Hospital-based surveillance of congenital rubella syndrome in Indonesia

Eur J Pediatr. 2017 Mar;176(3):387-393. doi: 10.1007/s00431-017-2853-8. Epub 2017 Jan 13.

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.

Keywords: Congenital rubella syndrome; Hospital-based surveillance; Immunization; Indonesia; Vaccine.

MeSH terms

  • Adult
  • Antibodies, Viral / isolation & purification*
  • Cross-Sectional Studies
  • Female
  • Hearing Disorders / etiology
  • Humans
  • Incidence
  • Indonesia / epidemiology
  • Infant
  • Infant, Newborn
  • Male
  • Population Surveillance
  • Pregnancy
  • Pregnancy Complications, Infectious
  • Prospective Studies
  • Rubella Syndrome, Congenital / diagnosis
  • Rubella Syndrome, Congenital / epidemiology*
  • Rubella Vaccine
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Antibodies, Viral
  • Rubella Vaccine
  • rubella antibodies