CTF Summary Table: Congenital Rubella Syndrome

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Screening and Vaccinating Adolescents and Adults to Prevent Congenital Rubella Syndrome

Adapted by Marie-Dominique Beaulieu, MD, MSc, FCFP, Department of Family Medicine, University of Montreal, from a report prepared for the US Preventive Services Task Force by Carolyn DiGuiseppi, MD, MPH

These recommendations were finalized by the Task Force in January 1994

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Screening for immunization status followed by vaccination*

Screening for immunization status (serology or proof of vaccination) and immunization of women at risk. Screening for immunization status and vaccination of women at risk can increase seropositivity rates to 95%. Cohort studies <12-14> (II) Fair evidence to include in the periodic health examination of women of child-bearing age. (B)

Screening for serologic proof of immunization in pregnant women and counselling of seronegative women. No studies have evaluated the effectiveness of this strategy. Knowledge of the serologic status of pregnant women is considered important to counsel/document new infection. Expert opinion <3> (III) Fair evidence to include in the periodic health examination of pregnant women. (B)

Universal vaccination*

Universal vaccination of adolescent and young women independently of prior knowledge of immunization. Confers immunity without significant adverse effects. Universal immunization of adolescent and young women is an effective alternative to screening followed by immunization and may be less expensive. Cohort studies <15,16> (II) Fair evidence to include in the periodic health examination of women of child-bearing age. (B)

Universal vaccination of young men in settings where large number of people gather. The only cohort study used a less immunogenic vaccine than the one used in women's studies. Cohort study (methodologic problems) <17> (II) Lack of evidence to include or exclude in the periodic health examination of young men gathered in large settings. (C)

* The decision of which strategy to use should be tailored to the individual clinician's practice population, depending on the availability of vaccination records, the rate of immunity, the cost of serologic testing and of follow-up vaccination for susceptible people.

Link to Full Text of this review

Link to Structured Abstract of this review

Link to Selected References list of this review

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Screening for immunization status (serology or proof of vaccination) and immunization of women at risk.	Screening for immunization status and vaccination of women at risk can increase seropositivity rates to 95%.	Cohort studies <12-14> (II)	Fair evidence to include in the periodic health examination of women of child-bearing age. (B)
Screening for serologic proof of immunization in pregnant women and counselling of seronegative women.	No studies have evaluated the effectiveness of this strategy. Knowledge of the serologic status of pregnant women is considered important to counsel/document new infection.	Expert opinion <3> (III)	Fair evidence to include in the periodic health examination of pregnant women. (B)

Universal vaccination of adolescent and young women independently of prior knowledge of immunization.	Confers immunity without significant adverse effects. Universal immunization of adolescent and young women is an effective alternative to screening followed by immunization and may be less expensive.	Cohort studies <15,16> (II)	Fair evidence to include in the periodic health examination of women of child-bearing age. (B)
Universal vaccination of young men in settings where large number of people gather.	The only cohort study used a less immunogenic vaccine than the one used in women's studies.	Cohort study (methodologic problems) <17> (II)	Lack of evidence to include or exclude in the periodic health examination of young men gathered in large settings. (C)