EVALUATION OF RUBELLA SCREENING IN PREGNANT-WOMEN

Background: The rationale for rubella vaccination in the general popul ation and for screening for rubella in pregnant women is the preventio n of congenital rubella syndrome. The objective oi this study was to e valuate the effectiveness of the prenatal rubella screening program in Quebec. Methods: A historical cross-sectional study was designed. Six teen hospitals with obstetric services were randomly selected, 8 from among the 35 ''large'' hospitals in the province (500 or more live bir ths/year) and 8 from among the 50 ''small'' hospitals (fewer than 500 live births/year). A total of 2551 women were randomly selected from a ll mothers of infants born between Apr. 1, 1993, and Mar. 31, 1994, by means of stratified 2-stage sampling. The proportions of women screen ed and. vaccinated were ascertained from information obtained from the hospital chart, the physician's office and the patient. Results: The overall (adjusted) screening rate was 94.0%. The rates were significan tly different between large and small hospitals (94.4% v. 89.6%). Five large hospitals and one small hospital had rates above 95.0%. The lik elihood of not having been screened was statistically significantly hi gher for women who had been pregnant previously than for women pregnan t for the first time (4.8% v. 1.4%; p < 0.001). Of the 200 women who w ere seronegative at the time of screening (8.4%), 79 had been vaccinat ed postpartum, had a positive serological result on subsequent testing or did not require vaccination, and 59 had not been vaccinated postpa rtum; for 62, subsequent vaccination status was unknown. Interpretatio n: Continued improvement in screening practices is needed, especially in small hospitals. Because vaccination rates are unacceptably low, it is crucial that steps be taken to address this issue.