Susceptibility for varicella and factors associated with immunity among pregnant women in a tertiary care hospital in Sri Lanka- a cross-sectional study

Abstract

Background Varicella during pregnancy can lead to serious maternal and fetal consequences. Although an effective vaccine is available it is not incorporated in to the routine vaccination programs in most of the Asian countries. Objectives of the study were to determine the susceptibility to varicella and factors associated with immunity, among a group of pregnant women attending to a tertiary care hospital in Sri Lanka. Methods A hospital based descriptive cross sectional study was carried out at De Soyza maternity Hospital, Colombo. A sample of 385 pregnant women was selected. Data were collected through an interviewer administered questionnaire; presence of varicella IgG in blood was assessed by a validated commercial ELISA (Enzyme Linked Immunosorbant Assay. Results The sample had a mean age of 28.5 years and majority was educated beyond General Certificate of Education (GCE) Ordinary Level. We found that 34% of study population was susceptible for the infection. A past history of varicella had a 89.5% positive predictive value and 53.1% negative predictive value for varicella immunity. Varicella sero-positivity was only associated with a lower educational level and number of childhood household members more than four. There was no association of sero-positivity with age. Conclusion This study demonstrates that a significant proportion of pregnant women of the study population are varicella-susceptible. Pre-pregnancy screening and preventive strategies including vaccination should be evaluated. History of past varicella infection could be a useful screening tool to exclude patients for vaccination. Electronic supplementary material The online version of this article (10.1186/s12879-019-3996-1) contains supplementary material, which is available to authorized users.

Evaluation of Varicella Immunity during Pregnancy in Apulia Region, Southern Italy

“…While the prevalence of susceptible pregnant women in the current study is similar to other studies [ 19 , 20 ] and higher than in Northern European countries [ 16 , 19 , 21 ], it is lower than in other populations (i.e., in Sri Lanka) [ 22 ]. These differences in seroprevalence could be related to the country of birth, the country in which childhood is spent and educational level [ 19 , 22 ].…”

High susceptibility to varicella among urban and rural pregnant women in South India: a brief report

“…[19,20] This is not only true in temperate regions with low susceptibility rates but also in countries like Sri Lanka. [11] This poor PPV (82.4%) noted in our study has important implications in vaccination strategies. Serological testing may be required to identify women who may benefit from the vaccine.…”

“…It also mirrors data from others regarding the high proportion of the susceptible population in India and other South Asian countries. [11][12][13][14] This epidemiological pattern is also reflected by the high burden of varicella-zoster among young adults during epidemics. [5,6,15] Ongoing varicella transmission, through early adulthood, ensures near-complete protection The poor PPV of self-reported history is an important finding from our study.…”

“…[5,6,15] Ongoing varicella transmission, through early adulthood, ensures near-complete protection The poor PPV of self-reported history is an important finding from our study. Typically, the PPV is more than 95% among pregnant women across the studies done in the temperate regions [11,18] Many authors have concluded that maternal history can be used safely to exclude patients from serological testing. [19,20] This is not only true in temperate regions with low susceptibility rates but also in countries like Sri Lanka.…”

“…Unfortunately, this age group is interspersed by The poor PPV of self-reported history is an important finding from our study. Typically, the PPV is more than 95% among pregnant women across the studies done in the temperate regions [11,18]. Many authors have concluded that maternal history can be used safely to exclude patients from serological testing [19,20].…”