Abstract
Background Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus. Despite increased episodes of rubella epidemics (127 outbreaks in 2009–2015), rubella national vaccination is not yet introduced in Ethiopia. In January 2018, an increase of fever and rash cases was reported in Kuyu District of Oromia. We investigated the outbreak to confirm rubella, determine risk factors, and guide interventions. Methods We identified rubella cases from health centers and conducted a case-control study (1 case : 2 controls) with 150 participants, from March 12 to 15, 2018. Cases were people who presented with fever and rash or laboratory-confirmed cases. Controls were age matched (<15 yrs) with neighbors selected purposively. We interviewed parents by a structured questionnaire and observed the housing condition. Variables include sex, age, vaccination status, family size, contact history, housing condition, and travel history. Simple logistic regression was used to select the candidate variable at a P value <0.25. We identified risk factors at P < 0.05 with AOR and 95% CI by multivariate logistic regression. Results We identified 50 cases (with no death), and out of them, seven (14%) were confirmed cases (rubella IgM positive). The mean age of the cases was 6 ± 3 years and of the controls was 8 ± 4 years. Family size >5 (AOR = 2.4; 95% CI: 1.5–4.11), not well-ventilated living room (AOR = 4.7; 95% CI: 3.43–8.12), history of contact with rash people (AOR = 2.2; 95% CI: 1.6 3.5), no history of diarrhea in the last 14 days (AOR = 0.8; 95% CI: 0.6–0.9), and no history of vitamin A supplementation (AOR = 2.9; 95% CI: 1.7–2.6) were significant factors for rubella infection. Conclusions We identified rubella outbreak in the rural area. Crowded living condition, large family size, not receiving vitamin A in the last 6 months, and contact with people with symptoms of rubella were factors that drove the outbreak, while not having diarrhea in the last 14 days was the protective factor. We recommended the introduction of rubella immunization national programs and advocated the policy on rubella vaccine and strengthening surveillance for congenital rubella syndrome and rubella.
Highlights
Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus
Odds of acquiring rubella infection were higher among children living in poorventilated rooms. is was consistent with the result of the study done in Zimbabwe, Douglas County in Latin America, Tanzania, and Rural Kenya, where poor-ventilated living room of the household was a significant risk factor for contracting rubella [10,11,12,13]. is finding is biologically plausible considering that rubella spreads through respiratory secretions
E odds of acquiring rubella infection among children from households with family size greater than five were 2.4 times higher than those among children with family size less than five. is was consistent with a study of rubella outbreak investigation done in India, Zimbabwe, and Metekel Zone of Ethiopia whereby overcrowding at home was a risk factor for contracting rubella [12, 14]. is implies that having more children in the household increased the risk of being in contact with the infected child
Summary
Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus. Size >5 (AOR 2.4; 95% CI: 1.5–4.11), not well-ventilated living room (AOR 4.7; 95% CI: 3.43–8.12), history of contact with rash people (AOR 2.2; 95% CI: 1.6 3.5), no history of diarrhea in the last 14 days (AOR 0.8; 95% CI: 0.6–0.9), and no history of vitamin A supplementation (AOR 2.9; 95% CI: 1.7–2.6) were significant factors for rubella infection. Large family size, not receiving vitamin A in the last 6 months, and contact with people with symptoms of rubella were factors that drove the outbreak, while not having diarrhea in the last 14 days was the protective factor. Infection in early pregnancy results in serious consequences to the fetus It is an infectious disease caused by an enveloped RNA virus of the Togaviridae family and the Rubivirus genus, for which humans are the only known host [1]. Its incubation period ranges from 12 to 23 days, with an average of 14 days [2,3,4]
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