title: Evaluation of measles-rubella vaccination for mothers in early puerperal phase.
abstract: BACKGROUND
  The postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella.
  
  
  METHODS
  A prospective study of measles-rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers, who had insufficient antibody titers when screened for immunity to measles (≤ 1:4 on the neutralization test [NT]) or rubella (≤ 1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period, we determined their post-vaccination antibody titers and immune responses to vaccination, and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk.
  
  
  RESULTS
  Of the 169 participants who completed the study schedule, 117 and 101 had low antibody titers against measles and rubella, respectively. In the measles-seronegative group, the antibody-positive rate was 87% on the NT assay, and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI], 10.0-13.0). In the rubella-seronegative group, the antibody-positive rate was 88% on the HI test assay, and the HI geometric mean antibody titer was 64.0 (95% CI, 53.9-76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group, subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P=0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers, breastfeeding was not associated with clinical disease in any infants.
  
  
  CONCLUSIONS
  MR vaccination in the early puerperal phase is considered an effective way to prevent the diseases, regardless of the mother's immunological status and hormonal milieu.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan. Electronic address: hisano-m@ncchd.go.jp.
authors.forename: Michi
authors.initials: M
authors.lastname: Hisano
authors.affiliation: National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kato
authors.affiliation: Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Koushi
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D000956:Antigens, Viral / Q000302:isolation & purification; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007115:Immunization Schedule; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000627:therapeutic use; D008895:Milk, Human / Q000821:virology; D009500:Neutralization Tests; D049590:Postpartum Period; D011247:Pregnancy; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D012367:RNA, Viral / Q000302:isolation & purification; D012409:Rubella / Q000517:prevention & control*; D012411:Rubella Vaccine / Q000008:administration & dosage* / Q000627:therapeutic use; D058408:Th1-Th2 Balance; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D008458:Measles Vaccine; D012367:RNA, Viral; D012411:Rubella Vaccine; D014613:Vaccines, Attenuated; D011388:Prolactin
keywords: Breastfeeding; MR vaccine; Measles; Postpartum period; Pregnancy; Rubella