Rubella virus vaccine associated arthropathy in postpartum immunized women: Influence of preimmunization serologic status on development of joint manifestations

Objective. To measure preimmunization rubella virus (RV)-specific IgG level s and to relate these to the development of acute and chronic (persistent o r recurrent) joint manifestations following rubella vaccination. Methods. Specific IgG was determined by whole RV enzyme immunoassays (EIA) (Abbott Rubazyme and M33, an in-house method), immunoblot, neutralization d omain peptide (BCH-178c) EIA, and neutralization bioassay in prevaccine sam ples of 268 RV seronegative women (Abbott absorbance < 0.999 units) who had received monovalent live attenuated RA27/3 strain RV vaccine in a clinical trial that recorded joint manifestations. Results. Of rubella vaccinated women tested for prevaccine antibodies, 21.7 % were actually positive (greater than or equal to 10 IU/ml) by M33 EIA, 33 .2% had Abbott values greater than or equal to 0.250 units, and 47.6% had R V protein-specific antibody (immunoblot), while only 17.6% were positive (g reater than or equal to 10 IU/ml) by neutralization domain peptide EIA and 12.7% had neutralization titers greater than or equal to 1:8, Seropositivit y by the various methods was compared to recorded occurrence of acute and c hronic arthropathy (arthralgia and/or arthritis) after RV vaccination. Rela tive to women who had no joint manifestations, prevaccine seropositivity ra tes for subjects with acute arthropathy were significantly (p < 0.05) lower in the Abbott test (< 0.250 units), BCH-178c peptide EIA, and neutralizati on bioassay, while those who also developed chronic arthropathy had signifi cantly lower prevaccine seropositivity rates for the Abbott (< 0.250 units) and M33 EIA and neutralization bioassay, Conclusion. Results suggest that risk for arthropathy following RA27/3 rube lla vaccination may be higher in women who have very low prevaccine levels of antibody, particularly in assays measuring functional (neutralizing) ant ibodies.