European Journal of Pediatrics

, Volume 176, Issue 7, pp 955–962 | Cite as

Underreporting of congenital rubella in Italy, 2010–2014

  • Cristina Giambi
  • Antonino Bella
  • Antonietta Filia
  • Martina Del Manso
  • Gloria Nacca
  • Silvia Declich
  • Maria Cristina Rota
  • Regional contact points for rubella
Original Article
First Online:
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Revised:
Accepted:

Abstract

In accordance with the goals of the World Health Organization Regional Committee for Europe, the Italian national Measles and Rubella Elimination Plan 2010–2015 aimed to reduce the incidence of congenital rubella cases to <1 case/100,000 live births by 2015. In Italy, a passive national surveillance system for congenital rubella and rubella in pregnancy is active since 2005. We estimated the degree of underreporting of congenital rubella, performing a capture-recapture analysis of cases detected through two independent sources: the national surveillance system and the national hospital discharge database, in the years 2010–2014. We found that 6 out of 11 cases tracked in the retrospective case-finding from hospital registries had not been notified to the surveillance system, and we estimated a degree of underreporting of 53% for the period 2010–2014. This approach showed to be simple to perform, repeatable, and effective.Conclusion: In order to reduce underreporting, some actions aimed at strengthening surveillance procedures are needed. The adoption on a routine basis of the review of hospital discharge registries for case-finding, monthly zero-reporting, and actions to train and sensitize all the specialists involved in the care of pregnant women and the newborns to notification procedures are recommended.

What is Known

• In Italy, the incidence of congenital rubella was below the WHO target of 1/100,000 live births in 2005–2015, except for two peaks in 2008 and 2012 (5 and 4/100,000, respectively).

• Further efforts are required to improve congenital rubella surveillance so that it is more sensitive and specific. The WHO proposes retrospective case-finding from hospital records as an alternative approach to detect infants with congenital rubella.

What is New

• Underreporting of congenital rubella in Italy was 53% in 2010–2014.

• Hospital discharge registries resulted to be an appropriate source to detect congenital rubella cases.

Keywords

Congenital rubella Surveillance Hospital discharge records Underreporting Capture-recapture method 

Abbreviations

AA.PP

Autonomous Provinces

CR

Congenital rubella

CRI

Congenital rubella infections

CRS

Congenital rubella syndrome

HDR

Hospital Discharge Registry

IHR

Individual hospital record

ICD9-CM

International Classification of Diseases, Ninth Revision, Clinical Modification

ISS

Istituto Superiore di Sanità

MMR

Measles, mumps, and rubella

NSS

National Surveillance System

RHA

Regional Health Authority

WHO

World Health Organization

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Notes

Acknowledgements

We wish to thank all the regional and local contact points for rubella, the physicians, and the laboratories that routinely contribute to the notification, investigation, data collection, and monitoring of cases. We also wish to thank the hospital staff that contributed to retrievement of hospital discharge records and individual patients’ records in this study.

Multiple affiliations: Di Giacomo M (Abruzzo); Locuratolo F, Cauzillo G (Basilicata); Natter B (PA Bolzano); Mignuoli A (Calabria); Pascucci MG, Frasca G (Emilia-Romagna); Gallo T, Braida C (Friuli Venezia Giulia); Vitagliano A, Guerra M, Scognamiglio P (Lazio); Cremonesi I (Liguria); Piatti A, Cereda D, Senatore S (Lombardia); Fiacchini D, Giuliani S (Marche); Ponzio GV (Molise); Ferrara L, Giovannetti F (Piemonte); Prato R, Cappelli MG (Puglia); Palmas MA, Macis F (Sardegna); Palermo M (Sicilia); Balocchini E, Pecori L (Toscana); Carraro V, Zuccali MG (PA Trento); Ruffier M (Valle d’Aosta); Russo F, Zanella F, Bano M (Veneto); Tosti A (Umbria).

Authors’ contributions

CG coordinated surveillance activities for congenital rubella and rubella in pregnancy at the national level, analyzed the data, interpreted the results, and drafted and edited the manuscript.

AF, MR, and SD coordinated surveillance activities, interpreted the results, and critically revised the manuscript.

AB and MD analyzed the data, interpreted the results, and critically revised the manuscript.

GN entered individual reports and follow-up information in the national database.

Regional contact points for rubella coordinated surveillance activities at the regional level and critically revised the manuscript.

Compliance with ethical standards

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The study was partially funded by the Italian Ministry of Health.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Cristina Giambi
    • 1
  • Antonino Bella
    • 1
  • Antonietta Filia
    • 1
  • Martina Del Manso
    • 1
  • Gloria Nacca
    • 1
  • Silvia Declich
    • 1
  • Maria Cristina Rota
    • 1
  • Regional contact points for rubella
  1. 1.Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health PromotionIstituto Superiore di SanitàRomeItaly

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