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Adult immigrants at risk for measles, mumps, rubella
Foreign-born women may be at greater risk for contracting measles and rubella than men.
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More than one-third of adult immigrants and refugees in Canada are susceptible to measles, mumps or rubella, and may benefit from targeted vaccination programs according to the findings of a study conducted by Christina Greenaway, MD, and colleagues at McGill University and recently published in the Annals of Internal Medicine.
The study was undertaken because researchers suspected that a high porportion of adult immigrants would be more susceptible to measles, mumps and rubella. This is because childhood vaccination programs did not begin in most developing countries until the 1970s. Mumps and rubella vaccines are not part of many of the National Vaccination Programs, said Greenaway assistant professor of medicine at McGill University in Montreal. Immigrants also have been overrepresented in rubella outbreaks in the 1990s, she said.
Data collected
In this seroprevalence study, 1,480 adult immigrants and refugees aged 18 years and older were recruited from two hospitals and three clinics in Montreal from October 2002 to December 2004. All of the participants had lived in Canada for five years or less. They were recruited consecutively by convenience sample to gather a sufficient study population from each of six world regions.
Forty-seven percent of the participants had a college eduction, and 94% described their families of origin as middle or upper income.
Regarding immunity to measles, mumps and rubella, 36% of the participants were not immune to at least one of the three diseases. Susceptibility differed by age, sex and geographic region of origin, but not by immigration class.
Immigrant women were more susceptible to measles (2.1 OR; 95% CI, 1.2-3.8) and rubella (1.7 OR; 95% CI, 1.2-2.6) but not to mumps (1.1 OR; 95% CI, 0.8-1.5) than were men. The researchers theorized that female immigrants were more susceptibile as compared to their male counterparts because they may have had less access to vaccines in their countries of origin.
In Canada, vaccinations are not updated in adult immigrants prior to arrival. In the United States, immigrants are required to have their vaccination updated prior to arrival; however, there are gaps in this system as some groups are excluded, and there is no system to verify vaccinations after arrival. Rubella outbreaks in the United States in themid-1990s, in which 80% of infected people were unvaccinated Hispanic immigrants, emphasize the need for greater awareness that there is a risk with undervaccination. From these outbreaks, there was some spread to children who were ineligible for vaccine because they were too young or who had missed their vaccine, but the risk is low. The risk of transmission is greatest within the immigrants own communities, said Greenaway, The purpose of this study was to improve the health status of the immigrant population.
Physicians need to know that a large proportions of immigrants are susceptible to MMR, Greenaway said. The results of this study, therefore, highlight the need for health care providers to take all opportunities to update MMR vaccines in the adult immigrant population.
“Effectively delivering vaccination in adults, however, is a challenge, even in nonimmigrant populations because there is no set point of contact with the health care system specifically to update vaccines,” she said. – by Kirsten H. Ellis
For more information:
- Greenaway C, Dongier P, Boivin JF, et al. Susceptibility to measles, mumps and rubella in newly arrived adult immigrants and refugees. Ann Intern Med. 2007;146; 20-21.