title: Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating.
abstract: OBJECTIVE
  To estimate rubella, rubeola, and mumps (MMR) susceptibilities in pregnant women and determine the percentage not immune to rubeola or mumps, depending on rubella immunity status. A secondary objective was to assess costs of vaccination and testing programs aimed at eliminating these viral susceptibilities to determine an optimal strategy.
  
  
  METHODS
  This was an observational study of women presenting for prenatal care. All women had MMR antibody titers measured. Viral susceptibilities were compared by age, gravidity, parity, and recall of vaccine booster. A logistic regression was performed to assess for predictors of MMR immunity. A cost comparison of different screening and vaccination strategies was performed.
  
  
  RESULTS
  Overall, 91 (9.4%) women were susceptible to rubella, 161 (16.5%) to rubeola, and 159 (16.3%) to mumps. Three hundred seventeen (32.6%) were susceptible to at least 1 virus, whereas only 17 (1.7%) were susceptible to all 3. Of the women who were immune to rubella, a large percentage were not immune to either rubeola or mumps (n = 226, 25.6%). Only 74.2% of women who knew they had a booster vaccine were immune to all components of the MMR vaccine. Receiving a booster was predictive of immunity to all 3 viruses. A cost analysis demonstrated that broader screening strategies are more comprehensive and more expensive.
  
  
  CONCLUSIONS
  The current screening and vaccine program has left many reproductive-aged women susceptible to rubella, rubeola, and mumps infections. Perhaps a more comprehensive viral screening program is needed to ensure immunity.
authors.affiliation: Department of Obstetrics and Gynecology, Naval Hospital Camp Lejeune, Jacksonville, North Carolina 28547, USA. dmhaas@nhcl.med.navy.mil
authors.forename: David M
authors.initials: DM
authors.lastname: Haas
authors.forename: Coy A
authors.initials: CA
authors.lastname: Flowers
authors.forename: Christine L
authors.initials: CL
authors.lastname: Congdon
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D004198:Disease Susceptibility; D004797:Enzyme-Linked Immunosorbent Assay / Q000191:economics; D005260:Female; D006801:Humans; D007117:Immunization, Secondary / Q000191:economics; D008457:Measles / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D022542:Measles-Mumps-Rubella Vaccine; D009107:Mumps / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D011295:Prenatal Care; D012409:Rubella / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D014481:United States; D014611:Vaccination / Q000191:economics
chemical_list: D000914:Antibodies, Viral; D022542:Measles-Mumps-Rubella Vaccine