Rubella in pregnancy in Israel: 15 years of follow-up and remaining problems.

Despite extensive vaccination programs introduced in Israel since 1973, rubella virus continues to pose a threat to pregnant women. Screening for antibodies from women of childbearing age between 1980 and 1994 showed a decrease in seronegativity from 15.4% to 7% between the years 1980 and 1988, followed by an increase to 9.6% in 1991-92 due in part to the large wave of immigration from the former USSR, and a decrease back to 6.9% in 1993-94. The morbidity fluctuated, with peaks in 1983, 1987 and 1991, yielding a total of 219 cases in the target population of women of childbearing age. Additional problems encountered were reinfections, vaccine failures, and false positive results in screening. During the study period we confirmed 35 cases of reinfections in pregnancy, 19 of which resulted in delivery of healthy babies. In two of four cases of abortion following reinfection that we could follow, the fetus was infected. Immunization of 15-month-old babies introduced in 1989 and the new policy of two-dose vaccination introduced in 1995 are expected to further reduce the spread of rubella virus in the coming years.