Phylogenetic analysis of congenital rubella virus from Indonesia: a case report.

BACKGROUND: Rubella is a common inherited infection resulting in congenital cataracts and a significant cause of permanent vision loss in developing countries. In 2016, Indonesia had the highest number of congenital rubella syndrome (CRS) cases globally. Here, we report the first genotype of the rubella virus extracted from the eye lens from a child with congenital cataracts due to CRS. CASE PRESENTATION: A female neonate was delivered by an elective caesarean delivery with normal birth weight at term from a 24-year-old mother in the rural setting. The baby presented with bilateral congenital cataracts, small-moderate secundum atrial septal defect, severe supravalvular pulmonary stenosis, and profound bilateral hearing loss. She also had microcephaly and splenomegaly. The patient's serology showed persistent positive IgG for rubella virus at the age of four years and four months. Following extraction during cataract surgery, viral detection of the lenses identified the presence of rubella. Phylogenetic analysis confirmed that the virus was grouped into genotype 1E. CONCLUSIONS: Our study reports the first phylogenetic analysis of the rubella virus extracted from the eye lens of a child with CRS in Indonesia. The detection of the rubella virus from eye lenses is remarkably promising. Our findings also emphasize the importance of molecular epidemiology in tracking the origin of rubella infection toward achieving virus eradication.

Sí­ndrome da rubéola congênita: análise dos casos notificados no Brasil entre 1990 a 2016 / Congenital rubella syndrome: analysis of cases notified in Brazil from 1990 to 2016

Objetivo: analisar os casos de Síndrome da Rubéola Congênita notificados no Brasil durante o período de 1990 a 2016. Método: estudo transversal realizado no Brasil, cuja amostra foi de 122 casos notificados com Síndrome da Rubéola Congênita. Os dados foram disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A coleta de dados foi realizada durante os meses de fevereiro e março de 2021. O tratamento dos dados se deu por análise estatística uni-variada. Resultados: observa-se prevalência no Estado de São Paulo cuja capital apresentou o maior número destas notificações. O ano em que houve prevalência do diagnóstico foi em 2008 e o mês de maior notificação foi dezembro. Todos os pacientes apresentavam idade menor que um ano, sexo feminino, com confirmação final para a doença por meio de critérios laboratoriais, e evolução para a cura. Conclusão: a idade apresentou significância no estudo. A terapêutica mostrou-se eficiente para um melhor prognóstico de cura, bem como a vacinação como medida preventiva.(AU)

Objective: to analyze the cases of Congenital Rubella Syndrome notified in Brazil from 1990 to 2016. Method: cross-sectional study conducted in Brazil, whose sample consisted of 122 cases notified with Congenital Rubella Syndrome. Data were made available by the Departamento de Informática do Sistema Único de Saúde. Data collection was conducted during February and March 2021. The data were processed using univariate statistical analysis. Results: prevalence was observed in the state of São Paulo, whose capital city had the highest number of these notifications. The year in which there was prevalence of the diagnosis was 2008, and the month of greatest notification was December. All patients were less than one year old, female, with final confirmation of the disease through laboratory criteria, and progression to cure. Conclusion: Age was significant in this study. Therapy proved to be efficient for a better prognosis of cure, as well as vaccination as a preventive measure.(AU)

Objetivo: analizar los casos de Síndrome de Rubéola Congénita notificados en Brasil entre 1990 a 2016. Método: estudio transversal realizado en Brasil, cuya muestra fue 122 casos notificados con Síndrome de Rubéola Congénita. Los datos fueron facilitados por el Departamento de Informática del Sistema Único de Salud. La recogida de datos se realizó durante los meses de febrero y marzo de 2021. El tratamiento de los datos se realiza mediante un análisis estadístico univariante. Resultados: se observa una prevalencia en el Estado de São Paulo, cuya capital presenta el mayor número de notificaciones. El año y mes en que se produjo la prevalencia del diagnóstico fue 2008 y diciembre. Todos los pacientes presentaban una edad inferior a un año, sexo femenino, con confirmación final de la enfermedad mediante criterios de laboratorio y evolución para la cura. Conclusión: la edad presentó un significado en el estudio. El tratamiento es eficiente para un mejor pronóstico de curación, así como la vacunación como medida preventiva.(AU)

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2019.

The Australian Paediatric Surveillance Unit (APSU) has been prospectively collecting national data on rare childhood conditions since 1993, with monthly reporting of cases by paediatricians. In this report we describe annual results from studies for ten communicable diseases and complications of communicable diseases that were conducted using APSU surveillance in 2019 and place these in an historic context. Results are reported on acute flaccid paralysis, congenital cytomegalovirus infection, neonatal herpes simplex virus infection, perinatal exposure to HIV, paediatric HIV infection, severe complications of seasonal influenza, juvenile onset recurrent respiratory papillomatosis (JoRRP), congenital rubella syndrome, congenital varicella syndrome and neonatal varicella infection. APSU provides rich clinical data to complement data collected from other surveillance systems and to improve understanding and response to rare childhood infections.

Síndrome da rubéola congênita / Congenital rubella syndrome

A rubéola é uma doença viral, caracterizada como autolimitada e com evolução benigna,porém o fator de maior preocupação relacionado ao vírus da rubéola ocorre quando a infecção acomete gestantes, devido à capacidade que o vírus possui de causar infecção transpondo a barreira placentária podendo gerar a síndrome da rubéola congênita (SRC). Objetivo: O estudo pesquisou dados atualizados sobre a temática para advertir a população sobre os riscos relacionados à síndrome da rubéola congênita, além de contribuir com conhecimento científico de acadêmicos, profissionais da saúde e pesquisadores. Método: Para a elaboração do artigo de atualização, foi realizada uma revisão bibliográfica na ferramenta de busca Google Acadêmico, Sistema de Informação de Agravos de Notificação (SINAN), Ministério da Saúde e alguns livros, a fim de selecionar artigos e conteúdos disponíveis e atualizados para proporcionar maior compreensão do tema. Considerações Finais: O surgimento da vacina contra o vírus da rubéola foi uma grande conquista para a humanidade, uma vez que, após sua inclusão, houve uma redução significativa no número de casos novos de síndrome da rubéola congênita. Além disso, observou-se no decorrer da pesquisa uma grande dificuldade de encontrar trabalhos recém-publicados relacionados ao tema estudado

Rubella is viral disease, characterized as self-limiting and with a benign course, however the factor of greater concern related to rubella virus occurs when the infection affects pregnant women, due to the ability of the virus to cause infection by transposing the placental barrier, cangenerate the congenital rubella syndrome (CRS). Objective: The study searched update data on the subject to warn the population on related risks congenital rubella syndrome besides contributing with scientific knowledge of academics, health professionals and researchers. Method: For the elaboration of the update article, a bibliographic review was carried out in the Google Scholar search tool, the Notification of Injury Information System (SINAN), the Ministry of Health and some books, in order to select articles and contents available and update to provide understanding of the theme. Final considerations: The emergence of the rubella virus vaccine was great achievement for mankind, since after its inclusion there was a significant a reduction in the number of new cases of congenital rubella syndrome. In addition, it was observed during the research a great difficulty to find recently published papers related to the subject studied

Vigilancia de enfermedades febriles exantemáticas y casos de sarampión de la CABA / Surveillance of febrile diseases and measles cases at Buenos Aires City

En esta edición, se expondrán fundamentalmente los casos de sarampión confirmados de la Ciudad. Ante la circulación del virus de sarampión en países de América y el resto del mundo, la importación de casos es actualmente la forma de entrada del mismo al país y la Ciudad. Se deberá tener en cuenta que la Ciudad de Buenos Aires no presenta casos autóctonos desde 1999 y que confluyen en el momento actual varios factores que pueden desencadenar un brote ante la introducción de un caso: el incremento de susceptibles; la vigilancia cuya tasa de detección, durante varios años, no llegó a la establecida internacionalmente; bajas coberturas de vacunación y que la Ciudad representa el punto más importante del país para la entrada y salida de turistas hacia y desde otros países del mundo. La principal medida para evitar la reintroducción y diseminación del virus del sarampión y la rubéola es sin duda la vacunación de la población susceptible; ésta, junto a un sistema de vigilancia (clínica y de laboratorio) de alta calidad y suficientemente sensible son los pilares para impedir la producción de brotes relacionados con la importación y mantener eliminada esta enfermedad. El sistema de Vigilancia cumple el rol fundamental: detectar oportunamente los casos sospechosos a fin de accionar de manera rápida y efectiva.

Pre-anesthetic echocardiographic findings in children undergoing non-cardiac surgery at the University of Benin Teaching Hospital, Nigeria.

BACKGROUND: A pre-anaesthestic echocardiogram (echo) is requested for most non-cardiac surgeries to identify possible cardiac structural anomalies. OBJECTIVE: To describe the prevalence and spectrum of structural cardiac abnormalities seen in various non-cardiac conditions. METHODS: We carried out a retrospective review of pre-anaesthetic echos performed over five years on children scheduled for non-cardiac surgery. The requests were categorised according to referring specialities, and the biodata and echo findings were noted. RESULTS: A total of 181 children and 181 echocardiograms were studied, and 100 (55.2%) of the patients were male. Most of the children (87, 48.1%) with oro-facial clefts were referred from dentistry. Of the 181 children, 39 (21.5%) had cardiac abnormalities, most (34, 87.2%) of whom had congenital heart disease (CHD). Ophthalmic requests with suspected congenital rubella syndrome (CRS) had the highest prevalence of 8/12 (66.7%) while the lowest was oro-facial clefts at 15/87 (17.2%). Atrial septal defect was the commonest abnormality, found in 14 patients (35.9%). CONCLUSION: Pre-anaesthetic echo should be performed, especially for children with suspected CRS and other congenital anomalies, requiring non-cardiac surgery.

Genotypes of rubella virus and the epidemiology of rubella infections in the Democratic Republic of the Congo, 2004-2013.

Rubella is a viral infection that may cause fetal death or congenital defects, known as congenital rubella syndrome (CRS), during early pregnancy. The World Health Organization (WHO) recommends that countries assess the burden of rubella and CRS, including the determination of genotypes of circulating viruses. The goal of this study was to identify the genotypes of rubella viruses in the Democratic Republic of the Congo (DRC). Serum or throat swab samples were collected through the measles surveillance system. Sera that tested negative for measles IgM antibody were tested for rubella IgM antibody. Serum collected within 4 days of rash onset and throat swabs were screened by real-time RT-PCR for rubella virus RNA. For positive samples, an amplicon of the E1 glycoprotein gene was amplified by RT-PCR and sequenced. 11733 sera were tested for rubella IgM and 2816 (24%) were positive; 145 (5%) were tested for the presence of rubella RNA by real-time RT-PCR and 10 (7%) were positive. Seventeen throat swabs were analyzed by RT-PCR and three were positive. Sequences were obtained from eight of the positive samples. Phylogenetic analysis showed that the DRC rubella viruses belonged to genotypes 1B, 1E, 1G, and 2B. This report provides the first information on the genotypes of rubella virus circulating in the DRC. These data contribute to a better understanding of rubella burden and the dynamics of rubella virus circulation in Africa. Efforts to establish rubella surveillance in the DRC are needed to support rubella elimination in Africa. J. Med. Virol. 88:1677-1684, 2016. © 2016 Wiley Periodicals, Inc.

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination.

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

Echocardiography findings in clinically confirmed congenital rubella syndrome cases seen at the University of Port Harcourt Teaching Hospital, Nigeria.

BACKGROUND: Congenital rubella syndrome (CRS) is known to affect thousands of children in the developing world because rubella vaccination is not available routinely in most of these countries. Among its many manifestations only congenital heart disease is life threatening. This study was undertaken to ascertain the cases of echocardiographic determined congenital heart disease in clinically confirmed CRS cases. METHODS: Data of patients with clinically confirmed CRS seen over a period of 5 years in the Paediatric cardiology clinic of the University of Port Harcourt Teaching Hospital was retrieved and analysed. RESULTS: Seven cases (2.8 % of total cardiac cases) were seen. 6 (85.7%) cases had at least one murmur on auscultation. Patent ductus arteriosus was the commonest cardiac defect seen either in isolation or incombination with a VSD or ASD. Only one child had no cardiac defect. 4 (57.1%) of them had been admitted for heart failure at least once and 2 (28.6 %) were on anti-failure regimen, one of whom had cardiac surgery one month ago. CONCLUSION: In view of the fact that 6 (85.7%) of the patients with CRS had at least one congenital heart defect, we advocate routine echocardiography on patients with CRS to ensure early treatment and reduce mortality and morbidity.We also advocate that rubella vaccination be given routinely in developing countries.

Mortalidade infantil e as malformações congênitas no Município de Pelotas, Estado do Rio Grande do Sul, Brasil: estudo ecológico no período 1996-2008 / Infant mortality and congenital abnormalities in the Municipality of Pelotas, State of Rio Grande do Sul, Brazil: ecologic study in the period 1996-2008

Objetivo: o estudo pretende verificar as tendências da mortalidade infantil e da mortalidade por malformações congênitas e avaliar o impacto nos indicadores em razão da epidemia de rubéola (ocorrida em 2007) no Município de Pelotas, Estado do Rio Grande do Sul, Brasil, no período 1996-2008. Métodos: estudo ecológico descritivo das taxas de mortalidade infantil e mortalidade por malformações congênitas entre 1996 e 2008; foram utilizados dados dos sistemas de informações; as tendências foram avaliadas por regressão linear. Resultados: as taxas de mortalidade infantil observadas apresentaram redução estatisticamente significativa (β=-0,03; IC95 por cento: -0,05 a -0,01; p<0,01), embora o mesmo não tenha ocorrido com a mortalidade por malformações congênitas, cuja redução observada não foi estatisticamente significativa (β=-0,01; IC95 por cento: -0,04 a 0,02; p 0,41); foi identificado apenas um caso de síndrome da rubéola congênita. Conclusão: a efetividade confirmada das medidas introduzidas para a diminuição da mortalidade infantil e da epidemia de rubéola ocorrida em 2007 não modificou a mortalidade infantil por malformações congênitas em Pelotas-RS.

Objective: the study aims to verify trends in infant mortality and mortality from congenital malformations, and to evaluate the impact on indicators by the epidemic of rubella (occurred in 2007) in the Municipality of Pelotas, State of Rio Grande do Sul, Brazil, in the period 1996-2008. Methods: ecological and descriptive study of the rate of infant mortality and mortality from congenital malformations between 1996 and 2008; it was used data from information systems. Results: the authors perceived significant decrease in infant mortality (β=-0.03; CI95 per cent: -0.05 to -0.01; p<0.01), despite the same did not occurred for mortality by congenital malformations, which reduction observed had not statistical significance (β=-0.01; CI95 per cent: -0.04 to 0.02; p=0.41); it was identified only one case of congenital rubella syndrome. Conclusion: the confirmed effectiveness of measures introduced to reduce infant mortality and the epidemic of rubella occurred in 2007 did not affectinfant mortality from congenital malformations in Pelotas-RS.

Survey of rubella knowledge and acceptability of rubella vaccination among Brazilian adults prior to mass vaccination / Encuesta sobre el conocimiento de la rubéola y la aceptabilidad de la vacunación antirrubeólica en los adultos brasileños antes de una campaña de vacunación masiva

OBJECTIVE: Evaluate knowledge of rubella and acceptability of vaccination and identify sources of health information among brazilian adults to inform communication strategies for a national vaccination campaign to eliminate rubella and congenital rubella syndrome (CRS). METHODS: From 5-8 July 2008 a qualitative telephone survey was conducted among a nonprobabilistic sample of brazilian adults 18 to 65 years of age (n = 1 023) from all five geographic regions of Brazil to measure knowledge of rubella and willingness to receive the vaccine and to identify sources of health information. Frequencies of responses were stratified by respondents' sex, age, education, and income. RESULTS: Although 69.9 percent of respondents said they knew what rubella was, actual knowledge of the disease was limited, with only 29.9 percent answering affirmatively when asked if they would recognize symptoms of rubella infection. Self-reported knowledge increased with increasing age, education, and income, and was higher among women than men. A total of 94.5 percent of the respondents expressed willingness to be vaccinated for rubella elimination. The most frequently mentioned sources of health information were television and doctors. CONCLUSIONS: Despite limited knowledge of rubella, brazilian adults expressed willingness to be vaccinated for disease elimination.

OBJETIVO: Evaluar el conocimiento de la rubéola y la aceptabilidad de la vacunación antirrubeólica, y determinar las fuentes de información sanitaria en los adultos brasileños, con objeto de fundamentar las estrategias de comunicación de una campaña nacional de vacunación dirigida a eliminar la rubéola y el síndrome de rubéola congénita (SRC). MÉTODOS: Del 5 al 8 de julio del 2008 se llevó a cabo una encuesta telefónica cualitativa en una muestra no probabilística de adultos brasileños de 18 a 65 años de edad (n = 1 023) de las cinco regiones geográficas del Brasil, con objeto de evaluar el conocimiento de la rubéola y la disposición a recibir la vacuna antirrubeólica, y determinar las fuentes de información sanitaria. Las frecuencias de las respuestas se estratificaron según el sexo, la edad, el nivel educativo y los ingresos de los entrevistados RESULTADOS: Aunque 69,9 por ciento de los entrevistados dijeron que sabían lo que era la rubéola, el conocimiento real de la enfermedad era limitado, ya que solo 29,9 por ciento respondieron afirmativamente cuando se les preguntó si reconocerían los síntomas de esta infección. El grado de conocimiento notificado por los propios entrevistados aumentó con la edad, el nivel educativo y los ingresos, y fue mayor en las mujeres que en los hombres. El 94,5 por ciento de los entrevistados expresaron su disposición a vacunarse con objeto de eliminar la rubéola. Las fuentes de información sanitaria mencionadas con mayor frecuencia fueron la televisión y los médicos. CONCLUSIONES: A pesar de tener un conocimiento limitado de la rubéola, los adultos brasileños expresaron su disposición a vacunarse con objeto de eliminar la enfermedad.

Phylogenetic analysis of rubella viruses involved in congenital rubella infections in France between 1995 and 2009.

Rubella is an acute infectious disease that normally has a mild clinical course. However, infections during pregnancy, especially before week 12 of gestation (WG), can cause severe birth defects known as congenital rubella syndrome (CRS). The aim of this study was to perform genotyping and molecular characterization of rubella viruses involved in congenital infections in France over the past 15 years (1995 to 2009). Amniotic fluid (AF) specimens (n = 80) from pregnant women with congenital rubella infections (CRI) before week 20 of gestation, and a few other samples available from children/newborns with CRS (n = 26), were analyzed. The coding region of the rubella virus E1 gene was amplified directly from clinical specimens by reverse transcriptase PCR, and the resulting DNA fragments were sequenced. Sequences were assigned to genotypes by phylogenetic analysis with rubella virus reference sequences. Sufficient E1 gene sequences were obtained from 56 cases. Phylogenetic analysis of the sequences showed that at least five different genotypes (1E, 1G, 1B, 2B, and 1h) were present in France and were involved in congenital infections, with a strong predominance of genotype 1E (87%). This is one of the very few comprehensive studies of rubella viruses involved in CRI. The results indicated that over the past 15 years, multiple introductions of the dominant genotype E caused most of the CRI cases in France. A few sporadic cases were due to other genotypes (1B, 1G, 1h, 2B).

A cost-utility analysis of antenatal screening to prevent congenital rubella syndrome.

In low vaccination coverage regions (LVR) in The Netherlands people often reject participation in the National Immunization Programme for religious reasons. During a rubella epidemic in 2004-2005, 32 pregnant women were notified with rubella, and 11 babies were born with defects related to maternal infection. This study presents a cost-utility analysis of a screening and vaccination programme for rubella focusing on three scenarios: (1) screening non-vaccinated pregnant women in LVR; (2) screening all pregnant women in LVR; (3) screening all non-vaccinated pregnant women in The Netherlands (including pregnant first-generation non-Western immigrant women). Cost-utility was estimated over a 16-year period which included two rubella outbreaks. Observed complications from the 2004-2005 epidemic were used to estimate average cost savings and quality-adjusted life-years (QALY) gained. The programme would be cost-effective (euro1100/QALY gained) when assuming an acceptability of vaccination of 20% in women belonging to orthodox protestant risk groups.

Congenital rubella syndrome after rubella vaccination in 1-4 weeks periconceptional period.

OBJECTIVE: To examine weather exposure to rubella vaccine during 1-4 wk periconceptional period can cause congenital rubella syndrome (CRS). METHODS: This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wk pre or post conception. Time of conception was determined by last menstrual period (LMP) and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody titers in cord blood samples. RESULTS: A total of 60 pregnant women with the median gestational age of 38 weeks were studied. The mean maternal age was 22 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects (fever, lymphadenopathy, arthritis, arthralgia). None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3100grs and 6.7% of them were premature. No signs of CRS were found in the neonates based on systemic physical exam at birth and one month later. Mean value of cord blood anti rubella IgG titere was 148/28+/-67/26 lu/ml. cord blood anti rubella IgM was negative in all of the neonates. CONCLUSION: In this study inadvertent rubella vaccination 1-4 wk before and after conception did not cause CRS in neonates and according to all reasearches pregnancy termination is not indicated in these cases.

Serologic survey of specific rubella virus IgM in the sera of pregnant women in Makurdi, Benue State, Nigeria.

Although a major section of pregnant women in Nigeria are immune to rubella infection, cases of congenital rubella syndrome are still been seen in hospitals. Rubella is not a reportable disease in Nigeria and data of its epidemiology are extremely rare. In this study, we estimate the burden of acute rubella virus infection among pregnant women during their first trimester in Makurdi-Benue State-Nigeria. Anti-rubella IgM were detected using a commercially available quantitative enzyme immunoassay. Of the 534 (mean age = 28.1 +/- 1.7 years) sera sample tested, 21 (3.9%; 95% CI = +/- 1.64%) were positive for Rubella IgM antibodies. We also extrapolated by mathematical modeling that 4.2% represents the actual/real susceptible population in Nigeria. There was no significant correlations between rubella infection and age (p > 0.05). Although the incidence of rubella is low we suggest the antenatal screening and vaccination of all females of child bearing age to eliminate this potentially devastating virus in the county.

Eliminating congenital rubella: a seroepidemiological study on women of childbearing age and MMR vaccine coverage in newborns.

INTRODUCTION: Rubella can have particularly serious effects on the product of conception if contracted during pregnancy. Thus, the main aim of rubella vaccination programmes is to prevent infection during pregnancy. MATERIALS AND METHODS: A seroepidemiological study was conducted from July 2006 to December 2007 on 1000 women of childbearing age, 15 to 45 years old, using specific rubivirus antibody assays, IgG and IgM. A questionnaire administered at the same time allowed us to survey how much women knew about this disease. In addition, MMR vaccine coverage rates were analysed for cohorts born in the local health districts of Messina for the period 1993-2006. RESULTS: An analysis of the replies given to the questionnaire showed an estimated 42.8% of the women to have immunity from rubella, while the serological study showed an immunity coverage rate of80.6%. Vaccination coverage in the local health districts regarding the first dose of MMR was 81% (cohorts 1993-2005), while the rate was only 24% for the second dose (cohorts 1993-2002). CONCLUSIONS: Both immunity coverage in women of childbearing age and that for newborns (for the cohort considered)fall below the 95% target set by the National Elimination Plan for Measles and Congenital Rubella (PNEM). It is therefore necessary to provide women with adequate information about the risks of rubella during pregnancy and about the benefits of vaccination, as well as to recoup subjects at risk or those whose immune status is unknown. Public health authorities also need to make continued efforts to increase the number of MMR vaccinations throughout the region.

Eliminating congenital rubella syndrome in Spain: does massive immigration have any influence?

In this short report we highlight the importance of implementing good immunization programs adapted to the epidemiological situation of rubella and congenital rubella syndrome (CRS), discuss the influence of massive immigration and stress the need to improve surveillance and control by implementing comprehensive national surveillance and promoting awareness among primary healthcare workers and midwives to find out any signs and symptoms compatible with rubella in pregnant women who have recently arrived from countries with high susceptibility to rubella infection.

Prevalence of eye signs in congenital rubella syndrome in South India: a role for population screening.

PURPOSE: Congenital rubella syndrome (CRS) resulting from maternal rubella infection, especially in the first trimester, affects an estimated 100 000 infants each year worldwide. Immunisation has reduced its occurrence in the developed world, though it remains a problem in countries with poor immunisation coverage. This population-based study was aimed at screening children below 5 years of age for ocular signs suspicious of CRS. METHODS: Suspected CRS cases were recruited from hospital and outreach services of the Aravind Eye Care System over a 24-month period. Clinical confirmation was based on the fulfilment of the World Health Organization (WHO) definition, and laboratory confirmation was based on a positive test for IgM antibody. RESULTS: Children under 5 years of age (n = 51 548) with ocular complaints were screened for eye signs suspicious of CRS; CRS compatible signs were detected in 1.92% (1090) children. Of these suspects (299), 27.42% were subsequently confirmed clinically according to WHO definition, and (46) 4.2% were serologically (Laboratory) confirmed. Of all the eye signs evaluated for screening, cataracts were the most sensitive (80.43%). CONCLUSIONS: Cataracts among children have a high sensitivity for detecting CRS in India. It is the only clinical eye finding that has a high enough sensitivity and specificity to be useful as a screening tool for CRS.

Impacto da vacinação contra rubéola na ocorrência da síndrome da rubéola congênita / Impact of rubella vaccination strategy on the occurrence of congenital rubella syndrome

OBJETIVO: A vacinação rotineira contra a rubéola foi implementada na Paraíba, nordeste brasileiro, através de uma campanha de catch-up direcionada a crianças com idades entre 1 e 11 anos em 1998. Uma campanha entre as mulheres em idade reprodutiva foi realizada em 2001. Descrevemos a epidemiologia da rubéola e da síndrome da rubéola congênita (SRC) no estado da Paraíba entre 1999 e 2005. MÉTODOS: Foram analisados os dados de vigilância da rubéola e da SRC entre 1999 e 2005. Os casos suspeitos de rubéola foram confirmados por exames laboratoriais, vínculo epidemiológico ou por critério clínico. Foram utilizadas as definições internacionais padrão de SRC. RESULTADOS: Dos 5.924 casos suspeitos de rubéola entre 1999 e 2005, 1.266 (21 por cento) foram confirmados, 766 (61 por cento) deles através dos exames laboratoriais. Durante uma epidemia de rubéola em 2000 (18,8/100.000), a incidência entre os indivíduos com idades entre 14 e 19 anos (42/100.000) quadruplicou em relação a crianças com idades entre 1 e 13 anos (intervalo de confiança de 95 por cento = 3,2-5,1). A incidência geral da rubéola foi de 0,9/100.000 em 2005. Dos 177 casos suspeitos de SRC entre 1999 e 2005, 167 (94 por cento) foram testados para a presença de IgM. Dos 14 (8 por cento) casos de SRC confirmados laboratorialmente, 12 (86 por cento) haviam nascido em 2001, com uma incidência de 0,2/100.000 crianças menores de 1 ano nesse ano. CONCLUSÕES: A campanha de vacinação contra a rubéola em 1998 não foi suficiente para prevenir um surto entre adultos jovens em 2000, com uma alta incidência de SRC em 2001. Entre 2002 e 2005, as incidências de rubéola e de SRC diminuíram; entretanto, a alta cobertura da vacina e a vigilância de alta qualidade são importantes para que se atinja a erradicação da SRC até 2010.

OBJECTIVE: Routine rubella vaccination was introduced in Paraíba, northeastern Brazil, through a catch-up campaign targeting children aged 1-11 years, in 1998. A campaign among women of childbearing age was conducted in 2001. We describe the epidemiology of rubella and congenital rubella syndrome (CRS) in the state of Paraíba between 1999 and 2005. METHODS: Rubella and CRS surveillance data for the 1999-2005 period were analyzed. Suspected cases of rubella were confirmed by laboratory findings, epidemiological link, or clinical data. International standardized CRS definitions were used. RESULTS: Of 5,924 suspected cases of rubella between 1999 and 2005, 1,266 (21 percent) were confirmed, 766 (61 percent) by laboratory findings. During a rubella epidemic in 2000 (18.8/100,000), the incidence among individuals aged 14-19 years (42/100,000) had a fourfold increase relative to children aged 1-13 years (95 percent confidence interval = 3.2-5.1). The overall rubella incidence was 0.9/100,000 in 2005. Of 177 suspected cases of CRS between 1999 and 2005, 167 (94 percent) were tested for IgM. Of 14 (8 percent) laboratory confirmed cases of CRS, 12 (86 percent) were born in 2001, with an incidence of 0.2/100,000 children aged less than 1 year. CONCLUSIONS: The 1998 rubella vaccination campaign was insufficient to prevent an outbreak among young adults in 2000, with a high CRS incidence in 2001. Between 2002 and 2005 the incidence of rubella and CRS decreased; however, high routine vaccination coverage and high-quality surveillance remain critically important to achieve CRS elimination by 2010.