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, 19 (1), 813

Rubella Transmission and the Risk of Congenital Rubella Syndrome in Liberia: A Need to Introduce Rubella-Containing Vaccine in the Routine Immunization Program


Rubella Transmission and the Risk of Congenital Rubella Syndrome in Liberia: A Need to Introduce Rubella-Containing Vaccine in the Routine Immunization Program

Abyot Bekele Woyessa et al. BMC Infect Dis.


Background: Rubella is an RNA virus in the genus Rubivirus within the Matonaviridae family. Rubella remains a leading vaccine-preventable cause of birth defects. Most African countries including Liberia do not currently provide rubella-containing vaccine (RCV) in their immunization program. We analyzed the existing surveillance data to describe rubella cases and identify the at-risk population.

Methods: We conducted a retrospective descriptive statistics on the suspected-measles case-based surveillance data that obtained from the national database. Suspected-measles cases who were negative and indeterminate for measles IgM and tested for rubella IgM were extracted from the database. We used only rubella IgM positive cases to calculate trends and percentages by person, place and time. The cumulative-percent curve was used to visually describe the age distribution of rubella cases.

Results: During 2017-2018, a total of 2027 suspected-measles cases with known laboratory results were reported; of which, 1307 were tested for rubella IgM. Among tested cases, 472 (36%) were positive, 769 (59%) were negative and 66 (5%) were indeterminate for rubella IgM. Female contributed 269 (57%) of the confirmed rubella cases respectively. The median age was 7 years with an interquartile range of 5-10 years. From the total rubella cases, 6 (1%) were under 1 year, 109 (23%) were 1-4 years, 207 (44%) were 5-9 years, 87 (18%) were 10-14 years and 56 (12%) were more than or equal to 15 years. Women in their reproductive-age contributed 23 (5%) of rubella cases with 17% positivity rate. Two-thirds or 307 (65%) of the cases were reported from February to May which is dry season in Liberia.

Conclusions: Our analysis revealed that rubella was widely circulating in Liberia. Majority of the cases were reported among children < 15 years. However, rubella was also reported among women of reproductive age and infants < 1 year with no report of congenital rubella syndrome (CRS). Detail investigation of rubella cases among infants of < 1 year and women of reproductive age is important to uncover CRS. Establishment of CRS surveillance and the introduction of RCV in the immunization program are crucial to prevent rubella infection and avert the risk of CRS.

Keywords: Epidemiology; Liberia; Measles case-based surveillance; Pre-vaccine era; Rubella; West Africa; Women of childbearing age.

Conflict of interest statement

The authors declare that they have no competing interests.


Fig. 1
Fig. 1
Frequency of laboratory-confirmed rubella-specific immunoglobulin M antibody testing result by age and sex with a cumulative age distribution curve, 2017–2018, Liberia, N = 472 (6 months to 61 years old)
Fig. 2
Fig. 2
Trends of rubella IgM positive cases by month, 2017–2018, Liberia, N = 472 and cumulative positivity rate = 36%
Fig. 3
Fig. 3
Map showing the distribution of rubella IgM positive cases and its positivity rate by district, 2017–208, Liberia

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    1. Rubing Chen, Suchetana Mukhopadhyay, Andres Merits, Bethany Bolling, Farooq Nasar, Lark L. Coffey, Ann Powers, Scott C. Weaver, Donald Smith PS and SS. Create one new unassigned family Matonaviridae to contain the genus Rubivirus, moved from the family Togaviridae 2018.013S. Accessed 05 Sept 2019.
    1. World Health Organization . Rubella Fact Sheet. 2018.
    1. Center for Disease Control And Prevention. Rubella Virus. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Atlanta; 2015. p. 325–40. Accessed 15 Apr 2019.
    1. Centers for Diseases Control and Prevention . Last reviewed For Healthcare Professionals. Centers for diseases control and prevention. 2019.
    1. Khanal S, Bahl S, Sharifuzzaman M, Dhongde D, Pattamadilok S, Reef S, et al. Progress toward Rubella and congenital Rubella syndrome control —South-East Asia region, 2000–2016. Morb Mortal Wkly Rep. 2020;67(21):2016–2020. - PMC - PubMed

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