Primary Prevention and Rubella Immunity: Overlooked Issues in the Outpatient Obstetric Setting

• Published in: Infection control and hospital epidemiology 1997-09, Vol.18 (9), p.633-636
• Main Authors: Schoenhoff, Deborah D., Lane, Timothy W., Hansen, Charles J.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Documentation; Epidemiology; Female; Fertility; Gynecology; Health care industry; Health Surveys; Human viral diseases; Humans; Immune status; Immunity; Immunity, Cellular; Immunization; Infectious Disease Transmission, Professional-to-Patient - prevention & control; Infectious diseases; Male; Medical personnel; Medical practice; Medical schools; Medical sciences; Nursing; Obstetrics; Physicians; Physicians - statistics & numerical data; Pregnancy; Pregnancy Complications, Infectious - prevention & control; Regression analysis; Rubella; Rubella - immunology; Rubella - prevention & control; United States; Vaccination; Vaccines; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/647688

Objective: To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting. Design: Mailed survey questionnaire, August through December 1994. Setting: Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings. Participants: 3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database. Main Outcome Measures: Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed. Results: Questionnaires were returned from 50% 1,666) of the 3,302 surveyed, and 96% (1,599) were evaluble. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [$CI_{95}$], 1.8-3.1), medical school graduation since 1980 (OR, 2.6;$CI_{95}$, 2.0-3.3), providing obstetric or fertility services (OR, 1.5;$CI_{95}$, 1.2-1.9), and group practice setting (≥5 physicians; OR, 1.2;$CI_{95}$, 1.1-1.4). Conclusions: Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guide