One-point evaluation of children exposed to rubella infection In Utero in Maiduguri, North-Eastern Nigeria: A follow-up Study

Abstract

Background: Rubella is a disease caused by a virus, rubella virus. Major obstetrics concerns are profound effects of the virus on developing fetuses, which may result in multiple congenital malformations. Although vaccination has reduced the incidence of rubella virus substantially; the World Health Organization (WHO) estimated that more than 100,000 cases of congenital rubella syndrome occur each year worldwide, most of them in developing countries. Diagnosis of rubella cannot be made on clinical grounds alone due to lack of specific symptoms or signs that are unique to the disease. Women infected with rubella during pregnancy are at increased risk of developing complication for the women and their fetuses. Some of these complications may not present at birth, but several years during childhood and later in life. Methodology: The main rubella sero-prevalence study was conducted in 2013, at the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, North-Eastern Nigeria. This is a follow-up descriptive study. The children of women who had significant titres of Immunoglobulin M antibodies, and who were negative for Immunoglobulin G antibodies were followed during their pregnancies and childbirth. The children born to these women who acquired rubella virus infection in mid pregnancy were reviewed at 10-11 years of age, and their current state of health is reported. Their biodata, educational status, rubella serostatus, state of health, and history of vaccination with measles were obtained. Results: There were 459 pregnant women who consented and participated in the main sero-prevalence study. Four hundred twenty-one women (91.7%) women tested positive for rubella-specific IgG antibodies, and of the remaining 38 women, 6 (15.8%) were positive for IgM rubella-specific antibody. All the patients with positive IgM antibodies were followed up till birth. All the pregnancies were carried to term and delivered in hospital. None of the neonates was found to have any congenital malformation at birth. At 10 years review of the six (6) children, 1 (16.7%) child developed cataract. None of the children developed cardiac, ear, or other complications of rubella. Five (5) children (83.3%) tested positive for both IgG, one (1) was negative (the child with cataract) for rubella antibodies. None had IgM rubella antibodies. All the children were enrolled in schools and their performance is at least average of their peers. Conclusion: None of the known types of congenital rubella syndrome was found in this study, this may be as a result of smaller number of infected pregnancies. It is recommended that inclusion of rubella vaccination in the National programme on Immunization protocol will be cost effective in the prevention of rubella-associated complication in children.