Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-15T01:45:24.710Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Deborah D. Schoenhoff ,
Timothy W. Lane  and
Charles J. Hansen
Deborah D. Schoenhoff*
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
Timothy W. Lane
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
Charles J. Hansen
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
*
Internal Medicine Training Program, Moses Cone Health System, 1200 N Elm St, Greensboro, NC 27401-1020
Get access Rights & Permissions [Opens in a new window]

Abstract

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 evaluable. 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 [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting ≥5 physicians; OR, 1.2; CI95, 1.1-14).

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 guidelines need to be addressed, particularly in the office setting.

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 633 - 636
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention. Rubella and congenital rubella syndrome—United States, January 1, 1991-May 7, 1994. MMWR 1994;43:391–401.Google Scholar
2. National Coalition for Adult Immunization—standards for adult immunization practice. Am J Infect Control 1993;21:331–332.Google Scholar
3. Weinstein, W, Fliegel, P. Rubella outbreak in a prenatal clinic. Am J Infect Control 1981;93:27. Abstract.Google Scholar
4. Strassburg, MF, Stephenson, TG, Hazel, LA, Sarrin, SL. Rubella in hospital employees. Infect Control 1984;5:123–126.CrossRefGoogle ScholarPubMed
5. Polk, BF, White, JA, DeGirdami, PC, Modlin, JF. An outbreak of rubella among hospital personnel. N Engl J Med 1980;303:541–545.CrossRefGoogle ScholarPubMed
6. Mellinger, AK, Cragan, JD, Atkinson, WL, et al. High incidence of congenital rubella syndrome after a rubella outbreak. Pediatr Infect Dis J 1995;14:573–578.CrossRefGoogle ScholarPubMed
7. Centers for Disease Control and Prevention—National Immunization Program. State Immunization Requirements, 1993-1994. Atlanta, GA: US Department of Health and Human Services, CDC.Google Scholar
8. Lane, TW, Falk, P, Ivey, F. Survey of the knowledge of rubella immunity among obstetricians. In: Program and Abstracts of the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy; 10 1986; New Orleans, LA. Abstract 699.Google Scholar
9. Fraser, V, Spitznagel, E, Medoff, G, Dunagan, WC. Results of a rubella screening program for hospital employees. Am J Epidemiol 1993;138:756–764.CrossRefGoogle ScholarPubMed
10. Poland, GA, Nichol, KL. Medical schools and immunization policies: missed opportunities for disease prevention. Ann Intern Med 1990;113:628–631.CrossRefGoogle ScholarPubMed
11. Lewy, R. Immunization status of entering housestaff physicians. J Occup Med 1988;30:822–823.Google ScholarPubMed
12. Greaves, WL, Orenstein, WA, Stetler, HC, Preblud, SR, Hinman, AR, Bart, KJ. Prevention of rubella transmission in medical facilities. JAMA 1982;248:861–864.CrossRefGoogle ScholarPubMed
13. Centers for Disease Control. Rubella in hospitals—California. MMWR 1983;32:37–39.Google Scholar
14. Hartstein, AI, Quan, MA, Williams, ML, Osterud, HT, Foster, LR. Rubella screening and immunization of health care personnel: critical appraisal of a voluntary program. Am J Infect Control 1983;11:1–9.CrossRefGoogle ScholarPubMed
15. Immunization Practices Advisory Committee. Recommendations of the Immunization Practices Advisory Committee (ACIP): update on adult immunization. MMWR 1991;40:7–9.Google Scholar
16. Levy, MA, Arnold, RM, Fine, MJ, Kapoor, WN. Professional courtesy—current practices and attitudes. N Engl J Med 1993;329:1627–1631.CrossRefGoogle ScholarPubMed
17. Cykert, S, Kissling, G, Layson, R, Hansen, C. Health insurance does not guarantee access to primary care. J Gen Intern Med 1995;10:345–348.CrossRefGoogle Scholar