Hospital-based surveillance of congenital rubella syndrome in Indonesia
- 438 Downloads
Congenital rubella syndrome (CRS) has serious consequences, such as miscarriage, stillbirth, and severe birth defects in infants, resulting from rubella virus infection during pregnancy. However, rubella vaccine has not yet been implemented in Indonesia. This study aimed (1) to estimate the incidence of CRS in Indonesia, (2) describe the clinical features of CRS at our referral hospital, and (3) pilot a CRS surveillance system to be extended to other hospitals. We conducted a 4-month prospective surveillance study of infants aged <1 year with suspected CRS in 2013 at an Indonesian hospital. Infants with suspected CRS were examined for rubella-specific IgM antibody or rubella IgG antibody levels. Of 47 suspected cases of CRS, 11/47 (23.4%), 9/47 (19.1%), and 27/47 (57.5%) were diagnosed as laboratory-confirmed, clinically compatible, and discarded CRS, respectively. The most common defects among laboratory-confirmed CRS cases were hearing impairment (100%), congenital cataracts (72.7%), microcephaly (72.7%), and congenital heart defects (45.5%).
What is Known:
•Congenital rubella syndrome (CRS) has serious consequences in infants resulting from rubella virus infection during pregnancy.
•The incidence of CRS in most developed countries has greatly decreased since implementation of rubella vaccination.
•Rubella vaccine has not yet been implemented in many developing countries.
What is New:
•The number of laboratory-confirmed CRS cases among Indonesian infants was high.
•Implementation of rubella vaccine into immunization programs in Indonesia is important because of the high number of CRS cases.
•Our study highlights the need for ongoing prospective surveillance of CRS in Indonesia.
KeywordsCongenital rubella syndrome Hospital-based surveillance Vaccine Immunization Indonesia
Auditory brainstem response
Atrial septal defect
Congenital rubella syndrome
Double outlet right ventricle
Patent ductus arteriosus
Sensorineural hearing loss
Transposition of the great arteries
Ventricular septal defect
Within normal limits
We are grateful to all infants and their parents for their participation in this study. We also thank Dr. Michael Friedman and all those who provided excellent technical support and assistance during the study. The abstract has previously been presented at the 7th Asian Congress of Pediatric Infectious Diseases in Beijing, China on October 12–15, 2014.
ESH conceived the study, and AT and AWEM participated in its design and coordination. AT provided key technical guidance, ESH and G drafted the manuscript, and NM, R, YS, and SER critically revised the manuscript for important intellectual content.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Sources for funding
The work was supported in part by a grant from the World Health Organization (WHO).
- 2.Centers for Disease Control and Prevention (2013) Three cases of congenital rubella syndrome in the postelimination era—Maryland, Alabama, and Illinois, 2012. Morb Mortal Wkly Rep 62:226–229Google Scholar
- 3.Centers for Disease Control and Prevention (2014) Progress toward control of rubella and prevention of congenital rubella syndrome---worldwide, 2009. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5940a4.htm Accessed October 25, 2014
- 5.Department of Health, Australian Government (2015) Rubella (Postnatal and Congenital) Laboratory Case Definition (LCD). Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-phlncd-rubella Accessed June 17, 2015
- 6.Deverell M, Zurynski Y, Elliott E, chief investigators of APSU surveillance studies (2012) Australian paediatric surveillance unit annual report, 2011. Commun Dis Intell Q Rep 36:E263–267Google Scholar
- 8.Hussain N, Jaffery G, Hasnain S, Anwar MS (2006) Seroprevalence of Rubella IgG and IgM antibodies in infants suspected of having Rubella infection. Biomedica 22:25–30Google Scholar
- 10.Maria BL, Bale JF Jr (2006) Infections of the nervous system. In: Menkes JH, Sarnat HB, Maria BL (eds) Child neurology, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 433–555Google Scholar
- 11.Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z (2006) Laboratory assessment and diagnosis of congenital viral infections: rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Reprod Toxicol 21:350–382CrossRefPubMedGoogle Scholar
- 12.National Statistical Office (2014) Statistic in Yogyakarta Province, 2014. Available at: http://yogyakarta.bps.go.id/index.php/Publikasi Accessed October 25, 2014
- 20.WHO (2013) Rubella and congenital rubella syndrome control and elimination—global progress, 2012. Wkly Epidemiol Rec 88:521–527Google Scholar
- 21.WHO (2012) Surveillance guidelines for measles, rubella and congenital rubella syndrome in the WHO European Region. Geneva, Switzerland: World Health Organization, 2012. Available at: http://www.euro.who.int/__data/assets/pdf_file/0018/79020/e93035-2013.pdf?ua=1 Accessed November 7, 2016