Rubella Immunity Across Generations: A Longitudinal Study of IgG Seroprevalence in Females (2000–2024) in Palestine

Abstract

Ibrahim Salhi

Background and Objectives: Rubella remains a significant public health concern, particularly for women of reproductive age due to the risk of congenital rubella syndrome (CRS). Monitoring immunity through Rubella IgG seroprevalence is essential to ensure adequate protection, particularly in regions with variable access to vaccination. This study aims to assess Rubella IgG seroprevalence among females in Palestine over a 24-year period (2000–2024), with a focus on age-specific and geographical variations in immunity. Identifying immunity gaps will provide insights into the effectiveness of vaccination programs and inform potential public health interventions.

Materials and Methods: A total of 7,296 females, aged 0-59, were tested for Rubella IgG antibodies at Medicare Laboratories between 2000 and 2024. Seroprevalence was categorized into negative (<5 IU/ml), grey zone (5-10 IU/ml), and positive (>10 IU/ml). Participants were stratified by age and locality, and seroprevalence trends were analysed over time. Data were sourced from the Laboratory Information System (LIS), and statistical analyses were conducted to assess immunity levels across age groups and regions, as well as time-based trends.

Results: Overall, 89.2% of the study population tested positive for Rubella IgG, indicating strong immunity. However, 7.5% of individuals were in the grey zone, and 3.2% tested negative, highlighting potential susceptibility. The highest immunity levels were observed in women aged 20-39 years, with 89.7% testing positive. Children aged 0-9 years had the highest proportion of negative results (26.5%), indicating gaps in early childhood vaccination. Geographically, Ramallah and Hebron demonstrated the highest immunity levels, while Bethlehem, Jerusalem, and smaller regions exhibited greyer zone and negative cases, signalling regional disparities in immunity. Immunity levels increased consistently from 2001 to 2024, though grey zone cases also rose, indicating potential waning immunity.

Conclusion: Rubella immunity is robust in the female population of Palestine, particularly among women of reproductive age. However, the presence of grey zone and negative results in children and certain regions highlights gaps in vaccination coverage and potential waning immunity. Targeted booster vaccination campaigns and improved adherence to the Palestinian immunization schedule are recommended to close these gaps and sustain immunity, particularly in vulnerable populations.

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