Rubella vaccination of schoolgirls: factors affecting vaccine uptake.

In a national sample of 16-year-old girls who were aged 12 when the rubella vaccine programme was implemented in 1970, 71% were reported to have received rubella vaccine. There was a high regional disparity in the uptake of rubella vaccine: 81% of girls living in Scotland had been vaccinated but only 61% of girls living in Wales. Similarly there was a difference in reported vaccine uptake according to the family social background, the lowest proportion vaccinated came from professional and unskilled manual families. Girls attending independent schools also had a lower vaccine uptake than girls in schools maintained by the local educational authorities. If rubella immunisation is to be effective uptake of vaccine must increase to almost 100%.     

Rubella screening and immunisation of schoolgirls: results six to seven years after vaccination.

A long term follow-up study was carried out of girls given RA27/3 or Cendehill rubella vaccine in their 13th-14th year compared with a group of girls who had been found to be naturally immune at the age. A high proportion of the girls in all groups had persistent rubella antibody six to seven years after inclusion in the study, although some of these would have been considered to be susceptible to rubella by methods currently in use for screening for rubella antibody. Great care should be taken in interpreting the efficiency of the schoolgirl immunisation policy in the United Kingdom; women in their childbearing years who may have received vaccine but are found by a screening test to be seronegative should be retested by a more sensitive procedure before a final report is made.     

Mucosal immunity and vaccination.

The gut mucosal immune system is a critical component of the body's defense against pathogenic organisms, especially those responsible for enteric infections associated with diarrhoeal disease. Attempts to vaccinate against infections of mucosal tissues have been less successful than vaccination against systemic infections, to a large extent reflecting a still incomplete knowledge about the most efficient means for inducing protective local immune responses at these sites. Secretory IgA (SIgA) is the predominating immunoglobulin along mucosal surfaces, and SIgA antibodies generated in gastrointestinal, respiratory or genito-urinary mucosal tissues can confer protection against infections affecting or originating in these sites. An efficacious intestinal SIgA immunity-inducing oral vaccine against cholera has been developed recently, and development of oral vaccines against other enteric infections such as those caused by enterotoxigenic Escherichia coli, Shigella and rotaviruses is in progress as well. Based on the concept of a common mucosal immune system through which activated lymphocytes from the gut can disseminate immunity to other mucosal and glandular tissues, there is currently also much interest in the possibility of developing oral vaccines against infections in the respiratory and urogenital tracts. However, the large and repeated antigen doses often required to achieve a protective immune response still makes this vaccination approach impractical for many purified antigens. There is, therefore, a great need to develop strategies for enhancing delivery of antigen to the mucosal immune system as well as to identify mucosa-active immunostimulating agents (adjuvants). These and other aspects of mucosal immunity in relation to immunization and vaccine development are discussed in this short review article.     

Rubella vaccination: persistence of antibodies for up to 16 years.

Sera from 123 volunteers vaccinated six to 16 years previously with one of four rubella vaccines (Cendehill, RA27/3, HPV77-DE5, and To-336) were tested for rubella antibodies by single radial haemolysis and radioimmunoassay. By radioimmunoassay 110 (89.4%) of the vaccinees had antibody concentrations greater than the minimum immune titre (that is, greater than 15,000 IU/1), 11 (8.9%) were seropositive but had concentrations less than or equal to 15,000 IU/1, and two (1.6%) were seronegative. Eight (6.5%) were seronegative by single radial haemolysis, of whom five had received Cendehill vaccine. Six to eight years after vaccination subjects who had received Cendehill vaccine had the lowest geometric mean titre of antibody by radioimmunoassay while the subjects who had received HPV77-DE5 vaccine had the highest. Although antibody concentrations less than or equal to 15,000 IU/1 were not detected among subjects given RA27/3 vaccine six to eight years previously, such low levels were detected in two (15.4%) vaccinated 11-16 years previously. These results emphasise the importance of long-term surveillance programmes so that vaccination policies may be reviewed.     

Rubella immunity in pregnant women in a north London practice.

Congenital malformations due to rubella embryopathy are preventable. All women embarking on pregnancy should be immune and know that they are immune to rubella to guard against the risk of contracting the disease during pregnancy. A previous history of clinical rubella or rubella vaccination is not reliable, and women should be screened for antibodies when possible before planning to conceive, and particularly before a first pregnancy. As general practitioners committed to the practice of prevention, we should undertake rubella screening for all our women patients before they conceive. This could easily be incorporated into our contraceptive services. We will be greatly helped if family planning clinics adopted a policy of screening for rubella antibodies, always remembering that good documentation and communication will avoid duplication and confusion and reduce costs.     

Mucosal immunity and vaccination

Abstract The gut mucosal immune system is a critical component of the body's defense against pathogenic organisms, especially those responsible for enteric infections associated with diarrhoeal disease. Attempts to vaccinate against infections of mucosal tissues have been less successful than vaccination against systematic infections, to a large extent reflecting a still incomplete knowledge about the most efficient means for inducing protective local immune responses at these sites. Secretory IgA (SIgA) is the predominating immunoglobulin along mucosal surfaces, and SIgA antibodies generated in gastrointestinal, respiratory or genito-urinary mucosal tissues can confer protection against infections affecting or originating in these sites. An efficacious intestinal SIgA immunity-inducing oral vaccine against cholera has been developed recently, and development of oral vaccines against other enteric infections such as those caused by enterotoxigenic Escherichia coli, Shigella and rotaviruses is in progress as well. Based on the concept of a common mucosal immune system through which activated lymphocytes from the gut can disseminate immunity to other mucosal and glandular tissues, there is currently also much interest in the possibility of developing oral vaccines against infections in the respiratory and urogenital tracts. However, the large and repeated antigen doses often required to achieve a protective immune response still makes this vaccination approach impractical for many purified antigens. There is, therefore, a great need to develop strategies for enhancing delivery of antigen to the mucosal immune system as well as to identify mucosa-active immunostimulating agents (adjuvants). These and other aspects of mucosal immunity in relation to immunization and vaccine development are discussed in this short review article.     

Implications of vaccination and waning immunity

For infectious diseases where immunization can offer lifelong protection, a variety of simple models can be used to explain the utility of vaccination as a control method. However, for many diseases, immunity wanes over time and is subsequently enhanced (boosted) by asymptomatic encounters with the infection. The study of this type of epidemiological process requires a model formulation that can capture both the within-host dynamics of the pathogen and immune system as well as the associated population-level transmission dynamics. Here, we parametrize such a model for measles and show how vaccination can have a range of unexpected consequences as it reduces the natural boosting of immunity as well as reducing the number of naive susceptibles. In particular, we show that moderate waning times (40–80 years) and high levels of vaccination (greater than 70%) can induce large-scale oscillations with substantial numbers of symptomatic cases being generated at the peak. In addition, we predict that, after a long disease-free period, the introduction of infection will lead to far larger epidemics than that predicted by standard models. These results have clear implications for the long-term success of any vaccination campaign and highlight the need for a sound understanding of the immunological mechanisms of immunity and vaccination.