title: Primary prevention and rubella immunity: overlooked issues in the outpatient obstetric setting.
abstract: OBJECTIVE
  To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.
  
  
  METHODS
  Mailed survey questionnaire, August through December 1994.
  
  
  METHODS
  Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.
  
  
  METHODS
  3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.
  
  
  METHODS
  Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.
  
  
  RESULTS
  Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting (> or = 5 physicians; OR, 1.2; CI95, 1.1-1.4).
  
  
  CONCLUSIONS
  Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.
authors.affiliation: Internal Medicine Training Program, Moses Cone Health System, Greensboro, NC 27401-1020, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Schoenhoff
authors.forename: T W
authors.initials: TW
authors.lastname: Lane
authors.forename: C J
authors.initials: CJ
authors.lastname: Hansen
mesh_terms: D005260:Female; D006176:Gynecology; D006306:Health Surveys; D006801:Humans; D007111:Immunity, Cellular; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008297:Male; D009774:Obstetrics; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D012409:Rubella / Q000276:immunology / Q000517:prevention & control*; D014481:United States