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School of Medicine





Perfluoroalkyl substances (PFASs) have been associated with decreased immunity to child- hood tetanus and diphtheria immunizations. If these vaccinations are vulnerable to influence from PFASs, questions arise about associations with other common inoculations.


To examine whether serum PFASs were associated with reduced immunity to rubella immu- nization, and whether interactions with sex or ethnicity warranted analytic stratification. Usually, toxicology analyses are calculated controlling for race and sex. However, sex differ- ences in immune function have been reported and a reduction of immunity to rubella in women could pose risks such miscarriage.


We analyzed a nationally representative sample of individuals 􏰕 12 years from the National Health and Nutrition Examination Survey (NHANES) for years 1999–2000 and 2003–2004 for whom PFAS measures were available. Our analytic strategy was to start with separate analyses for youth and adults controlling for several covariates including ethnicity and sex, as well as the interaction of these terms with PFASs. If there was a main effect of PFASs and an interaction term, we would stratify analyses of effect size. The outcome variable was Rubella IgG titers by quartile of perfluoroalkyl substances.


After exclusion for missing data, the analyzed sample contained 581 adult women, 621 adult men, and 1012 youth. There was no significant effect of PFASs on immunity in youths but a significant effect of both PFOA and PFOS in adults, as well as a significant interaction of PFOA x sex and a borderline significant interaction of PFOS x sex. When effect size anal- yses were stratified by sex, a significant association between rubella titres and PFOA was found in men but not women and PFOS was not significant in either sex.


These results support our earlier studies showing sex specific responses to PFASs and indi- cate the importance of thinking carefully about analytic strategies in population based toxi- cology research.

Source Citation

Citation: Pilkerton CS, Hobbs GR, Lilly C, Knox SS (2018) Rubella immunity and serum perfluoroalkyl substances: Sex and analytic strategy. PLoS ONE 13(9): e0203330.


Copyright: © 2018 Pilkerton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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