the low frequency of vaccination observed. However, in our sample, only a limited proportion of women had low CD4 count or clinically relevant immunosuppression that may have prevented vaccination. The significant reduction in the rate of susceptibility during the last decade, coupled with the concurrent significant increase in the proportion of vaccinated women, is encouraging and suggests that a further decline in rubella susceptibility can be obtained in this population using appropriate vaccination strategies. Our data also suggest that susceptibility to rubella is associated to susceptibility to other infections that may be responsible for congenital syndromes or newborn infections (Toxoplasma, CMV, or sexually transmitted infection), and as such reinforce the need for an appropriate preconception counseling and care in this particular population. Next SectionAcknowledgments The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy Project coordinators: M. Floridia, M. Ravizza, E. Tamburrini. Investigators: M. Ravizza, E. Tamburrini, F. Mori, P. Ortolani, E.R. dalle Nogare, G. Sterrantino, M. Meli, S. Polemi, J. Nocentini, M. Baldini, G. Montorzi, M. Mazzetti, B. Borchi, F. Vichi, E. Pinter, E. Anzalone, R. Marocco, C. Mastroianni, V.S. Mercurio, A. Carocci, E. Grilli, A. Maccabruni, B. Mariani, A. Moretti, G. Natalini, G. Guaraldi, K. Luzi, G. Nardini, C. Stentarelli, A. Degli Antoni, A. Molinari, P. Rogasi, M.P. Crisalli, A. Donisi, M. Piepoli, V. Cerri, A. Viganò, V. Giacomet, V. Fabiano, S. Stucchi, C. Cerini, G. Placido, M. D'Alessandro, A. Vivarelli, P. Castelli, F. Savalli, V. Portelli, F. Sabbatini, D. Francisci, S. Alberico, G. Maso, M. Tropea, A. Meloni, D. Gariel, C. Cuboni, F. Ortu, P. Piano, A. Citernesi, I. Vicini, E. Periti, A. Spinillo, M. Roccio, A. Vimercati, E. Bassi, B. Guerra, F. Cervi, E. Tridapalli, G. Brighi, M. Stella, G. Faldella, C. Puccetti, M. Sansone, P. Martinelli, A. Agangi, C. Tibaldi, L. Trentini, S. Marini, G. Masuelli, I. Cetin, A. Crepaldi, M.L. Muggiasca, E. Ferrazzi, C. Giaquinto, M. Fiscon, R. Rinaldi, E. Rubino, A. Bucceri, R. Matrone, G. Scaravelli, G. Anzidei, C. Fundarò, O. Genovese, C. Cafforio, C. Pinnetti, G. Liuzzi, V. Tozzi, P. Massetti, M. Anceschi, A.M. Casadei, F. Montella, A.F. Cavaliere, V. Finelli, C. Riva, L. Lazier, M. Cellini, S. Garetto, G. Castelli Gattinara, A.M. Marconi, S. Foina, S. Dalzero, M. Moneta, F. Di Lorenzo, C. Polizzi, A. Mattei, M.F. Pirillo, R. Amici, C.M. Galluzzo, S. Donnini, S. Baroncelli, M. Floridia. Pharmacokinetics: M. Regazzi, P. Villani, M. Cusato. Advisory Board: A. Cerioli, M. De Martino, P. Mastroiacovo, M. Moroni, F. Parazzini, E. Tamburrini, S. Vella. SIGO-HIV Group National Coordinators: P. Martinelli, M. Ravizza. We thank all the women who participated in the study, Cosimo Polizzi and Alessandra Mattei for technical support to the project, and Maria Cristina Rota and Pierpaolo Mastroiacovo for their help in discussing the manuscript and the data. Financial support. This work was supported by the Italian National Program on Research on AIDS (public grants 39C/A, 31D55, and 31D56); and the Italian Medicines Agency (AIFA; public research grants). No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI). Potential conflicts of interest. All authors: no conflicts. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. Previous Section References 1.↵Duszak RS. Congenital rubella syndrome-major review. Optometry 2009;80:36-43. Medline2.↵Nardone A, Tischer A, Andrews N, et al. Comparison of rubella seroepidemiology in 17 countries: Progress towards international disease control targets. Bull World Health Organ 2008;86:118-25. CrossRefMedlineWeb of Science3.↵Floridia M, Ravizza M, Tamburrini E, et al. Diagnosis of HIV infection in pregnancy: Data from a national cohort of pregnant women with HIV in Italy. Epidemiol Infect 2006;134:1120-7. Medline4.↵Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy Registry international Interim Report for 1 January 1989 – 31 January 2010. Wilmington, NC: Registry Coordinating Center; 2010. Available at: www.APRegistry.com. Accessed 19 November 2010. 5.↵Townsend C, Willey B, Cortina-Borja M, Peckham C, Tookey P. Antiretroviral therapy and congenital abnormalities in infants born to HIV-infected women in the UK and Ireland, 1990–2007. AIDS 2009;23:519-24. CrossRefMedlineWeb of Science6.↵Girardi E, Vanacore P, Costa F, et al. Trends in HIV prevalence among pregnant women in Italy, 1994 to 2002. J Acquir Immune Defic Syndr 2006;41:361-4. CrossRefMedlineWeb of Science7.↵Rota MC, Bella A, Gabutti G, et al. Rubella seroprofile of the Italian population: An 8-year comparison. Epidemiol Infect 2007;135:555-62. Medline« Previous | Next Article » Table of Contents This Article Clin Infect Dis. (2011) 52 (7): 960-962. doi: 10.1093/cid/cir040 ExtractFree » Full Text (HTML)Free Full Text (PDF)Free - Classifications CORRESPONDENCE - ServicesAlert me when cited Alert me if corrected Alert me if commented Find similar articles No Web of Science related articles Similar articles in PubMed Add to my archive Download citation Request Permissions + Citing ArticlesNo citing articlesCiting articles via CrossRefNo Scopus citing articlesNo Web of Science citing articlesCiting articles via Google Scholar + Google ScholarArticles by Floridia, M.Articles by Tamburrini, E.Search for related content + PubMedPubMed citationArticles by Floridia, M.Articles by Pinnetti, C.Articles by Ravizza, M.Articles by Tibaldi, C.Articles by Sansone, M.Articles by Fiscon, M.Articles by Guaraldi, G.Articles by Guerra, B.Articles by Alberico, S.Articles by Spinillo, A.Articles by Castelli, P.Articles by Dalzero, S.Articles by Cavaliere, A. F.Articles by Tamburrini, E. + Related ContentNo related web pages - ShareCiteULikeConnoteaDeliciousFacebookGoogle+MendeleyTwitterWhat's this? Navigate This Article Top Acknowledgments References Search this journal: Advanced »Current Issue August 1, 2012 55 (3) Alert me to new issues Published on behalf of Infectious Diseases Society of America HIV Medicine Association Society Members: For your free access to this journal, log in via the IDSA members area. Impact Factor: 9.154 Editor-in-Chief Sherwood L. Gorbach, M.D. View full editorial board Contact the Editorial Office IDSA Conflict of Interest policy Archival Material Browse the archive Supplement archive Cover archive For Authors Instructions to Authors ICMJE Form Submit Now! OUP Services for Authors Rights & Permissions Self-archiving Policy For Reviewers CME Information Conflict of Interest disclosure form For the Media Press Room Alerting Services Email table of contents CiteTrack XML RSS feed MostMost ReadMost CitedMost Read Measurement of Airborne Influenza Virus in a Hospital Emergency Department The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America Smallpox Vaccination: A Review, Part II. Adverse Events Shining Light on "Dark Winter" Tularemia with Vesicular Skin Lesions May Be Mistaken for Infection with Herpes Viruses » View all Most Read articles Most CitedPharmacokinetic/Pharmacodynamic Parameters: Rationale for Antibacterial Dosing of Mice and MenDefining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants: An International ConsensusInvolvement of Panton-Valentine Leukocidin--Producing Staphylococcus aureus in Primary Skin Infections and PneumoniaNosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance StudyPractice Guidelines for the Management of Community-Acquired Pneumonia in Adults» View all Most Cited articles
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