Cases Of Congenital Rubella Syndrome Research Articles

Rubella in Poland in 2021.

Rubella is a viral infectious disease, and humans are the only reservoir of the virus. In 2020, all WHO member countries conducted epidemiological surveillance for rubella, and almost all (99%) had access to rubella testing at laboratories operating under the WHO Global Measles and Rubella Laboratory Network. The aim of this study was to evaluate epidemiological indicators of rubella in Poland in 2021 compared to previous years, taking into account the impact of the COVID-19 pandemic. The assessment of the epidemiological situation was based on a review of data from the bulletin , "Infectious Diseases and Poisons in Poland in 2021" (5), and the assessment of the immunization status of the population was based on data from the bulletin , "Immunization in Poland in 2021" (6). Classification of cases was made based on the definition used in the 2021 surveillance (7). Data from the epidemiological surveillance system "EpiBase" were also used. In 2021, 50 cases of rubella were registered, 48 fewer than in 2020 (98 cases). There was also a decrease in incidence to 0.13 per 100,000, compared to 0.26 per 100,000 in 2020. The highest incidence, regardless of gender and residential environment, was recorded in the 0-4 age group (1.23 per 100 thousand). No cases of congenital rubella syndrome were reported in 2021. In 2021, there was a decrease in the number of rubella cases in Poland, which could be a result of the COVID-19 pandemic and the introduced restrictions. In addition, rubella was registered 99% on the basis of clinical diagnoses, without the required laboratory confirmation, which means that other rash diseases could be registered as rubella.

Age-specific prevalence of IgG against measles/rubella and the impact of routine and supplementary immunization activities: A multistage random cluster sampling study with mathematical modelling

BackgroundVietnam continues to have measles and rubella outbreaks following supplementary immunization activities (SIA) and routine immunization despite both having high reported coverage. To evaluate immunization activities, age-specific immunity against measles and rubella, and the number of averted Congenital Rubella Syndrome (CRS) cases, must be estimated. MethodsDried blood spots were collected from 2091 randomly selected individuals aged 1-39 years. Measles and rubella virus-specific immunoglobulin G (IgG) were measured by enzyme immunoassay. Results were considered positive at ≥120 mIU/mL for measles and ≥10 IU/mL for rubella. The number of CRS cases averted by immunization since 2014 were estimated using mathematical modelling. ResultsOverall IgG seroprevalence was 99.7% (95%CI: 99.2-99.9) for measles and 83.6% (95%CI: 79.3-87.1) for rubella. Rubella IgG seroprevalence was higher among age groups targeted in the SIA than in non-targeted young adults (95.4% [95%CI: 92.9-97.0] vs 72.4% [95%CI: 63.1-80.1]; P < 0.001). The estimated number of CRS cases averted in 2019 by immunization activities since 2014 ranged from 126 (95%CI: 0-460) to 883 (95%CI: 0-2271) depending on the assumed postvaccination reduction in the force of infection. ConclusionsThe results suggest the SIA was effective, while young adults born before 1998 who remain unprotected for rubella require further vaccination.

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

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.

Congenital Rubella Syndrome-a Case Report with Clinical Manifestation and Management Approach

Congenital rubella syndrome (CRS) is an illness in infant resulting from maternal infection with rubella virus during pregnancy. Patients suffer from some complications included deafness, cataract, heart defects, mental retardation, bone alterations, liver and spleen damage. Purpose of this study is to create attention, early identification and keep special concern in management of such case. A 15 years old girl presented with dimness of vision since childhood. Her mother had a history of fever and skin rash during prenatal period. She had mental retardation, deafness, dumbness, thin stature, microchephaly. Unaided vision fixed and follows in both eyes. Anterior segments showed bilateral microphthalmos, nystagmus, microcornea, aphakia. Intraocular pressure was 40 mm of Hg in each eye. Color fundus photograph showed myopic crescent with tessellated fundus. Echocardiogram showed pulmonary stenosis. Ultrasonography whole abdomen revealed chronic hepatitis. LDH level was 380 units/L. She had hyperthyroidism. Her sensory neural hearing loss was detected by audiometry. She was referred to glaucoma clinic for raised ocular pressure; low vision clinic for visual rehabilitation; medicine specialist for cardiac problem, liver problem and hormonal imbalance. All presenting features revealed that it was a case of congenital rubella syndrome as the girl had deafness, cardiac problem and ocular abnormality which are triad of CRS. Early diagnosis, timely management and proper counseling to patient and guardian will consequently increase life quality of this patient. National awareness should be increased for full coverage of antenatal check up with MMR vaccination in all health care centers of developing countries. J.Natl.Inst.Ophthalmol.2023;6(1): 54-59

Sero-prevalence of rubella-specific antibodies in pregnant women attending antenatal care in Maiduguri, north-eastern Nigeria

Context: 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. Laboratory confirmation of suspected cases is done based on the detection of the presence of immunoglobulin M (IgM) during the acute illness or a significant rise in rubella – immunoglobulin G (IgG) antibody titres in the serum of previously infected individuals. Methodology: This is a descriptive cross-sectional study conducted at the antenatal clinic of the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, North-Eastern Nigeria. Eligible women who presented for booking for antenatal care at the hospital were recruited. Their bio-data, educational status, and history of vaccination with measles and previous obstetrics outcomes were obtained. Five milliliters of venous blood was taken and the serum obtained from the sample was analyzed for anti-rubella IgG antibodies. The samples that were negative for IgG were tested for IgM antibodies. Data obtained analyzed using the statistical package for social science SPSS v16.0.0 (Sept 13, 2007) Inc, Illinois, USA. Results: There were 459 pregnant women who consented and participated in the study. Their age range is 17-43 years (mean= 25.8±5.3). There were 280 (61.0%) patients who were multiparous (mean=3.5±2.1) and women with secondary education accounted for 39.4%. 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. Most of the patients (98.1%) with positive IgG had serum titers in the range of 51-150U/mL. All the patients with positive IgM antibodies were followed up till birth, all the pregnancies were carried to term and none of the neonates was found to have any congenital malformation. None of the socio-demographic characteristics were found to be significantly associated with presence of IgG antibodies. Past history of abortions and congenital cataracts were significantly associated with IgG sero-positivity. Conclusion: The sero-prevalence of anti-rubella IgG sero-positivity is high in Maiduguri and this indicates high herd immunity. The number of pregnant women requiring rubella vaccination postpartum in also large. It is recommended that inclusion of rubella vaccination in the National programme on Immunization protocol will be cost effective in the control of rubella and CRS.

Congenital rubella syndrome surveillance in India, 2016–21: Analysis of five years surveillance data

BackgroundIn India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016–2021 from 14 sentinel sites to describe the epidemiology of CRS. MethodWe analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. ResultsDuring 2016–21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6–16.2), cataract (OR = 7.8, 95% CI: 5.4–11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3–13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2–12.2) and glaucoma (OR = 3.1, 95% CI: 1.2–8.1). Nomogram, along with a web version, was developed. ConclusionsRubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.

Rubella virus infection in endothelial cells reduces angiogenesis via interferon beta-induced CXCL10.

Rubella virus (RuV) infection during pregnancy can lead to abortion, stillbirth, and embryonic defects, resulting in congenital rubella syndrome (CRS). It is estimated that there are still 100,000 cases of CRS per year in developing regions with a mortality rate of over 30%. The molecular pathomechanisms remain largely unexplored. Placental endothelial cells (EC) are frequently infected with RuV. RuV reduced the angiogenic and migratory capacity of primary human EC, as confirmed by treatment of EC with serum from RuV IgM-positive patients. Next generation sequencing analysis revealed the induction of antiviral interferon (IFN) type I and III and CXCL10. The RuV-induced transcriptional profile resembled the effects of IFN-β treatment. The RuV-mediated inhibition of angiogenesis was reversed by treatment with blocking and neutralizing antibodies targeting CXCL10 and the IFN-β receptor. The data identify an important role for antiviral IFN-mediated induction of CXCL10 in the control of EC function during RuV infection.

Rubella in Poland in 2020.

Since 2005, rubella has been included in the eradication program coordinated by the World Health Organization (WHO). The elimination of rubella in the country is possible provided that it is achieved by min. 95% immunization status and monitoring of the epidemiological situation, including the recording all suspicions of rubella and conducting laboratory diagnostics in the WHO Reference Laboratory. The aim of the study is to assess the epidemiological situation of rubella in Poland in 2020, taking into account the assessment of rubella vaccination status and the degree of implementation of the WHO rubella elimination program in Poland. Assessment of the epidemiological situation of rubella in Poland based on aggregated reports of suspected rubella cases sent to the National Institute of Public Health NIH - National Research Institute by the Voivodeship Sanitary and Epidemiological Stations, data from the bulletin "Infectious diseases and poisoning in Poland in 2020" and data from the Epibaza system and the bulletin "Preventive vaccination in Poland in 2020". In 2020, 98 cases of rubella were registered, 187 cases less than in 2019 (285 cases). There was also a decrease in the incidence to 0.26 per 100,000, compared to 0.74 per 100,000 in 2019. The highest incidence, iregardless of gender and place of residence, was recorded in the 0-4 age group (2.98 per 100,000). In 2020, no cases of congenital rubella syndrome were reported. In 2020, only one case (1.02%) was classified as a case confirmed in a laboratory test. The remaining 98.98% (97 cases) were diagnosed on the basis of clinical symptoms. In 2020, in Poland, a decrease in the number of rubella was observed. Rubella was registered in 99% on the basis of a general diagnosis, without the required laboratory confirmation, which means that other rash diseases can be registered as rubella.

Factors Related to the Incidence of Congenital Rubella Syndrome (CRS) in Indonesia

Congenital Rubella Syndrome (CRS) is a serious consequence in infants due to Rubella virus infection during early pregnancy which can cause several congenital abnormalities. In 2021, Indonesia became the country that reported the highest cases of CRS in the WHO Southeast Asia region with 229 cases out of a total of 402 cases (57%). There are various factors related to the incidence of CRS including vaccination, health facilities and mother and baby factors. Knowledge on these factors can be applied to improve efforts to prevent and control CRS cases. This study aims to determine the factors related to the incidence of CRS in Indonesia. This was a case-control study using secondary data derived from the 2020-2021 CRS sentinel surveillance reports of the Ministry of Health of the Republic of Indonesia. Based on the results of multivariate analysis using multiple logistic regression, it was revealed that there was one factor related to the incidence of CRS, namely the area of residence with an OR of 2.3 (95% CI: 1.49-3.42). The area of residence outside Java-Bali had a higher risk for the incidence of CRS by 2.3 times compared to the area of residence in Java-Bali. In contrast, other variables such as history of maternal vaccination, history of maternal Rubella infection, maternal age and the child gender were not found to be statistically related to the incidence of CRS. It can be concluded that the area of residence outside Java-Bali was a factor related to the incidence of CRS. Therefore, it is necessary to have an even distribution of Rubella vaccination coverage, strengthen the surveillance system and prepare equal distribution of health facilities to prevent the spread of Rubella cases.

Comparison of population-based measles-rubella immunoglobulin G antibody prevalence between 2014 and 2019 in Lao People's Democratic Republic: Impacts of the national immunization program

ObjectivesWe evaluated the effectiveness of the Lao People's Democratic Republic's measles-rubella immunization program using the seroprevalence from two cross-sectional surveys. MethodsThe nationwide surveys occurred in 2014 and 2019 using a multistage cluster sampling, both requiring samples from 2184 individuals from 52 randomly selected villages. Immunoglobulin G titers, measured using enzyme-linked immunosorbent assay, were considered positive at ≥120 mIU/ml (measles) and ≥10 IU/ml (rubella). We calculated the vaccination-related reduction in the force of rubella infection and the number of congenital rubella syndrome cases averted in 2019. ResultsWe collected 2135 (women: 55.2%, mean age: 23.2 years) and 2001 (52.7%, 23.1 years) samples in 2014 and 2019, respectively. During 2014-2019, immunoglobulin G prevalence increased from 83.9% (95% confidence interval [CI]: 83.8-84.0) to 98.3% (97.7-98.8) for measles and from 75.4% (75.3-75.5) to 87.8% (86.4-89.2) for rubella. The most plausible reduction in the average force of rubella infection was 100% (95% CI: 28-100) since vaccination started, averting 78 (95% CI: 42-128) congenital rubella syndrome cases in 2019. ConclusionThis is the first population-based study for measles and rubella at two different time points in developing countries. Measles and rubella seroprevalence increased significantly during 2014-2019, greatly exceeding the immunity thresholds for their elimination.

Comparison of Congenital Rubella Syndrome Cases at a Philippine Tertiary Hospital from 2009-2012 to 2019-2022

Background and Objective. The Philippines does not have a national congenital rubella syndrome (CRS) surveillance or registry. Regular monitoring of CRS cases in hospitals, including in a Philippine tertiary hospital, helped in the past to provide clinico-epidemiologic data on CRS. This study aimed to continue providing clinico-epidemiologic data on CRS cases seen in the Philippine tertiary hospital from 2009-2012 and 2019-2022 and compare the cases seen from said timelines.Methods. A cross-sectional study was used, employing chart review of patients newly diagnosed with CRS from 2009-2012 and 2019-2022 in the Department of Ophthalmology and Visual Sciences at the Philippine tertiary hospital.Results. Forty-two patients newly diagnosed with CRS from 2009-2012 and 2019-2022 were included. Only 14(33%) were serologically-confirmed cases (albeit qualitatively). Median age (first and third interquartile ranges) atconsult was 1 year (0.4, 2.5). Twenty-four (57%) patients had maternal history of rashes and/or fever. Trimester of pregnancy when mother became symptomatic was not significantly correlated with chief complaint (p=0.20) and numbers of ophthalmic (p=0.68) and systemic manifestations (p=0.32). Cataract was the most common ophthalmic manifestation present in 40 (95%) patients. Twenty-six (62%) patients had other associated systemic findings of which hearing loss was the most common. Only 29 of 40 patients with cataract underwent lensectomy, with 23 patients having poor visual prognosis prior to surgery (5 with nystagmus alone, 10 with nystagmus and strabismus, and 8 with strabismus alone).Discussion. Using ophthalmic manifestations as primary indicator, this study provided an update on the CRS cases in the country. Laboratory confirmation remains a challenge in diagnosing CRS as the tests are costly and not widely available. There was increase from 2009-2012 compared to 2019-2022 in number of patients who underwent surgical treatment for cataract but visual outcomes were suboptimal due to delay in consultation. Although there was a decrease in number of CRS cases seen in the Philippine tertiary hospital, this cannot be attributed to increased rubella-containing vaccine (RCV) coverage alone.Conclusion. Provision of data from individual hospital-based studies similar to this highlights the need for a national CRS surveillance system or registry. This can better gauge the burden of CRS and identify the gap in RCV coverage.&nbsp

Efektivitas Vaksinasi Rubella Dalam Pengendalian Congenital Rubella Syndrome (CRS)

Measles or rubella is an infectious viral infectious disease that is a public health problem globally. Congenital Rubella Syndrome (CRS) is a disease in infants caused by infection of the fetus with the rubella virus during pregnancy. CRS therapy that can be done today is by giving rubella vaccination to children, adolescents, and adult women. To determine the effectiveness of the rubella vaccine in preventing and controlling CRS cases, an article review was carried out with a literature study using secondary data in the form of journals/articles, and books. Search the database of journals and articles retrieved through the internet through the google scholar database. Based on several journal results studied, it was concluded that rubella vaccination is effective and safe to prevent and control CRS cases.

Efektivitas Vaksinasi Rubella Dalam Pengendalian Congenital Rubella Syndrome (CRS)

Measles or rubella is an infectious viral infectious disease that is a public health problem globally. Congenital Rubella Syndrome (CRS) is a disease in infants caused by infection of the fetus with the rubella virus during pregnancy. CRS therapy that can be done today is by giving rubella vaccination to children, adolescents, and adult women. To determine the effectiveness of the rubella vaccine in preventing and controlling CRS cases, an article review was carried out with a literature study using secondary data in the form of journals/articles, and books. Search the database of journals and articles retrieved through the internet through the google scholar database. Based on several journal results studied, it was concluded that rubella vaccination is effective and safe to prevent and control CRS cases.

Leveraging a national biorepository in Zambia to assess measles and rubella immunity gaps across age and space

High-quality, representative serological surveys allow direct estimates of immunity profiles to inform vaccination strategies but can be costly and logistically challenging. Leveraging residual serum samples is one way to increase their feasibility. We subsampled 9854 residual sera from a 2016 national HIV survey in Zambia and tested these specimens for anti-measles and anti-rubella virus IgG antibodies using indirect enzyme immunoassays. We demonstrate innovative methods for sampling residual sera and analyzing seroprevalence data, as well as the value of seroprevalence estimates to understand and control measles and rubella. National measles and rubella seroprevalence for individuals younger than 50 years was 82.8% (95% CI 81.6, 83.9%) and 74.9% (95% CI 73.7, 76.0%), respectively. Despite a successful childhood vaccination program, measles immunity gaps persisted across age groups and districts, indicating the need for additional activities to complement routine immunization. Prior to vaccine introduction, we estimated a rubella burden of 96 congenital rubella syndrome cases per 100,000 live births. Residual samples from large-scale surveys can reduce the cost and challenges of conducting serosurveys, and multiple pathogens can be tested. Procedures to access quality specimens, ensure ethical approvals, and link sociodemographic data can improve the timeliness and value of results.

Epidemiology of Congenital Rubella Syndrome Related to the 2012-2013 Rubella Epidemic in Japan.

This study assessed the epidemiological characteristics of 45 congenital rubella syndrome cases in Japan following the 2012-2013 rubella epidemic. Rubella still poses significant health burdens and the uptake of rubella-containing vaccines among women of childbearing age should be improved.

Hearing loss in pediatric patients with congenital rubella syndrome

Congenital rubella syndrome (CRS) is caused by rubella infection in pregnant women. It was estimated 100.000 children with CRS, with 46% found in developing countries. The CRS consists of symptoms like sensorineural hearing loss (SNHL), congenital heart disease, cataract or congenital glaucoma, and other symptoms. Sensorineural hearing loss is the commonest symptoms compared with others. This study aimed to determine the hearing loss in CRS in Dr. Kariadi Central Hospital, Semarang, Central Java. This was a descriptive study using data from medical records from CRS pediatric patients who had BERA examination from January 2019 until December 2020. The CRS was characterized with one or more symptoms: SNHL, congenital cataract, congenital heart disease, and laboratory IgG and/or IgM Rubella (+). The SNHL was described from refer OAE result, tympanometry A, and BERA with hearing threshold ≥40 dB. Follow-up evaluation was performed with Google form questionnaire. There were 55 CRS cases with 70.9% had bilateral SNHL, mostly with very severe hearing loss. Normal hearing was found in 16 children (28.1%). From 30 children who were followed up, there were 20 children who had bilateral SNHL with 30% were moderate-severe degree and 70% profound. With further multidisciplinary management in children with CRS and parental support, 65% children used hearing aid and 40% had auditory-verbal therapy (AVT). Evaluation of the AVT showed progress in 30% children. In conclusion, SNHL is found in 70.9% children with CRS. Further management using hearing aid and AVT shows progress on few children.

Różyczka w Polsce w 2019 roku

Rubella has been included in the elimination program coordinated by the World Health Organization (WHO) since 2005. Elimination of rubella in the country is possible provided that min. 95% of the vaccination status of the population and monitoring the epidemiological situation, including recording all suspected rubella and conducting laboratory diagnostics at the WHO Reference Laboratory. The aims of the present article are to analyze the epidemiological situation of rubella in Poland in 2019 and to discuss the rubella vaccination coverage. The assessment of the epidemiological situation of rubella in Poland was conducted on the basis of aggregated reports of suspected rubella cases sent to the National Institute of Public Health - National Institute of Hygiene by Voivodeship Sanitary and Epidemiological Stations, and data from the bulletin "Infectious diseases and poisoning in Poland in 2019" and "Vaccinations in Poland in 2019 ". In 2019, there was a decrease in the number of rubella cases with registered 285 cases (in 2018 - 37 cases), and a decline in incidence (from 1.1 per 100,000 to 0.74). The highest incidence rate, regardless of gender and the environment, was observed among children agded 0-4 years (6.4 per 100,000). In 2019, no cases of congenital rubella syndrome were registered. In 2019, only 3 (1.05%) cases were classified as laboratoryconfirmed cases. The remaining 98.9% (282 cases) were diagnosed on the basis of clinical symptoms. In 2019, there was a decrease in the number of rubella cases. In Poland rubella in reported exclusively on the basis of the clinical picture. The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland.

A retrospective 5-year review of rubella in South Africa prior to the introduction of a rubella-containing vaccine.

South Africa has yet to introduce a rubella-containing vaccine (RCV) into its Expanded Programme on Immunisation (EPI). Here we evaluated the incidence of laboratory-confirmed rubella and congenital rubella syndrome (CRS) cases over the years 2015 to 2019, to document the epidemiology of rubella and CRS within South Africa prior to a RCV introduction. This retrospective study evaluated the number of laboratory-confirmed rubella cases reported through the national febrile rash surveillance system. A positive test for rubella immunoglobulin M (IgM) antibodies was considered a confirmed rubella case. For CRS cases, we reported laboratory-confirmed CRS cases collected from 28 sentinel-sites from all nine provinces of South Africa. From 2015–2019, 19 773 serum samples were tested for rubella IgM antibodies, 6 643 (33.6%) were confirmed rubella cases. Rubella was seasonal, with peaks in spring (September to November). Case numbers were similar between males (n = 3 239; 50.1%) and females (n = 3 232; 49.9%). The highest burden of cases occurred in 2017 (n = 2 526; 38%). The median age was 5 years (IQR: 3–7 years). Importantly, of females with rubella, 5.0% (161 of 3 232) of the cases were among women of reproductive age (15–44 years). A total of 62 CRS cases were reported, the mortality rate was 12.9% (n = 8), and the most common birth defect was congenital heart disease. In conclusion, rubella is endemic in South Africa. Children below the age of 10 years were the most affected, however, rubella was also reported among women of reproductive age. The baseline data represented here provides insight into the burden of rubella and CRS in South Africa prior to the introduction of a RCV, and can enable planning of RCV introduction into the South African EPI.

Congenital Rubella syndrome cases (based on WHO criteria) one decade after Measle and Rubella vaccination campaign in Tehran; Iran.

Background: Active CRS surveillance is recommended strongly even in country with full rubella vaccination. Objective: Searching the CRS based on WHO criteria one decade after MR vaccination campaign (2003) Methods: a prospective case control study carried out in a third referral educational hospital (Rasoul Akram hospital) in Tehran, IRAN during five years (2013 -2018). From 89 CRS suspected infants (according to WHO criteria); serum samples were tested for rubella-specific IgG and IgM by ELISA method. Selected samples (positive Rubella IgM) were tested for rubella RNA by reverse transcriptase–polymerase chain reaction (RT–PCR). Findings: “Confirmed CRS” based on positive IgM was found in 5.6% (5/89) all were &lt; 4 months old. Positive RT–PCR detected in 1.2 % (1/89) of “CRS suspected” infants.Except a good correlation between abnormal neurologic findings and positive IgM in “Confirmed CRS “cases, other clinical findings were not related to serologic tests. The “Compatible CRS” cases in the 31 patients who had primary negative IgM serology and did not have sufficient laboratory evidence to confirm CRS, but clinical symptoms favoured CRS. Conclusion: Despite MR vaccination in Iran, after one decade “confirmed CRS” and “compatible CRS” were diagnosed in 5 and 31 from 89 CRS suspected cases. The incidence of “confirmed CRS” in every 100 CRS suspected infants (after campaign) is 5.6 %; and 31 CRS Compatible cases are so important. Without active CRS surveillance; mild infection such as IUGR, hearing loss,heart abnormalities, impaired vision, and mental retardation even in developed country might be missed.Fetal infection is persistent which impose additional costs on the country..Another mass vaccination in women and girls is needed. Also, the antirubella IgG testing before pregnancy in women who were not vaccinated; vaccination of women before marriage /preganacy should be obligatory in order to prevent the CRS.

Clinical manifestations of congenital rubella syndrome at the Korle-Bu Teaching Hospital, Ghana

Background: Congenital rubella syndrome (CRS) is a variable constellation of birth defects related to intrauterine rubella infection which may result in visual, hearing, intellectual and cardiac impairments. Objective: The objective of this study is to describe the clinical manifestations in patients presenting with CRS at the Korle Bu Teaching Hospital using the World Health Organization criteria. Methods: A retrospective analysis of the medical charts of 16 children under 16 years old who presented with CRS at the Lions International Eye and the National Cardiothoracic Centres of the Korle Bu Teaching Hospital from 2012 to 2015, was done. Ocular, cardiac and other systemic clinical and laboratory findings were documented for each patient using predesigned forms. Results: Sixteen cases of CRS were recorded over the period (2012-2015) comprising 9 males and 7 females. The median (interquartile range) age at diagnosis was 4.0 months (2.0-7.0 months), age range at diagnosis was 1.0-24.0 months. The main ocular manifestations were; cataract 10 (62.5 %), microcornea 10 (62.5 %), microphthalmia 9 (56.3 %), nystagmus 7 (43.8 %) and strabismus 4 (25.0 %). The main cardiac defects included patent ductus arteriosus 12 (75.0 %), pulmonary stenosis 5 (31.3 %), ventricular septal defect 5 (31.3 %) and small branch pulmonary artery5 (31.3 %). Systemic conditions recorded included hearing defects 7 (43.8 %), microcephaly 7 (43.8 %), failure to thrive 5 (31.3 %) and mental retardation 2 (12.5 %). Conclusion: Cataract, microcornea and microphthalmia were the main ocular manifestations in children presenting with CRS at the Korle Bu Teaching Hospital. Patent ductus arteriosus and hearing defects were the main cardiac and systemic defects among children presenting with CRS at the Korle Bu Teaching Hospital.