Anti-Rubella antibodies seroprevalence among pregnant women in South-Western Romania

Abstract

Rubella infection during pregnancy poses significant risks, including congenital rubella syndrome (CRS), miscarriage, and fetal death. Vaccination programs have reduced rubella incidence globally, but regional differences in coverage and immunity persist. The objective of the study was to assess the seroprevalence of anti-rubella IgM and IgG antibodies among pregnant women in South-Western Romania, with a focus on temporal trends, demographic factors, and the impact of vaccination eligibility. This observational, cross-sectional study included pregnant women screened for TORCH infections at the County Clinical Emergency Hospital of Craiova, Romania, during two periods: 2013–2016 and 2019–2022. Serum samples were tested for anti-rubella IgM and IgG antibodies. Participants were stratified by age, area of residence (rural/urban), and eligibility for rubella vaccination based on birth year. A total of 3,268 samples were analyzed. The seroprevalence of acute rubella infection (IgM positive) was low and slightly decreased from 0.54% (2013–2016) to 0.50% (2019–2022), with the most notable decrease in rural areas and among women aged 21–25 years. The overall seroprevalence of protective IgG antibodies was stable (88.28% vs. 88.91%), but remained below the WHO target of 95%. IgG seroprevalence increased among the youngest (<20 years) and 31–35 years age groups, particularly in rural areas, suggesting improved vaccination coverage and natural immunity from past outbreaks. Mapping in Dolj County revealed high seroprevalence near major cities. Despite improvements, the relatively low IgG seroprevalence in South-Western Romania highlights the need to reinforce vaccination campaigns, especially in rural areas and among family physicians. Enhanced education and access to vaccination are essential to achieve the WHO eradication target and prevent CRS.