Surveillance for rubella and congenital rubella syndrome in the Caribbean and costing the burden of disease - abstract

ABSTRACT

Subsequently to the "BIG BANG" catch up measles vaccination campaign that was conducted in the sub-region during 1991, very low rubella incidence rates (<2.0 cases per 100,000 population) were recorded during the years 1992 through 1995. Beginning in 1995, however, and continuing through 1997, sizeable outbreaks of rubella have occurred in Jamaica, Barbados, Trinidad and Tobago, Guyana, and Belize. Subregional rubella incidence rates increased to 10.3 cases per 100,000 population in 1996 and a prototype surveillance system for congenital rubella syndrome (CRS) was developed and disseminated to all CAREC member countries in 1996. Analysis of surveillance data indicates that nearly half (47.1 percent) of these reported cases were diagnosed at birth. Intrauterine growth retardation and cataracts appear to be the predominant clinical manifestations. The maternal age distribution of CRS case (18-37 years) supports the hypothesis that we have not as yet increased our rubella vaccination coverage among women of child bearing age to prevent CRS and our use of Measles-Mumps-Rubelle vaccine in infant populations has been too recent to confer any significant benefit to such women. Direct costs alone associated with the care of an infant with CRS in Trinidad and Tobago are conservatively estimated at US$20,000 annually. These as well as indirect costs are, however, eminently avoidable. The costs of an immunisation campaign would have to exceed the hundreds of thousands spent on CRS care before an immunisation effort would fail to be beneficial. Expenditure of one half of what this syndrome cost might have prevented it altogether.(AU)