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Rubella virus vaccine associated arthropathy in postpartum immunized women: influence of preimmunization serologic status on development of joint manifestations.

OBJECTIVE
To measure preimmunization rubella virus (RV)-specific IgG levels and to relate these to the development of acute and chronic (persistent or recurrent) joint manifestations following rubella vaccination.


METHODS
Specific IgG was determined by whole RV enzyme immunoassays (EIA) (Abbott Rubazyme and M33, an in-house method), immunoblot, neutralization domain peptide (BCH-178c) EIA, and neutralization bioassay in prevaccine samples of 268 RV seronegative women (Abbott absorbance < 0.999 units) who had received monovalent live attenuated RA27/3 strain RV vaccine in a clinical trial that recorded joint manifestations.


RESULTS
Of rubella vaccinated women tested for prevaccine antibodies, 21.7% were actually positive (> or = 10 IU/ml) by M33 EIA, 33.2% had Abbott values > or = 0.250 units, and 47.6% had RV protein-specific antibody (immunoblot), while only 17.6% were positive (> or = 10 IU/ml) by neutralization domain peptide EIA and 12.7% had neutralization titers > or = 1:8. Seropositivity by the various methods was compared to recorded occurrence of acute and chronic arthropathy (arthralgia and/or arthritis) after RV vaccination. Relative to women who had no joint manifestations, prevaccine seropositivity rates for subjects with acute arthropathy were significantly (p < 0.05) lower in the Abbott test (< 0.250 units), BCH-178c peptide EIA, and neutralization bioassay, while those who also developed chronic arthropathy had significantly lower prevaccine seropositivity rates for the Abbott (< 0.250 units) and M33 EIA and neutralization bioassay.


CONCLUSION
Results suggest that risk for arthropathy following RA27/3 rubella vaccination may be higher in women who have very low prevaccine levels of antibody, particularly in assays measuring functional (neutralizing) antibodies.