Læknablaðið - 15.12.1980, Blaðsíða 14

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LÆKNABLAÐIÐ
Tvær stefnur hafa verið ríkjandi við bólu-
setningu gegn rauðum hundum og hefur áður
verið um þær rætt. (16) Hvorki í Bandaríkjun-
um né Bretlandi hefur náðst að bólusetja jafn
marga og pyrfti. (8, 12) Ástæðan er ef til vill
fólksfjöldi landanna og erfiðleikar að ná til
allra þeirra, sem áætlanir gerðu ráð fyrir.
Rauðu hunda faraldrar hafa stungið sér niður í
Bretlandi (8) og Bandaríkjunum. (14) í Banda-
ríkjunum hafa faraldrar gengið í öðrum ald-
urshópum en áður p. e. í ríkari mæli meðal
táninga og fullorðinna. Breyting hefur orðið á
ónæmistíðni kvenna síðustu árin í báðum
löndum, aukin tíðni jákvæðra í Bretlandi (2, 3)
en neikvæðra í Bandaríkjunum. (18) Hefur
faraldurshegðun sýkinnar greinilega breyzt
sem afleiðing bólusetningarherferða. Á íslandi
eru áætlanir nokkuð frábrugðnar pessum tveim
stefnum. Auk pess að bólusetja neikvæðar
12 ára telpur hafa hér verið hafnar skipulegar
mótefnamælingar kvenna á aldrinum 12 til 45
ára með pað fyrir augum að bjóða peim, sem
neikvæðar reynast bólusetningu. Á pennan
hátt er nú reynt að útrýma fósturskemmdum
af völdum rauðra hunda með pví að verja
hverja einstaka konu gegn sýkingu. Nið-
urstöður rannsóknarinnar, sem hér er greint
frá sýna, að meginporri hinna bólusettu hafa
varist endursýkingu 2 árum eftir bólusetningu.
Pær 5, sem hækkuðu mótefni sín svo skömmu
eftir bólusetningu og pær 2 sem fengu klínisk
einkenni minna okkur pó á, að ekki er hægt að
treysta í blindni á bóluefnið. Verður pví að
halda áfram að fylgjast vel með ónæmis-
ástandi kvenna á íslandi gegn rauðum hund-
um, ekki sízt með endurteknum mælingum
mótefna telpnanna í pessum fyrsta bólusetning-
arhópi.
SUMMARY
This report describes a follow-up on 345 schoolgirls
in Reykjavík, Iceland, given RA/27/3 rubella vaccine
early in 1977, when they were 12 years old. They
lived in a rubella free environment during the first
year after vaccination and showed insignificant
changes in titer of rubella hæmagglutinations-
inhibitions (HI) antibodies, when sera taken 6 weeks
after vaccination were compared with sera taken at
the end of the first year (17). Those who then had
the lowest positive HI titer, 22 girls with a titer of
1/20, were revaccinated with no »booster« effect
detectable 6 weeks after revaccination. Two years
after vaccination all these 345 vaccinees were
heavily exposed to wild rubella virus in a severe
rubella epidemic reaching a peak in mid-winter
1978-79. There were many clinical cases of rubella
in unvaccinated boys in all their classes at school
and 116 vaccinees (33,6 °/o) were exposed to clinical
cases in their homes.
Originally these vaccinees were selected from a
group of 720 girls screened for rubella HI antibodi-
es. Of the 345 vaccinees here studied 333 were
seronegative prior to vaccination and 12 low
positive naturally immune (H1 titer 1/20). In this
study 193 of their naturally immune classmates, that
did not need rubella vaccination in 1977 served as a
control group. The control group was equally
exposed in the same classes at school and 41 of
these girls (21,2%) reported clinical cases in their
homes.
Paired sera were available from all. The vaccinees
were bled a year after vaccination. These specimens
were kept frozen at —25°C and so were sera from
the unvaccinated controls taken for screening tests
in 1977. This material was thawn and retested for
comparison with sera taken shortly after the peak
of the epidemic (March 79). AU specimens were
tested for Hl antibodies and single radial immuno-
diffusion (HIG test) done on them all. Complement
fixations (CF) test was done on paired sera from 149
vaccinees and 77 girls from the control group, who
either had close contact with clinical cases or
reported illness with exanthem or arthralgia during
the epidemic. 30 vaccinated girls (8,7 %) and 15
naturally immune girls in the control group (7,7 %)
gave histories of rubelliform exanthema and 24
(6,9%) vaccinees and 16 (8,3%) of the controls
gave history of arthralgia. Only 5 vaccinees, all
seronegative prior to vaccination, (1,5%) and 2
naturally immune unvaccinated girls (1 %) showed
significant rise in antibody titers in the serological
tests, indicating reinfection. Thereof 2 vaccinees of
the 5 had histories of rubelliform exanthem lasting a
few days, but no other clinical signs. The others
reported no illness. These 7 cases of reinfection
were not from the lowest positive group of vaccine-
es and naturally immune, as might have been
expected. Prior to exposure in the epidemic they all
had antibody titers considered protective, but they
all reported close contact with clinical cases of
rubella. As highly significant increase in more than
one type of rubella antibodies was demonstrated
viremia cannot be excluded in these ases
HEIMILDIR
1. Árnadóttir, Þ.: Mæling á mótefnum gegn tveim-
ur fósturskemmandi veirum rubellaveiru og
cytomegaloveiru B. Sc. ritgerð við Háskóla
Íslands.
2. M. Clarke, J. Boustred, G. C. Schild, V. Seagro-
att, T. M. Pollock, S. E. Finlay, J. A. J-. Barbara.
Effect of rubella vaccination programme on
serological status of young adults in United
Kingdom. Lancet, June 9, 1224-1226, 1979.