Hospital-based surveillance of congenital rubella syndrome in Indonesia

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Abstract

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%).

Conclusion: The number of laboratory-confirmed CRS cases among Indonesian infants is high. Furthermore, hearing impairment is the most common clinical feature of CRS in infants. Our findings indicate the importance of implementation of rubella vaccine in Indonesia. Conducting hospital-based surveillance of CRS in other hospitals in Indonesia may be appropriate.

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.

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Abbreviations

ABR:

Auditory brainstem response

ASD:

Atrial septal defect

CRS:

Congenital rubella syndrome

DORV:

Double outlet right ventricle

F:

Female

Ig:

Immunoglobulin

LA:

Left auditory

M:

Male

Mo:

Month

N/a:

Not determined

PDA:

Patent ductus arteriosus

PH:

Pulmonary hypertension

RA:

Right auditory

SNHL:

Sensorineural hearing loss

TGA:

Transposition of the great arteries

TI:

Tricuspid insufficiency

VSD:

Ventricular septal defect

Wnl:

Within normal limits

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Acknowledgements

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.

Author’ contributions

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.

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Correspondence to Elisabeth Siti Herini.

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Ethical approval

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).

Additional information

Communicated by David Nadal

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Herini, E.S., Gunadi, Triono, A. et al. Hospital-based surveillance of congenital rubella syndrome in Indonesia. Eur J Pediatr 176, 387–393 (2017). https://doi.org/10.1007/s00431-017-2853-8

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Keywords

  • Congenital rubella syndrome
  • Hospital-based surveillance
  • Vaccine
  • Immunization
  • Indonesia