Contrary to federal recommendations, many women who are eligible for rubella vaccination are not being immunized after giving birth, a new study of Miami-area hospitals has found.

"Overall, studies have shown that two-thirds or more of women get vaccinated appropriately," said co-author Susan Reef, M.D., of the Centers for Disease Control and Prevention. "We found that in this high-risk population, only 21 percent of non-immune women were vaccinated."

Reef and colleagues from the CDC and the Miami-Dade County Health Department reviewed medical records for 2001 from four Miami birthing hospitals . The majority of births at these hospitals are to women of Hispanic and Haitian origin, a group at high risk for congenital rubella syndrome due to historically low vaccination rates in their native countries.

Vaccination rates were even lower among women who had not been screened for rubella immunity --just 2 percent received vaccinations, according to the study in the latest American Journal of Preventive Medicine.

Of the 1,991 women whose medical records were reviewed, 410 were eligible for vaccination, either because they were not immune or because there was no record that they had been screened. Only 44 of these women (11 percent) received postpartum vaccinations.

The Advisory Committee on Immunization Practices recommends that the measles-mumps-rubella (MMR) vaccine be offered to all women of childbearing age who do not have evidence of rubella immunity. The goal of the U.S. rubella vaccination program is to prevent congenital rubella infections, which can result in miscarriages, stillbirths, and a constellation of birth defects known as congenital rubella syndrome (CRS).

As postpartum immunization of the mother comes too late for the child already born, only future children of the woman will be protected from CRS. It is not considered safe to give the rubella vaccine during pregnancy.

"Rubella is a mild disease for the most part," said Stanley Gall, M.D., professor of obstetrics and gynecology at the University of Louisville College of Medicine, who was not involved with the study. "It would be on the scrapheap of medicine but for its effect on the early developing fetus."

Last year, the CDC announced that rubella has been eliminated in the United States. That means that any cases of rubella occurring in the United States arise from other countries. Several Latin American countries have become more aggressive in their rubella-prevention efforts with recent mass vaccination campaigns.

"Ensuring immunity among women of childbearing age is very important to prevent congenital rubella syndrome," said Reef. "Up to half of CRS cases could be prevented if women were vaccinated postpartum."

Bloom SA, et al. Low rubella postpartum vaccination rates in high-risk women, Miami, Florida, 2001. Am J Prev Med 30(2), 2006.

Susan Reef, M.D.
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