Susan Reef

Publications (16)118.07 Total impact

• Article: Toward rubella elimination in Europe: an epidemiological assessment.

  Mark Muscat, Laura Zimmerman, Sabrina Bacci, Henrik Bang, Steffen Glismann, Kåre Mølbak, Susan Reef
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  ABSTRACT: The elimination of rubella and prevention of congenital rubella syndrome (CRS) by 2015 are established goals for Europe. Our aim was to review the epidemiology of rubella in relation to this goal. National surveillance institutions from 32 European countries provided information on rubella and CRS surveillance systems and data for 2000-08. We reported the number of notified rubella cases by year for countries with a national mandatory notification system for rubella covering total country population consistently throughout 2000-08 and analysed rubella surveillance data for 2008. Throughout 2000-08, 24 countries conducted passive routine surveillance based on mandatory reporting rubella covering total country population. Altogether these countries reported 526,751 rubella cases. The median incidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By 2008, the number of countries with mandatory notification systems for rubella increased to 28. These countries reported 21,475 rubella cases of which 1.5% (n=317) were laboratory-confirmed. Most cases (n=21,075; 98%) were reported from Poland, Italy and Romania. Ten countries reported zero rubella cases and five others reported an incidence of <1 per million inhabitants. In 2008, 20 CRS cases were reported from five countries. The overall decline in rubella incidence and increase in the number of countries conducting rubella surveillance through a mandatory notification system are notable achievements toward the goal of rubella elimination in Europe. However, in a few countries with high rubella incidence the risk for CRS still exists. Achievement and maintenance of the required high vaccination coverage and high-quality surveillance of rubella and CRS including laboratory testing of all suspected cases are fundamental to eliminate rubella and prevent CRS in Europe.
  Vaccine 12/2011; 30(11):1999-2007. · 3.77 Impact Factor
• Article: Developing rubella vaccination policy in Nepal--results from rubella surveillance and seroprevalence and congenital rubella syndrome studies.

  Shyam Raj Upreti, Kusum Thapa, Yasho Vardan Pradhan, Geeta Shakya, Yuddha Dhoj Sapkota, Abhijeet Anand, Thomas Taylor, Ondrej Mach, Susan Reef, Sirima Pattamadilok, Jayantha Liyanage, Patrick O'Connor, Tika Sedai, Sagar Ram Bhandary, Jeffrey Partridge, William Schluter
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  ABSTRACT: The Government of Nepal is interested in preventing congenital rubella syndrome (CRS). Surveillance data were analyzed and studies conducted to assess the burden of rubella and CRS and aid in developing a rubella vaccination strategy. (1) Analysis of rubella cases reported through measles surveillance, 2004-2009; (2) in 2008, rubella seroprevalence among women 15 to 39 years of age was evaluated; and (3) in 2009, children attending a school for the deaf were examined for ocular defects associated with CRS. From 2004-2009, there were 3,710 confirmed rubella cases and more than 95% of these cases were less than 15 years of age. Of 2,224 women of childbearing age (WCBA) tested for anti-rubella IgG, 2,020 (90.8%) were seropositive. Using a catalytic infection model, approximately 1,426 infants were born with CRS (192/100,000 live births) in 2008. Among 243 students attending a school for the deaf, 18 (7.4%) met the clinical criteria for CRS. Rubella and CRS were documented as significant public health problems in Nepal. A comprehensive approach is necessary, including introducing rubella vaccine in the routine program, assuring immunity among WCBA, strengthening routine immunization, integrating rubella surveillance with measles case-based surveillance, and establishing CRS surveillance.
  The Journal of Infectious Diseases 07/2011; 204 Suppl 1:S433-8. · 6.41 Impact Factor
• Article: Rubella epidemiology in Africa in the prevaccine era, 2002-2009.

  James L Goodson, Balcha Masresha, Annick Dosseh, Charles Byabamazima, Deogratias Nshimirimana, Stephen Cochi, Susan Reef
  The Journal of Infectious Diseases 07/2011; 204 Suppl 1:S215-25. · 6.41 Impact Factor
• Source

  Available from: Pawel Stefanoff

  Article: Toward rubella elimination in Poland: need for supplemental immunization activities, enhanced surveillance, and further integration with measles elimination efforts.

  Laura Zimmerman, Justyna Rogalska, Kathleen A Wannemuehler, Marzena Haponiuk, Adam Kosek, Ewa Pauch, Elzbieta Plonska, Daniel Veltze, Miroslaw P Czarkowski, Nilesh Buddh, Susan Reef, Pawel Stefanoff
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  ABSTRACT: All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella. We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003-2008 and case-based data from 4 provinces from the period 2006-2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008. Since 1966, rubella outbreaks have occurred every 4-6 years in Poland. Aggregate and case-based data from the period 2003-2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%. Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts.
  The Journal of Infectious Diseases 07/2011; 204 Suppl 1:S389-95. · 6.41 Impact Factor
• Article: A review of the smallpox vaccine adverse events active surveillance system.

  Tracy N Thomas, Susan Reef, Linda Neff, Mercedes M Sniadack, Gina T Mootrey
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  ABSTRACT: In response to concern about smallpox possibly being used as a biological weapon, the President of the United States launched the National Smallpox Pre-Event Vaccination Program on 13 December 2002. Given safety concerns, identifying potentially serious adverse events (SAEs) was an essential tool of the program. To monitor for SAEs, both enhanced passive surveillance and active surveillance systems were used. The enhanced passive system was built, in part, on the existing Vaccine Adverse Event Reporting System; the active system was implemented 24 January 2003. During January 2003-May 2005, the active system detected only 1 SAE in addition to those reported through the enhanced passive system. Furthermore, the active system was not universally used by states. With the enhancements to passive surveillance, the performance of enhanced passive surveillance was comparable to that of active surveillance. However, an active surveillance system may be important when there is no enhanced passive surveillance system available.
  Clinical Infectious Diseases 04/2008; 46 Suppl 3:S212-20. · 9.15 Impact Factor
• Article: Medical practices for prevention of perinatal infections in Puerto Rico.

  Gustavo H Dayan, Carmen Rodríguez Caquías, Yaniré García, Tasneem Malik, John Copeland, Daoling Bi, Susan Reef
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  ABSTRACT: Recommendations for screening for maternal infections and interventions to prevent disease in the fetus or newborn have been in place in Puerto Rico for more than 10 years. However, compliance with these recommendations has not been widely documented. We evaluated compliance with rubella/hepatitis B prenatal screening and vaccination recommendations, assessed hospital screening practices for syphilis and HIV, and determined risk factors for suboptimal prenatal care. Records of a random, stratified sample of 2003 pregnant women delivering in eight maternity hospitals in Puerto Rico in 2002 were reviewed. Obstetric prenatal and postnatal records were also reviewed when rubella/hepatitis B surface antigen (HBsAg) screening was not available at the hospital, and to document rubella postpartum vaccination (PPV). Prenatal screening rates were 98.4% for rubella and 98.8% for HBsAg. Overall, 5.4% [95% CI 4.4, 6.5] of women were susceptible to rubella. No eligible women received rubella PPV at the hospital and only 1.5% had documented rubella vaccine prescription at the obstetric records. Only one woman was found to be HBsAg positive and her newborn was adequately treated. However, only 0.9% newborns born to mothers with unknown HBsAg status received hepatitis B vaccine. Screening was documented in 85.7% of the hospital records for HIV and 87.9% for syphilis. Suboptimal prenatal care was more likely among teenagers, low-educated women, and women with >3 previous pregnancies. Screening rates for rubella and hepatitis B were high; however, implementation of recommendations for prevention of rubella and hepatitis B needs to be improved.
  Paediatric and Perinatal Epidemiology 01/2008; 22(1):31-9. · 2.31 Impact Factor
• Source

  Available from: Maria L Avila-Aguero

  Article: Fetal risk associated with rubella vaccination during pregnancy.

  Xiomara Badilla, Ana Morice, Maria L Avila-Aguero, Elizabeth Saenz, Ilse Cerda, Susan Reef, Carlos Castillo-Solórzano
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  ABSTRACT: Costa Rica implemented a nationwide measles-rubella vaccination campaign among men and women (15-39 years old) in May 2001. A protocol was developed to follow-up the vaccinated women who were unknowingly pregnant, to determine the risk of congenital rubella syndrome (CRS) or congenital rubella infection only associated with the administration of the rubella vaccine RA27/3 during pregnancy. To classify the prevaccination maternal immune status, a serum sample was taken at the initial evaluation to detect IgM and IgG rubella antibodies (enzyme-linked immunosorbent assay). All pregnancies were followed up and all newborns were evaluated. A cord serum sample of their children was taken at birth. We calculated odds ratio, OR (95% confidence interval, 95% CI) associated with miscarriage, stillbirth, prematurity, low birth weight, and the presence of defects compatible with CRS. The prevaccination immune status was established in 797 women and 1191 mother and child pairs were analyzed. Adjusted OR for miscarriage (OR = 0.60, 95% CI = 0.26-1.39), stillbirth (OR = 1.32, 95% CI = 0.10-16.81), prematurity (OR = 0.25, 95% CI = 0.03-2.39), low birth weight (OR = 0.25, 95% CI = 0.03-2.23) and defects compatible with CRS (OR = 1.09, 95% CI = 0.34-3.54) showed no association between immune and susceptible maternal status. There were no cases of CRS and no children were IgM positive. No adverse pregnancy outcome such as miscarriages or CRS was documented in women who were vaccinated and unknowingly pregnant. These results support RA27/3 rubella vaccine safety.
  The Pediatric Infectious Disease Journal 10/2007; 26(9):830-5. · 3.58 Impact Factor
• Article: Estimating the burden of congenital rubella syndrome in Costa Rica, 1996-2001.

  Gabriela Jiménez, María L Avila-Aguero, Ana Morice, Hazel Gutiérrez, Alejandra Soriano, Xiomara Badilla, Susan Reef, Carlos Castillo-Solórzano
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  ABSTRACT: The epidemiology of rubella in Costa Rica changed during recent decades, shifting the susceptible groups to the reproductive age. This study estimates the burden of congenital rubella syndrome (CRS) from 1996 to 2001 in this country. Three methods to calculate CRS incidence were used. A retrospective search ("Observed cases") was conducted using hospital discharge records of children born from 1996 to 2001 with selected codes of ICD9 and ICD10 consistent with CRS and children <3 months of age with a positive serologic test for rubella IgM antibody at the National Children's Hospital (NCH). Cases were classified as either suspected, compatible or confirmed CRS and congenital rubella infection. "Expected" incidence of CRS was calculated using reported cases of rubella (women 15-45 years of age) and fertility rates, assuming CRS probability of 0.9 during the first trimester of pregnancy and 0.5 of asymptomatic rubella cases. "Estimated" CRS cases were calculated using incidence rates reported from modeling analysis during epidemic and endemic years. Of the 577 discharge charts reviewed and the 66 children reported as rubella IgM(+), 40 compatible CRS cases, 45 confirmed, and 4 with congenital rubella infection cases were identified. The range of annual incidence rate of CRS (per 1000 live births) was as follows: "Observed" = 0.00-0.33, "Expected" = 0.00-0.35 and "Estimated" = 0.5-1.5. Compared with the estimated number of CRS cases, only 27.2% of CRS cases were detected from the retrospective search and 10.1% would be expected when calculated using rubella reported cases. The under-detection of CRS cases using rubella reported cases in women of reproductive age and retrospective search of CRS reinforces the importance of suspecting CRS in the presence of a single compatible manifestation. Laboratory confirmation is indispensable to implement CRS elimination strategies and should be done in every suspected case.
  The Pediatric Infectious Disease Journal 05/2007; 26(5):382-6. · 3.58 Impact Factor
• Article: Reducing global disease burden of measles and rubella: report of the WHO Steering Committee on research related to measles and rubella vaccines and vaccination, 2005.

  Claude P Muller, Jacques R Kremer, Jennifer M Best, Ines Dourado, Henda Triki, Susan Reef
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  ABSTRACT: The WHO Steering Committee reviewed and evaluated the progress towards global control of measles and rubella and provided guidelines for future research activities concerning both diseases during its meeting in New Delhi, in April 2005. Global measles vaccination coverage increased from 71% in 1999 to 76% in 2004 and indigenous transmission was interrupted or kept at very low levels in many countries. However, Africa and Southeast Asia continue to experience endemic transmission and high mortality rates, despite a global mortality reduction of 39% between 1999 and 2003. On the basis of reports from countries with continued indigenous measles virus transmission, future control strategies as well as advantages and potential drawbacks of global measles eradication were discussed. Similarly the burden of rubella and congenital rubella syndrome (CRS) as well as the cost-effectiveness of rubella vaccination was assessed using different methods in several countries without vaccination programs. As measles and rubella viruses continue to circulate surveillance and control strategies need further optimization. RT-PCR was considered as an alternative method for laboratory diagnosis of CRS. The value of dried blood spots and oral fluid as alternative samples for measles and rubella IgG and IgM detection and genotype determination was evaluated. However further validation of these methods in different settings is required before their routine use can be recommended.
  Vaccine 02/2007; 25(1):1-9. · 3.77 Impact Factor
• Article: Low postpartum rubella vaccination rates in high-risk women, Miami, Florida, 2001.

  Sharon A Bloom, Mary Jo Trepka, Robert E Nobles, Merardo A Becerra, Susan Reef, Guoyan Zhang
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  ABSTRACT: To evaluate adherence to the Advisory Committee on Immunization Practices' recommendations on postpartum rubella vaccination in hospitals with a high proportion of foreign-born Latina mothers, the highest risk group for congenital rubella syndrome. In four large hospitals in Miami-Dade County, maternal medical records for births in 2001 were randomly selected. Using demographic information from birth certificates, vaccination information from medical records, and policy information from a hospital survey, postpartum rubella vaccination rates were characterized among women eligible for vaccination (non-immune and not screened) through univariate and multivariable analyses. Data collection was performed in 2002-2003 and the analysis was completed in 2004-2005. Among 1991 women, 1209 (61%) were foreign born. Overall, 410 (21%) were eligible for vaccination, and of these 44 (11%) were vaccinated. Vaccination rates were not associated with maternal race/ethnicity or the existence of institutional standing-order vaccination policies. A vaccination order was recorded for 59% (240/410), but even in the presence of an order, only 17% (31/240) of those women were vaccinated. Despite policies and standing orders to vaccinate, postpartum rubella vaccination rates were very low among all racial/ethnic subgroups in a sample of hospitals caring for high-risk, foreign-born women. These findings suggest that additional system-level interventions, such as comprehensive operational guidelines, must accompany standing orders to vaccinate rubella non-immune women postpartum.
  American Journal of Preventive Medicine 03/2006; 30(2):119-24. · 4.04 Impact Factor
• Article: An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.

  Fangjun Zhou, Susan Reef, Mehran Massoudi, Mark J Papania, Hussain R Yusuf, Barbara Bardenheier, Laura Zimmerman, Mary M McCauley
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  ABSTRACT: To evaluate the economic impact of the current 2-dose measles-mumps-rubella (MMR) vaccination program in the United States, a decision tree-based analysis was conducted with population-based vaccination coverage and disease incidence data. All costs were estimated for a hypothetical US birth cohort of 3803295 infants born in 2001. The 2-dose MMR vaccination program was cost-saving from both the direct cost and societal perspectives compared with the absence of MMR vaccination, with net savings (net present value) from the direct cost and societal perspectives of US dollars 3.5 billion and US dollars 7.6 billion, respectively. The direct and societal benefit-cost ratios for the MMR vaccination program were 14.2 and 26.0. Analysis of the incremental benefit-cost of the second dose showed that direct and societal benefit-cost ratios were 0.31 and 0.49, respectively. Varying the proportion of vaccines purchased and administered in the public versus the private sector had little effect on the results. From both perspectives under even the most conservative assumptions, the national 2-dose MMR vaccination program is highly cost-beneficial and results in substantial cost savings.
  The Journal of Infectious Diseases 06/2004; 189 Suppl 1:S131-45. · 6.41 Impact Factor
• Article: Accelerated rubella control and congenital rubella syndrome prevention strengthen measles eradication: the Costa Rican experience.

  Ana Morice, Xinia Carvajal, Mario León, Vicenta Machado, Xiomara Badilla, Susan Reef, Fabio Lievano, Ariel Depetris, Carlos Castillo-Solórzano
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  ABSTRACT: In 2000, Costa Rica set a goal for accelerated rubella control and congenital rubella syndrome (CRS) prevention in conjunction with its established measles eradication goal. To achieve this goal, a National Plan of Action for the integration of a measles-rubella (MR) vaccination strategy was implemented. The components of the national plan included conducting a national vaccination campaign with a single dose of MR vaccine for men and women aged 15-39 years, establishing routine postpartum MR vaccination of all previously unvaccinated women, maintaining high coverage among children with two doses of measles-mumps-rubella vaccine, strengthening the integrated measles and rubella surveillance system, and developing a CRS surveillance system. This report summarizes the results of a successful adult campaign. Targeting MR vaccination appropriately and using the opportunity to strengthen surveillance for rash illness has benefits beyond accelerated rubella control and CRS prevention, including strengthening of the measles eradication program.
  The Journal of Infectious Diseases 06/2003; 187 Suppl 1:S158-63. · 6.41 Impact Factor
• Article: Investigation of a rubella outbreak in Kyrgyzstan in 2001: implications for an integrated approach to measles elimination and prevention of congenital rubella syndrome.

  Gustavo H Dayan, Laura Zimmerman, Ludmila Shteinke, Kalya Kasymbekova, Amra Uzicanin, Peter Strebel, Susan Reef
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  ABSTRACT: In 1999, the Ministry of Health of Kyrgyzstan adopted the goal of measles elimination. This opportunity was used to launch a rubella and congenital rubella syndrome prevention program. Between January and August 2001, a rubella outbreak occurred in Bishkek City and Chui Oblast. Rubella surveillance data were reviewed for Kyrgyzstan (1981-2000) and rubella case-patient and laboratory information from Bishkek City and Chui Oblast during the outbreak. The data suggest that rubella is endemic in Kyrgyzstan with periodic epidemics every 3-5 years. From January to August 2001, 1936 rubella case-patients were reported from Bishkek City and Chui Oblast; 242 were tested and 176 (73%) were laboratory confirmed. Most case-patients were 3-14 years old. However, the incidence rate per 100,000 among persons aged 15-35 years increased >/=40-fold from 1 in 2000 to 41 in 2001. These findings highlight the importance of introducing rubella-containing vaccine in conjunction with measles elimination activities.
  The Journal of Infectious Diseases 06/2003; 187 Suppl 1:S235-40. · 6.41 Impact Factor
• Article: New horizons in the control of rubella and prevention of congenital rubella syndrome in the Americas.

  Carlos Castillo-Solórzano, Peter Carrasco, Gina Tambini, Susan Reef, Monica Brana, Ciro A de Quadros
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  ABSTRACT: Data from the regional measles surveillance system have documented widespread rubella virus circulation in many different countries in the Americas. In response to the ongoing endemic incidence of the disease and the potential for a major rubella epidemics in the region, the Pan American Health Organization Technical Advisory Group on Vaccine Preventable Diseases recommended the implementation of a regional initiative to strengthen rubella and congenital rubella syndrome (CRS) preventive efforts in 1997. This article summarizes and highlights the progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. Useful knowledge is being generated for the adaptation of similar rubella strategies elsewhere. The findings also document the feasibility of implementing the recommended strategies and their rapid impact on disease burden.
  The Journal of Infectious Diseases 06/2003; 187 Suppl 1:S146-52. · 6.41 Impact Factor
• Source

  Available from: immunizationforwomen.org

  Article: Vaccination and perinatal infection prevention practices among obstetrician-gynecologists.

  Stephanie J Schrag, Anthony E Fiore, Bernard Gonik, Tasneem Malik, Susan Reef, James A Singleton, Anne Schuchat, Jay Schulkin
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  ABSTRACT: To assist efforts to improve adult vaccination coverage by characterizing vaccination and infectious disease screening practices of obstetrician-gynecologists. A written survey of demographics, attitudes, and practices was mailed to 1063 American College of Obstetricians and Gynecologists Fellows, including the Collaborative Ambulatory Research Network (n = 413) and 650 randomly sampled Fellows. Seventy-four percent of Collaborative Ambulatory Research Network members and 44% of nonmembers responded. A majority (Collaborative Ambulatory Research Network members: 60%; nonmembers: 49%) considered themselves primary care providers. Fewer than 60% routinely obtained patient vaccination or infection histories. Most screened prenatal patients for hepatitis B surface antigen (89%) and rubella immunoglobulin G antibody (85%). Sixty-four percent worked in practices that offered at least one vaccine; the most common were rubella (52%) and influenza (50%). Ten percent worked in practices that offered all major vaccines recommended for pregnant or postpartum women. Despite recommendations to provide influenza vaccine to pregnant women during influenza season, only 44% did so; among those who did not, 14% reported a belief that pregnant women do not need influenza vaccine. Provision of vaccine was associated with working in a multispecialty practice (adjusted odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6, 4.1) and identifying as a primary care provider (adjusted OR 1.9; 95% CI 1.3, 2.7). The most common reasons for not offering vaccines were cost (44%) and a belief that vaccines should be provided elsewhere (41%). The high proportion of obstetrician-gynecologists who do not offer vaccines or screen for vaccine and infection histories suggests missed opportunities for prevention of maternal and neonatal infections.
  Obstetrics and Gynecology 05/2003; 101(4):704-10. · 4.73 Impact Factor
• Article: Congenital rubella syndrome burden in Morocco: a rapid retrospective assessment.

  Sharon Bloom, Ahmed Rguig, Amina Berraho, Layla Zniber, Naima Bouazzaoui, Zhalid Zaghloul, Susan Reef, Ahmed Zidouh, Mark Papania, Jane Seward
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  ABSTRACT: WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. We undertook case finding in the two cities with Morocco's main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1-12.7 cases per 100000 livebirths. We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.
  The Lancet 365(9454):135-41. · 38.28 Impact Factor