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November 2017 -
Volume 15, Issue 9

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From the Editor

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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Lesley Pocock
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November 2017 - Volume 15, Issue 9

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011


Ehsan Rahmanian (1)
Farideh Mogharab
(2)
Vahid Mogharab
(1)

(1) Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran
(2) Research Center, Department of Obstetrics and Gynecology, Jahrom University of Medical Sciences, Jahrom, Iran.

Corresponding author:
Vahid Mogharab,
Department of Pediatrics,
Jahrom University of medical sciences,
Jahrom, Iran
Tel: +989171912400
Email: mogharabvahid@yahoo.com

Abstract

Introduction:
Measles and rubella are acute viral diseases. Rubella often has mild clinical symptoms and cannot be diagnosed. Pregnant mother’s infection with this disease causes serious complications, especially congenital rubella syndrome which is one of the causes of neonatal mortality, severe congenital defects and permanent disability in children. In contrast, measles often occurs with severe symptoms. This study aimed to determine the immunity level of Jahrom’s young girls and women against measles and rubella 7 years after the public vaccination comparing to determine the percentage of infection with these two viruses, the effectiveness of the vaccine and an appropriate method to prevent the complications of these two diseases.

Methodology: This study was a cross-sectional descriptive study. According to the previous study conducted one year after the public vaccination in Jahrom City, 100% of the subjects were given immune anti-rubella antibody titer and 94% received immune anti-measles antibody titer. Now this study measured anti-measles and anti-rubella antibody titers (IgG) in 180 women and girls aged 15-25 in Jahrom City through ELISA assay.

Results: 165 subjects (91.7%) had positive rubella titer, 13 subjects (7.2%) had suspected rubella titer and 1 subject (0.6%) had negative rubella titer. Meanwhile, 170 subjects (94.4%) had positive, 6 subjects (13.3%) had suspected and 3 subjects(1.7%) had negative measles titer. Regarding suspected cases as positive for long-term maintenance of serums, a total of 98.5% of people were immunized measles and 97.5% were immunized rubella. With increase of age, antibody titer significantly increased (p<0.05). There was no significant relationship between taking or not taking steroids, immunity repressor and the subjects’ immunity percentage (p<0.05).

Conclusion: The results showed that although the national vaccinationcomparing in 2003 has been effective in immunizing the women of gestational age to measles and rubella, it seems that due to the gradual reduction of this immunity, all women, before pregnancy, should undergo a test to determine their immunity to these two diseases and if necessary, booster vaccine should be inoculated.

Key words: Measles, Rubella, Congenital rubella, vaccination, IgG.


INTRODUCTION

Measles is a highly contagious disease the incidence of which declined due to widespread vaccination. However, there are still outbreaks of the disease worldwide, which can be due to the primary vaccine failure in a small percentage of children and the lack of vaccination in some percentage of preschool children and, finally, because of the reduction in the anti-measles antibody levels in children born to the mothers with no history of wild virus infection [1]. Measles vaccine failure was reported in 5% of those who received only one dose of vaccine at 12 months of age. However, weaning immunity can be observed in some people after each vaccine [2]. Rubella is a mild disease with cutaneous rash that is more severe in children and infants than in adults, and the worst problem with rubella is its trans-placental transmission, fetal infection and congenital malformation which causes eye symptoms (cataract, glaucoma, etc.), microspheres, PDA, nerve deafness, etc. in the infants. Before vaccination, rubella epidemics were observed every 6 to 9 years. Now after vaccination, the incidence of the disease has reduced by 99% [1]. Infection with rubella was asymptomatic in 25-50% of cases, and immunity after infection with virus and with vaccine was prolonged. However, at the same time, some rare cases of infections were reported [2]. After the injection of MMR vaccine, sero conversion rate was different in children. In a study conducted in Korea, after MMR injection to 121 children 1-2 years old, sero conversion rate was reported to be 97-97% for rubella and 100% for measles. Regarding the children aged 4-6, who were sero negative, all 39 children had 100% sero conversion rate for measles and rubella after MMR injection [3]. In the study conducted by Dr. Zamani and Dr. Daneshjoo in Tehran in 2004 on 1,665 schoolchildren aged 6 to 12, 68.5% had no anti-rubella antibody titer. A year after the mass MR vaccination in Iran in 2004 and during that time all women under the age of 25 were vaccinated with MR. In a research project conducted in the city of Jahrom, IgG rate against measles and rubella was reviewed in girls of 15-25 year old by ELISA method and the seropositivity rate of the vaccinated subjects was reported to be 100%. The pregnant mother’s infection with measles virus, and especially rubella virus in the first three months, can have harmful irreparable effects on the fetus. The goal of measles and rubella vaccine preparation and all its immunization programs was to avoid these complications, especially congenital rubella syndrome. Selection of the appropriate measles and rubella vaccination requires obtaining information about these diseases and their complications and performing community-based epidemiological studies, especially in pregnant women and women of reproductive age, to determine their level of immunity.

Given that in 2003, public vaccination against these two diseases was carried out for the age group of 25.5 years, and after that several similar studies in Iran and a similar study in Jahrom City were conducted, and the immunity level of the subjects after the vaccination was investigated. This study aimed to determine the immunity level against measles and rubella 9 years after the public vaccination of 15 to 25 year-old women in Jahrom City to determine the sensitivity of individuals, the efficacy of the vaccine and an appropriate immunization method to prevent these two diseases.

METHODOLOGY

It was a cross-sectional descriptive-analytic study conducted to determine the immunity level of 15-25 year-old girls and women in Jahrom City against measles and rubella virus a few years after the public vaccination. Through convenience sampling method, a blood sample was taken from 180 women aged 15-25 years who referred to the laboratory of Peymaniyeh Hospital in Jahrom City. Then, that was centrifuged and frozen at 4°C. Then, anti-measles and anti-rubella IgE titer were measured using ELISA method and Spectrophotometer. After taking blood samples from 180 volunteers aged 15 to 25, who referred to the laboratory of Peymanieh Hospital in Jahrom, and serum centrifugation and isolation, serums were stored at 4°C for several months. The research methodology was based on the use of ELISA method, which showed 97% sensitivity and 94% specificity for anti-measles IgG and 95.5% sensitivity and 97.1% specificity for anti-rubella IgG. The samples were first placed at room temperature for one hour and shaken at form 8. 100 diluted serum was added to 5 serum. Meanwhile, 5 positive controls were added to one sample and 5 negative controls and 5 cut off controls were added to one sample. Then, the samples were shaken with sugar for 2 minutes and left in a 37°C incubator for 45 minutes. Then, the samples were washed with 0.3 volumes of solution 5 times. Immediately after that, 100 volumes of IgG solution were added to all samples and they were placed in a 37°C incubator for 30 minutes. For the second time, the samples were washed with rinsing solution 5 times and immediately after that 100 substrate solution was added to all samples. After the samples were kept away from the sunlight at room temperature for 20 minutes, 50 of stop solution was added to all of them, and finally, the samples were read using spectrophotometer with a wavelength of 450/620 nm one hour after stopping the test. Samples with a specific anti-measles IgG and specific anti-rubella IgG of less than 9 IU/ml were considered negative, those with 9-11 were considered suspected and those above 11 were considered positive according to the Kite manufacturer’s instruction (Vircell Spanish Company). In this method, the antigen-antibody complex was determined by ELISA method and was read by spectrophotometer. Data were analyzed by SPSS V11 software at the descriptive statistics level and the required charts were also designed by Excel XP software.

RESULTS

In this study, serum samples of 180 girls and women of 15- to 25 years in Jahrom City who had a history of public vaccination inoculation were evaluated in terms of measles and rubella IgG. IgG levels were measured by ELISA method based on the international unit of (IU/ml). ELISA method showed sensitivity of 97% and specificity of 94% for anti-measles antibody and 95.5% sensitivity and 97.1% specificity for anti-rubella antibody. The kits used belonged to Vircell Spanish company. Samples with an antibody level below 9 IU/ml were negative, those with a level of 9-11 were suspected and those with a level of more than 11 were considered positive (according to the kit manufacturer’s instructions). The results showed that 165 out of 180 subjects (91.7%) were positive for anti-measles antibody, 1 subject (5.6%) was negative and 13 subjects (17.2%) were suspected. Moreover, 170 subjects (94.4%) had positive anti-rubella antibody, 3 subjects (1.7%) had negative and 6 subjects (3.3%) were suspected. Since suspected cases were considered positive, eventually 98.5% of subjects are still immune against measles and approximately 97.5% are still immune against rubella. Meanwhile, this study reviewed the relationship between the individuals’ immunity, steroid use, the incidence of autoimmune diseases, the use of specific drugs and vaccination, and no significant relationship was observed between the individuals’ immunity or non-immunity and the use of steroids and self-immune drugs (p<0.05). In this study, 174 (96.7%) patients did not take steroids and 6 (13.3%) patients used steroids. Moreover, 97% of those who had positive anti-measles antibody and 96.5% of those with anti-rubella antibody had used no steroids. Meanwhile, 92% of those who did not take steroids had anti-measles antibody and 94.3% of those who did not take steroids had anti-rubella antibody (Table 1).

Click here for Table 1: A description of the relationship between the absolute and relative frequency of the volunteers’ immunity against measles and rubella and taking or not taking steroids.

Out of those who had positive anti-measles antibody, 98.2% and 97.6% of those with positive anti-rubella antibodies did not use the autoimmune disease drugs. Moreover, 92% of those who did not take the autoimmune disease drugs had anti-measles antibody and 94.3% of those who did not use steroids had positive anti-rubella antibody (Table 2).

Click here for Table 2: A description of the relationship between the absolute and relative frequency of the volunteers’ immunity against measles and rubella and taking or not taking autoimmune disease drugs

There was a significant relationship between age and anti-measles and anti-rubella antibody titer (P<0/05). That is, the antibody titer increases with age increase, so that, regarding the suspected cases as immune, in the age group of 20-25 years, 99.2% are immune against measles and 97.8% are immune against rubella. However, in the age group of 15-19 years, 15-19, these figures are 92.6% and 97.5%, respectively. You can observe this comparison in Tables 3 and 4, respectively.

Table 3: Absolute and relative frequency distribution of volunteers by age and anti-measles antibody titer


Table 4: Absolute and relative frequency distribution of volunteers by age and anti-rubella antibody titer

In general, the results showed that public vaccination was quite effective and an acceptable result was achieved after 9 years.

DISCUSSION

To be able to judge the efficacy of public measles-rubella vaccination system, we needed to collect data about the immunity of people in society, especially young women of reproductive age before and after vaccination. For this purpose, various studies were conducted in Iran. In a study in Shahrekord, 150 students were examined 4 weeks before and 8 weeks after the public vaccination, 86% of whom were immunized against rubella before vaccination and 14% who were sensitive to virus. After vaccination, these figures changed to 96.9% of immune cases and only 3.1% of non-immune cases. In this study, the effectiveness of vaccination was reported to be 80.95% (5). This information was consistent with the findings from the previous study in which 100% of the subjects were immunized against rubella after a national vaccination (6). In Mashhad, the vaccination responsiveness in women aged 15 to 23 was studied. At first, 1698 subjects were examined before vaccination out of which 67.19% were immune against measles and 70.38% were immune against rubella. After vaccination, these figures reached 77.37% and 89.5%, respectively (7). In comparison with our findings from the previous study in which these figures were 94% and 100% respectively (6 - 8), the responsiveness rate was less in Mashhad due to the exclusion of some subjects from the study