Burden of congenital rubella syndrome (CRS) in India based on data from cross-sectional serosurveys, 2017 and 2019-20.

Devika Shanmugasundaram,Shikha Malik,Bhagirathi Dwibedi,Amita Jain,Gajanan Sapakal,Shalini Tripathi,Himabindu Singh,Rajeswari Bonu,Anjoo Agarwal,J Priyasree,Manish Jain,R Sabarinathan,K Pushpalatha,G Kiruthika,Suji George,Nivedita Gupta,Ojas Kaduskar,Rajlakshmi Viswanathan,Saubhagya Kumar Jena,Bhupeshwari Patel,Debasis Biswas,Rahul Narang,Sonia Jain ,S Geetha ,Sanjay Awasthi ,Sudha D Madhuri ,Syed Ali ,Manoj Murhekar

doi:10.1371/journal.pntd.0009608

Abstract

BackgroundIndia has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to <15 years and established a hospital-based sentinel surveillance for CRS. Reliable data about incidence of CRS is necessary to monitor progress towards the elimination goal.MethodsWe conducted serosurveys in 2019–20 among pregnant women attending antenatal clinics of 6 hospitals, which were also sentinel sites for CRS surveillance, to estimate the prevalence of IgG antibodies against rubella. We systematically sampled 1800 women attending antenatal clinics and tested their sera for IgG antibodies against rubella. We used rubella seroprevalence data from the current survey and the survey conducted in 2017 among antenatal women from another 6 CRS surveillance sites to construct a catalytic models to estimate the incidence and burden of CRS.ResultThe seroprevalence of rubella antibodies was 82.3% (95% CI: 80.4–84.0). Rubella seropositivity did not differ by age group and educational status. Based on the constant and age-dependent force of infection models, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births (95% CI: 217.49–232.41) and 65.47 per 100,000 live births (95% CI: 41.60–104.16) respectively. This translated to an estimated 14,520 (95% CI: 9,225–23,100) and 50,028 (95% CI: 48,234–51,543) infants with CRS every year based on age-dependent and constant force of infection models respectively.ConclusionsOur findings indicated that about one fifth of women in the reproductive age group in India were susceptible for rubella. The estimates of CRS incidence will serve as a baseline to monitor the impact of MRCV SIAs, as well progress towards the elimination goal of rubella/CRS.

Highlights

Rubella is a highly contagious viral infection caused by rubella virus
Our findings indicated that about one fifth of women in the reproductive age group in India were susceptible for rubella
The estimates of congenital rubella syndrome (CRS) incidence will serve as a baseline to monitor the impact of measles-rubella containing vaccine (MRCV) supplementary immunization activity (SIA), as well progress towards the elimination goal of rubella/ CRS

Summary

Introduction

Rubella is a highly contagious viral infection caused by rubella virus. Rubella infection just before conception or during the first trimester of pregnancy leads to miscarriage, fetal death, still birth or birth of an infant with congenital defects known as congenital rubella syndrome (CRS) [1]. Rubella is the leading vaccine-preventable cause of birth defects [4]. India has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to

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Conclusion