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Hum Vaccin Immunother. 2014 June 1; 10(6): 1711.
Published online 2014 March 17. doi:  10.4161/hv.28496
PMCID: PMC5396227

Apropos “Incorporating immunizations into routine obstetric care to facilitate health care practitioners in implementing maternal immunization recommendations”

To the Editor

We compliment the team of investigators from Adelaide, Australia for their meticulous studies on the immunity status of health care workers (HCW) caring for perinatal women1 and feel that rubella immune status of males HCW looking after cases with congenital rubella syndrome should also be assessed including vaccination of those found to be disease- susceptible.

The episodes of congenital rubella syndrome are diagnosed and managed by female and male HCW of several disciplines like obstetrics, gynecology, pediatrics, ophthalmology, and laboratory. Usually during rubella immunity surveillance in hospital HCW, males would be ignored but females who lack rubella antibody would be advised rubella vaccines. Consequently, the susceptible HCW males run a risk not only of acquiring rubella infection but also its transmission to their patients. Any amplification and propagation of rubella virus in the hospital through unprotected male HCW handling patients with congenital rubella syndrome could be disastrous.

During the past decade, infections by rubella virus have been very common in males. For example, between July and June 2002, 85% of the laboratory-confirmed cases of rubella in Australia were males who were aged 20–52 y. Rubella IgG levels in 934 residual diagnostic sera stored at the Victoria Infectious Diseases Laboratory were surprising since in all subjects aged 10–55 y, males were more frequently susceptible to rubella infection than females (10.2% Vs. 2.6%, P < 0.0001).2

Even after introduction of rubella vaccination in 1989 in Japan, adult males have remained susceptible to rubella. From January 1 to May 1, 2013, a total of 5442 rubella cases were reported through the rubella surveillance system in Japan, with the majority (77%) of cases occurring among adult males while of the 5442 cases, males accounted for 4213 cases (77.4%), of which 3878 cases (92.0%) were in persons aged >20 y. Of the 4834 cases in persons aged >20 y, 1727 (36%) were in persons aged 30–39 y and 1535 (32%) in persons aged 20–29 y.3

With no prejudice to various national or international programs for rubella immunization in the community,4 it would be essential to screen male HCW for their rubella immune status. Immunization of susceptible HCW would be cost-effective as prevent any HCW linked spread of rubella virus in the hospital. In several countries, like Brazil, Chile, and Argentina, where only adolescent or adult females have been targeted through national immunization programs or as part of mass vaccination campaigns, large rubella outbreaks have occurred among adolescent and adult males along with a concomitant increase in the incidence of congenital rubella syndrome.3

In conclusion, surveillance of rubella susceptible male HCW including immunization of those lacking protective antibody would enhance their contribution toward implantation of maternal immunization recommendations.1

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.


The secretarial assistance of Ms Vandana Lodhi is acknowledged.


1. Webb H, Street J, Marshall H. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations. Hum Vaccin Immunother. 2014;10 doi: 10.4161/hv.27893. Forthcoming. [PMC free article] [PubMed] [Cross Ref]
2. Kelly H, Worth L, Karapanagiotidis T, Riddell M. Interruption of rubella virus transmission in Australia may require vaccination of adult males: evidence from a Victorian sero-survey. Commun Dis Intell Q Rep. 2004;28:69–73. [PubMed]
3. Centers for Disease Control and Prevention (CDC) Nationwide rubella epidemic--Japan, 2013. MMWR Morb Mortal Wkly Rep. 2013;62:457–62. [PubMed]
4. Muscat M, Shefer A, Ben Mamou M, Spataru R, Jankovic D, Deshevoi S, Butler R, Pfeifer D. The state of measles and rubella in the WHO European Region, 2013. Clin Microbiol Infect. 2014 doi: 10.1111/1469-0691.12584. Forthcoming. [PubMed] [Cross Ref]

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