Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to 2013.

In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian national measles and rubella elimination plan aims to reduce the incidence of congenital rubella cases to less than one case per 100,000 live births by the end of 2015. We report national surveillance data for congenital rubella and rubella in pregnancy from 2005 to 2013. A total of 75 congenital rubella infections were reported; the national annual mean incidence was 1.5/100,000 live births, including probable and confirmed cases according to European Union case definition. Two peaks occurred in 2008 and 2012 (5.0 and 3.6/100,000 respectively). Overall, 160 rubella infections in pregnancy were reported; 69/148 women were multiparous and 38/126 had had a rubella antibody test before pregnancy. Among reported cases, there were 62 infected newborns, 31 voluntary abortions, one stillbirth and one spontaneous abortion. A total of 24 newborns were unclassified and 14 women were lost to follow-up, so underestimation is likely. To improve follow-up of cases, systematic procedures for monitoring infected mothers and children were introduced in 2013. To prevent congenital rubella, antibody screening before pregnancy and vaccination of susceptible women, including post-partum and post-abortum vaccination, should be promoted. Population coverage of two doses of measles-mumps-rubella vaccination of ≥ 95% should be maintained and knowledge of health professionals improved.

Rubella in Poland in 2011.

INTRODUCTION: Since 2004 rubella is covered by the Program for the Elimination of Rubella of the World Health Organization (WHO). The aim of the Program is to interrupt transmission of rubella virus in the environment and prevention of congenital rubella cases in children. In Poland, the vaccination against rubella to 2003 were limited to women, which in turn resulted in an increase in the incidence of rubella among men, and hence a possibility of infection in susceptible pregnant women. PURPOSE OF THE STUDY: To assess the epidemiological situation of rubella in Poland in 2011, taking into account the vaccination coverage against rubella in the general population and in selected birth cohorts. MATERIAL AND METHODS: Evaluation of rubella epidemiological situation in Poland was based on data from the newsletters: "Infectious diseases and poisoning in Poland in 2011" and, "Vaccinations in Poland in 2011" (MP. Czarkowski, Warsaw 2012, NIPH-NIH, GIS). Classification of rubella cases was based on the definition of infectious diseases prepared by ECDC. RESULTS: In 2011, there was a slight increase in the incidence of rubella, compared to 2010 (from 11.0/100,000 to 11.1/100,000). Total of 4 290 cases were registered. The highest incidence, regardless of gender and the environment, has been among children 5 years old (94.1/100,000.) and 6-year-old (93.4/100,000). As in 2010, the incidence of rubella in girls and women was lower than the incidence in boys and men (9.6/100,000 versus 12.8/100,000.). In 2011 there were no recorded cases of congenital rubella. CONCLUSIONS: Still small proportion of reported rubella cases are laboratory confirmed. In 2011 it amounted to 0.2% of cases. This situation requires prompt improvement.

[Rubella in Poland in 2010]. / Rózyczka w Polsce w 2010 roku.

INTRODUCTION: Rubella is the disease subject to the elimination programme coordinated by the World Health Organization (WHO). Generally, rubella is an infection of mild course among children but in the case of pregnant women, who are not immunized, it may contribute to the occurrence of severe congenital abnormalities (congenital rubella syndrome) may amount to 95%. The strategy of the countries belonging to the WHO European Region is directed to the interruption of the rubella virus transmission in the environment in order to prevent the cases of congenital rubella syndrome (CRS). OBJECTIVES: The aims of the present article are to analyze the epidemiological situation of rubella in Poland in 2010 and to discuss the rubella vaccination coverage. MATERIAL AND METHODS: [corrected] The epidemiological situation of rubella in Poland was analyzed on the basis of publications: "Infectious diseases and poisonings in Poland in 2010" (Czarkowski MP et al. Warsaw 2011, NIPH-NIH and "Vaccinations in Poland in 2010". The classification of the rubella cases is based on the definition of the infectious diseases developed by the Department of Epidemiology (NIPH - NIH): "Definitions of the cases of infectious diseases for the purposes of the epidemiological surveillance". RESULTS: Comparing the epidemiological situation in 2009 and 2010, in 2010 a decline in the incidence of rubella was observed--from 19.0 per 100 000 population to 11.0 per 100 000 population. Overall, 4 197 cases of rubella were reported. While analyzing the definition of the rubella case for the purposes of the epidemiological surveillance, none of the cases was reported as the confirmed case, 29 (0.7%) were classified as the probable and the remaining cases were classified only on the basis of clinical criteria. In 2010, one congenital rubella syndrome (CRS) was registered. The rubella incidence among girls and women (9.0) was lower than the incidence observed among boys and men (13.1). The highest incidence--regardless of the gender and surroundings--was reported in children aged 7 years old (96.4 per 100 000) and 8 years old (93.1). The percentage of the 13-year-old girls vaccinated against rubella amounted to 99.2%. CONCLUSIONS: The epidemiological situation of rubella in 2010 in comparison with the situation in 2009, has improved. However, the concern is raised by the low percentage of the laboratory tests aiming at confirmation or exclusion of the rubella. The decline in the number of rubella cases is the consequence of the sustained high vaccination coverage among children. Theoretically, the high rubella vaccination coverage among the girls significantly decreases the probability of congenital rubella syndrome occurrence. On the other hand, the higher incidence of rubella among men who have the contact with the women in the reproductive age poses the risk of infecting the pregnant women who are not immunized.

[Case classification in measles surveillance system under the Two-level Logistic Model].

OBJECTIVE: To study the prevalence rates of Rash and Febrile Illnesses (RFIs) including measles, rubella, scarlet fever, exanthema subitum and the differences among measles and other RFIs to tentatively formulate the logistic regression model through clinical manifestation. METHODS: All the suspected cases of measles, rubella, scarlet fever, exanthema subitum reported by the county/prefecture lever hospitals at four counties were collected during March 2011 to February 2012. When setting laboratory confirmed measles as dependent variable and existed symptoms as independent variable, a logistic regression model was formulated and optimal operational point (OOP)chosen, according to the ROC curve. RESULTS: A total number of 551 cases were collected but the consistency of measles diagnosis between clinical and laboratory was not satisfied, with Kappa value = 0.349, same to the diagnosis of rubella. As for the result from the two-lever logistic regression model, symptoms that related to the confirmation of measles would include cough (OR = 5.75), conjunctivitis (OR = 3.00), Koplik spot (OR = 7.52), lymphadenectasis(OR = 0.07), rash after fever (OR = 0.07). The area under ROC curve was 0.97 and the optimal operational point was 0.249. CONCLUSION: A logistic regression model was formulated using the clinical symptoms which was resulted in better performance on prediction. As the sample size of this survey was small, the expansion on the scale of investigation and laboratory testings were needed before the types and components of measles-related RFIs be clarified.