Hospital based surveillance of congenital rubella syndrome cases in the pre-vaccine era in Amhara Regional State, Ethiopia: A base line information for the country

Abstract

BackgroundRubella virus infection in early pregnancy lead to serious multi-organ birth defects known as congenital rubella syndrome (CRS). The incidence of CRS varies in different populations and the highest burden is found in developing countries in which rubella vaccination is not included in their national immunization programs. In Ethiopia, there is scarcity of data about congenital rubella syndrome. Therefore, the aim of this study was to determine the burden of CRS-related birth defects and its incidence in the pre-vaccine era in Amhara Regional State, Ethiopia.Materials and methodsA cross sectional study was conducted in Dessie, Felege-Hiwot and University of Gondar Referral Hospitals, from December 2015 to August 2017. After getting informed assent from each parent/guardian, blood was collected from infants < 1 year of age for laboratory determination of anti-rubella virus antibodies. Their socio-demographic data and clinical information compatible with congenital rubella syndrome were collected using WHO guideline.ResultsDuring the study period, a total of 50 infants suspected for congenital rubella syndrome were included in the study. All infants suspected for CRS were tested against rubella specific IgM and IgG [for infants ≥ 6 months of age] antibodies using ELISA method. Of these, 9/50 (18%) and 4/14 (28.6%) of them were laboratory confirmed and potential CRS cases, respectively. In the present study, the most common laboratory confirmed defect was ocular manifestations 6 (66.7%) followed by heart related problems 5 (55.6%). In the present study, most of the laboratory confirmed cases (66.7%) were reported among 1–5 months of age infants. In addition, 5 (55.6%) of the infants with laboratory confirmed CRS cases were male and 6 (66.7%) of them were from urban settings. In this study, the incidence of CRS was 0.4 per 1000 live births.ConclusionIn this study, nearly one fifth of the infants had laboratory confirmed congenital rubella syndrome and most of them had multiple rubella associated congenital defects at a time. Most of these congenital anomalies were reported among infants ≥ 1 month of age. Based on our result, the incidence of the CRS was line with the global incidence of the CRS in the pre-vaccine era. Therefore, establishing strong rubella/CRS surveillance system as well as introducing the rubella containing vaccine in the national immunization program might be important to reduce the burden of rubella and CRS in the country.

Mechanisms and evidence of vertical transmission of infections in pregnancy including SARS‐CoV‐2s

“…Dong et al reported a sudden decrease in IgM levels barely above the positive threshold when the assay was repeated for a 2‐week‐old infant 75 . This rapid drop in SARS‐CoV‐2 IgM differs from serological trends observed in common congenital infections, where raised IgM may be detected for up to 19 months in ZIKV, 115 3 months in CMV and 6 months in rubella 116,117 …”

“…113 115 3 months in CMV and 6 months in rubella. 116,117 T A B L E 2 Biological samples to aid in diagnosis of transplacental infection Matured chorionic edematous villi.…”

Profile of Age and Sex of Congenital Rubella Syndrome Patients with Congenital Heart Disease

“…Whereas a study in South Africa reported the age of diagnosis for CRS ranged from 0 -11 months with the majority of cases diagnosed at 4 weeks after delivery (4) . Studies at the Gondar University Referral Hospital show mostly (66.7%) occur in infants aged 1-5 months (5) . Internationally, several countries have conducted national surveillance.…”

The Profile of Children With Congenital Rubella Sydrome Suffering From Hearing Disorders in DR Soetomo General Hospital, Surabaya

“…Researchers' crosstab data showed that only 16 patients had negative IgG and IgM results. This phenomenon may be caused by other viral agents, such as CMV (cytomegalovirus), toxoplasma gondii and herpes simplex which cause similar congenital abnormalities to rubella (Wondimeneh et al, 2018). Infants can be clinically diagnosed with CRS if they have 2 group A symptoms or 1 group A criteria and 1 group B criteria.…”

“…This difference may also happened due to the correlation of gestational age when the infection of rubella occurred with the organ systems involved, such as vision problems and congenital heart disease that is often affected during the first 8 weeks of pregnancy; whereas mental retardation and hearing loss are more common during 18 weeks of pregnancy. Based on all these studies, the most susceptible time to rubella is in the early trimester of pregnancy (Wondimeneh et al, 2018). The provision of an appropriate and correct vaccine is very effective in preventing the occurrence of CRS in children (CDC, 2019).…”