Rubella susceptibility profile in pregnant women with HIV

Rubella infection usually has a limited clinical relevance in children and young adults. However, its acquisition during pregnancy may lead to severe fetal or neonatal complications, such as miscarriage, fetal death, or an association of birth defects represented by the congenital rubella syndrome (CRS) [1]. Prevention of CRS through vaccination programs represents a priority in most national and international public health plans, and several countries have implemented vaccination programs aimed at obtaining the World Health Organization (WHO)-recommended target of a CRS incidence below 1 per 100,000 live births per year [2]. There are very limited data on the rubella susceptibility status of human immunodeficiency virus (HIV)-infected pregnant women, and it is still unknown whether this population may be at higher risk of acquiring rubella because of a higher susceptibility prevalence. We used data from a national study to investigate the prevalence of rubella susceptibility in a large series of pregnant women with HIV [3]. 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 [