Postgraduate Medicine

ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20

Screening for Rubella on a University Campus Marjorie J. McKusick To cite this article: Marjorie J. McKusick (1976) Screening for Rubella on a University Campus, Postgraduate Medicine, 59:3, 200-205, DOI: 10.1080/00325481.1976.11714310 To link to this article: http://dx.doi.org/10.1080/00325481.1976.11714310

Published online: 07 Jul 2016.

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community medicine SCREENING FOR RUBELLA ON A UNIVERSITY CAMPUS Marjorle J. McKuslck, MD Student Health Service University of Delaware Newark

Today·~

college-age students have not benefited from the mass immunization of children that followed the introduction of live attenuated rubella vaccine in 1969. Speculation on one university campus as to the number of young women who were susceptible to rubella led to a pilot program of rubella screening and a follow-up program of immunization and provided valuable data on the need for such a project.

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• On April23, 1975, the Student Health Service at the University of Delaware received a telephone cali from Scott Baumen, Office of Infectious Disease Control, Division of Public Health of the State of Delaware. He told us that of six cases of rubella reported to his office in 1975, two involved students at the university, both 19-year-old girls. He was curious to know if there was any connection between the two cases. Investigation revealed th at the two students did not know each other, lived in different dormitories, and did not attend classes together. Although the cases were not related epidemiologically, the report stirred us into action. We began to wonder how many of our students were susceptible to rubella and what we should be doing to promo te ru bella immunization in a population of young women of childbearing age, many of whom would certainly become pregnant in the next few years. Prellmlnary Investigation

From a review of the lite rature and conversations with experts in the field, we gathered sorne data on rubella that provided valuable background in assessing the need for a pilot screening project on our campus. In 1969, live attenuated vaccine for rubella was introduced. From 1970 to 1972, a major public effort was made to prevent the disease in children 1 to 12 years old. As a result, 45.8 million doses of rubella vaccine were distributed in the United States during those three years. 1 However, students presently of colle ge age ( 17 to 21) did not benefit from this mass immunization, since they were over 12 years of age at the time. Thus, most of the students on our campus were not immunized and would be protected only if they bad bad the disease or if their · persona! physician would take the risk of immunizing them when they might be pregnant and not know it or be unwilling to revea1 it. We learned that the experts bad disproved the theory of"herd immunity, " 2 ie, that the most Iikely contact of a pregnant woman is ber young children. If the theory were correct and if all young children were immunized, pregnant women would then be protected from contact with rubella by the "berd" of immunized preschool and school-age children. Since this bas not proved to be the case, it is clearly desirable to immunize young women before conception. 3 ..,.

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community medicine -NOTICETC ALL FEMALE STUDENTS This is the time of year that rubella (German measles) is on the rise. Several cases have occurred on campus. The Student Health Service is concerned that a number of female students may not be immune. If a susceptible female contracts the disease during the first three months of pregnancy, there is a high risk of serious damage to the fetus and birth of a baby with defects such as blindness, deafness, and/or mental retardation.

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To avoid this tragedy avery woman of childbearing age should know if she is immune to rubella. There is a blood test that will tell you if you are susceptible or immune. lmmunity generally lasts a lifetime and can be achieved by having the disease or by receiving a single shot of rubella vaccine. We recommend that any female student who thinks she has neither had the disease nor received a rubella shot during childhood or adolescence have a blood test. The Student Health Service will hold free clinics on three evenings this week to do the test on any female student who feels she may be susceptible. PLACE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ DATES:, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ TIME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Results of this test will be mailed the week of to ali students who participate. Those who ara found to be susceptible will be advised regarding the need for receiving rubella vaccine. Signed: _ _ _ _ _ _ _ _ _ _ _ _ __ Director, Student Health Service Figure 1. Sample notice of rubella screening program.

We learned that in another student population offered tes ting for ru bella susceptibility, only 1% took advantage of the offer. This study at Memphis State University 4 in 1974 showed that after the initial report of an outbreak, 205 of a total of20,000 students volunteered for rubella hemagglutinationinhibition antibody testing. From this, we extrapolated the number of students at the University of Delaware who might elect to be tested. Our student body numbers 13 ,000; thus, we estimated that 130 students might report for determination of titers. The Memphis State University population was different from ours, however, since most of the Memphis students were commuters, part-time students, or bath, whereas most of ours are resident and full-time students. Also, it was not clear how weil the Memphis program had been advertised. By saying that the

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students "volunteered" for testing, the report gave the impression that the investigators were acting as buyers, not sellers. We felt that we might attract more students by representing our program as a free service rather than by requesting volunteers for a research project. From this preliminary investigation we concluded that a pilot project of this kind would give us and others valuable information on the incidenc·e of ru bella susceptibility in college-age wo\nen, methods of motivating susceptible women to be immunized, methods of obtaining funds, and the anticipated response to such a program by an intelligent and captive group of women. Procedure

We began by soliciting the cooperation of the state division of public health, which

POSTGRADUATE MEDICINE o March 1976 o Vol. 59 o No. 3

community medicine - - - - - - - - - - - - - - - - - - - CERTIFICATE OF INFORMED CONSENT The Student Health Service is offering rubella (German measles) vaccine to ali female students who have rubella titers of 1 :10 or less, indicating that they are susceptible to rubella. lt is imperative that you are not pregnant at the ti me you get the shot and do not become pregnant for three (3) months after the shot is given. lt is presently felt that although an attenuated virus is used in the ru bella vaccine, it may damage the fetus in the same way that rubella can cause congenital anomalies if it is contracted during the first three months of pregnancy.

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1, , hereby certify that 1have read the above paragraph. lt has been explained to me, ali of my questions have been satisfactorily answered, and 1 voluntarily agree to be vaccinated for rubella. Signed: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Date: ________________ Witness: ________________ Figure 2. Sample certificate of informed consent for students electing ta receive rubella vaccine.

table 1. statistics of the rubella screening program, student health service, university of delaware, may 1975 13,000

Total student population Female student population

6,500

Number of students tested

338

Number of students susceptible Number of students immunized At Student Health Service During first follow-up Later Elsewhere

66 52 48 33 15 4

Number of susceptible students not immunized to date

14

table 2. expenses of the rubella screening program, student health service, university of delaware, may 1975 Laboratory technicians Nurse

$120 35

Physician Postage

50

Receptionist

25

Advertisement Total

204

$305

until this time had been offering a free rubella-susceptibility test only ta women who applied for a marriage license. The officiais responded ta our request, providing us with ali the necessary equipment and offering the division's services ta test as many blood specimens as we sent ta them. W e th en proceeded ta advertise our program. On May 9 and 13, we placed a notice (figure 1) in the semiweekly student newspaper. Three clinics were held, on successive evenings, during the week of May 12 ta 16, staffed by one receptionist, one physician, one nurse, and three laboratory technicians. A total of 338 students reported ta the Student Health Service f~r tes ting, and the receptionist noted sorne interesting patterns in their response. At times, large numbers of girls arrived together, obviously friends from a single dormitory or sorority house. It appeared that one or two leaders had rounded up the girls and herded them into the ciinic. A spirit of camaraderie and mock fear prevailed. Each evening the tests were offered, the number of students increased. Apparently the news spread rapidly by ward of mouth through dormitories and classrooms, and we regretted that we had not started earlier in the spring to allow more time for testing before the semester ended. Nevertheless. we were pleased that our expectation of 130 students, extrapolated from the Memphis study. was far exceeded.

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Results and Follow-up

The results of the tests (table 1) were about what we had expected in this age group on the basis of the report of Rauh and associates. 5 Of the 338 students tested, 66 (20%) proved to be susceptible to rubella. Two letters were prepared to be sent, as appropriate, with a copy of each student's laboratory report. One letter was sent to girls with titers great er th an 1: 10 dilution, indicating that they were immune. The other informed the students with titers equal to or less th an 1: 10 th at they were not immune and offered rubella vaccine. 6 Two vaccination clinics were held during the last week of school. However, many of the girls were having examinations that week or had already left campus, so we encouraged them to get rubella vaccine from their family physician if they could not come to the Student Health Service at one of the designated times. We offered immunization at the cast of the vaccine and had each student sign a release form (figure 2) indicating that she understood the possible hazard ofbecoming pregnant during the three months following immunization. Although pregnancy counseling was offered to ali students receiving the vaccine, none requested it. During the rubella immunization clinics, 33 students reported, exactly half of the target population. Follow-up letters were sent to those who did not report. Of the 33 nonimmunized students, four received vaccine from their own physician, 15 returned to the Student Health Service for vaccine in the fall, and 14 have not yet responded. The campus and community response to our rubella screening program has been very positive. Many letters were received commending the Student Health Service for providing the service to the young women on campus and urging us to continue the pro gram during the next few years. We hope that

Marjorie J. McKusick

Dr. McKusick is director of the Student Health Service, University of Delaware, Newark.

budget constraints will not interfere with our ability to offer a similar program. Bec ause of the support of the public health division, the costs for the first screening were minimal (table 2), amounting to about $1 per student. During the current academie year, we hope to get support once again from the state division of public health. This will be contingent on passage of a bill in the state legislature to appropriate funds to support the rubella screening pro gram for women of childbearing age. Summary

Of6,500 young women of childbearing age in a university population, 338 (5%) presented for free testing of their rubellasusceptibility statu s. Of 66 (20%) found to be susceptible, 48 (73%) were immunized at the Student Health Service and 4 (6%) were vaccinated elsewhere. The Student Health Service is campaigning actively to vaccinate the remaining 14 susceptible students (21% ). We also plan to conduct another campaign during this academie year to immun ize an even larger segment of the female students susceptible to rubella. • Presented at the third annual clinical and experimental research meeting of the Society for Adolescent Medicine. Washington, DC. Address reprint requests to Marjorie J. McKusick, MD, Director, Student Health Service. University of Delaware. Newark. DE 19711.

References l. Bolognese RJ, Carson SL: Rubella vaccination: A critical review. Obstet Gynecol 42:851, 1973 2. Klock LE. Rachelefsky GS: Failure of rubella herd immunity during an epidemie. N Engl J Med 288:69, 1973 3. Rachelefsky GS. Herrmann KL: Congenital rubella surveillance following epidemie rubella in a partially vaccinated community. J Pediatr 84:474, 1974

Vol. 59 • No. 3 o March 1976 • POSTGRADUATE MEDICINE

4. Guyer B, Giandelia JW. Bisno AL. et al: The Memphis State University ru bella outbreak: An example of changing ru bella epidemiology. JAMA 227:1298, 1974 5. Rauh JL. Schiff GM, Johnson LB: Follow-up studies of rubella vaccinees at adolescence. J Pediatr 86:138, 1975 6. Schiff GM, Rauh JL: Rubella control. Am J Dis Child 122:112, 1971

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Community medicine: screening for rubella on a university campus.

Today's college-age students have not benefited from the mass immunization of children that followed the introduction of live attenuated rubella vacci...
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