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.|
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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
Adam O, Ali AKM, Hübschen JM, Muller CP (2014) Identification of congenital rubella syndrome in Sudan. BMC Infect Dis 14:305
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 62:226–229
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
Deorari AK, Broor S, Maitreyi RS, Agarwal D, Kumar H, Paul VK, Singh M (2000) Incidence, clinical spectrum, and outcome of intrauterine infections in neonates. J Trop Pediatr 46:155–159
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
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:E263–267
Gregg NM (1991) Congenital cataract following German measles in the mother. Epidemiol Infect 107:iii–xiv
Hussain N, Jaffery G, Hasnain S, Anwar MS (2006) Seroprevalence of Rubella IgG and IgM antibodies in infants suspected of having Rubella infection. Biomedica 22:25–30
Khandaker G, Zurynski Y, Jones C (2014) Surveillance for congenital rubella in Australia since 1993: cases reported between 2004 and 2013. Vaccine 32:6746–6751
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 433–555
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 21:350–382
National Statistical Office (2014) Statistic in Yogyakarta Province, 2014. Available at: http://yogyakarta.bps.go.id/index.php/Publikasi Accessed October 25, 2014
Pham VH, Nguyen TV, Nguyen TT, Dang LD, Hoang NH, Nguyen TV, Abe K (2013) Rubella epidemic in Vietnam: characteristic of rubella virus genes from pregnant women and their fetuses/newborns with congenital rubella syndrome. J Clin Virol 57:152–156
Pitts SI, Wallace GS, Montana B, Handschur EF, Meislich D, Sampson AC, Canuso S, Horner J, Barskey AE, Abernathy ES, Icenogle JP (2014) Congenital rubella syndrome in child of woman without known risk factors, New Jersey, USA. Emerg Infect Dis 20:307–309
Rahman MM, Khan AM, Hafiz MM, Ronny FM, Ara S, Chowdhury SK, Nazir SS, Khan WI (2002) Congenital hearing impairment associated with rubella: lessons from Bangladesh. Southeast Asian J Trop Med Public Health 33:811–817
Reef SE, Redd SB, Abernathy E, Zimmerman L, Icenogle JP (2006) The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998–2004: the evidence for absence of endemic transmission. Clin Infect Dis 43(Suppl 3):S126–S132
Saraswathy TS, Rozainanee MZ, Asshikin RN, Zainah S (2013) Congenital rubella syndrome: a review of laboratory data from 2002 to 2011. Southeast Asian J Trop Med Public Health 44:429–435
Strebel PM, Gacic-Dobo M, Reef S, Cochi SL (2011) Global use of rubella vaccines, 1980–2009. J Infect Dis 204:S579–S584
Villagra E, Delgado LV, Olea A (2011) Enhanced surveillance for congenital rubella syndrome following mass rubella vaccination of girls and reproductive-aged women. J Infect Dis 204(Suppl2):S642–S646
WHO (2013) Rubella and congenital rubella syndrome control and elimination—global progress, 2012. Wkly Epidemiol Rec 88:521–527
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
Zimmerman L, Reef SE (2001) Incidence of congenital rubella syndrome at a hospital serving a predominantly Hispanic population, El Paso, Texas. Pediatrics 107:E40
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.
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).
Communicated by David Nadal
About this article
Cite this article
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
- Congenital rubella syndrome
- Hospital-based surveillance