Immunization gaps must be addressed to prevent congenital rubella syndrome

Salt-and-pepper retinopathy is the most common ocular manifestation of CRS.

While rubella is a mild disease, if a pregnant woman contracts it the fetus could develop congenital rubella syndrome (CRS), which can cause blindness, deafness, mental handicap, and other problems. Immunization of the mother before she becomes pregnant can eliminate this risk.

A systematic review published in Indian Pediatrics found that while there are no studies or epidemiologic information available on the prevalence of CRS in India, immunization is as low as 5% in some areas. The review found that most of the studies focusing on CRS have been done in hospitals, and not in the community, and that there also are no national data on rubella vaccination rates.

CRS accounts for 10% to 15% of pediatric cataract cases and is the second-leading cause[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] of nontraumatic childhood cataracts in India. By extrapolation, about 1.5% of childhood blindness in India is due to rubella cataracts, according to the article, which was funded by UNICEF.

Key Point: Congenital rubella syndrome (CRS) can include blindness, deafness, and mental handicaps. Pregnant women should be screened for CRS so that early interventions can take place. In India, data are limited regarding the prevalence of CRS, but immunization rates are known to be low. Many countries have combined universal immunization of infants with the vaccination of adolescent girls and adult women to eliminate rubella and CRS.

Of the infants suspected to have been infected as fetuses, only 1% to 15% of the cases were confirmed by laboratory evidence. Ultimately, only 3% to 10% of clinically suspected cases of CRS are confirmed with laboratory tests. Of children with congenital abnormalities, 10% to 50% have laboratory evidence of CRS.

Most studies found that 10% to 30% of adolescent girls and 12% to 30% of reproductive-age women are susceptible to rubella infection, meaning that they had not already contracted the illness or had not been vaccinated.

Nationwide there are no data on the coverage of rubella vaccine. But by locality, coverage of MMR (measles, mumps, and rubella) vaccine is reported as 42% in Delhi, 30% in Chandigarh, and 5% in Goa. All 3 regions’ coverage estimates are far below the government’s stated goal of 80%. The better coverage in Delhi may be due to the fact that in 1999, Delhi adopted an extra MMR vaccine, while Goa didn’t adopt it until 2003. Chandigarh, while it did not have any state immunization policy on MMR, probably showed a higher rate because that study was done in an economically affluent urban part of the state.

There should be a plan for rubella vaccination for all children under 5 years of age in India, and a “mass scale vaccination” for adolescent girls, the authors said in their paper.

The World Health Organization recommends 3 strategies to eliminate CRS:

  • investigate any rubella outbreak to assess CRS cases for 2 years to determine susceptibility among women of childbearing age;
  • begin a national immunization program and actively report all rubella and CRS cases;
  • investigate and report every febrile rash within 48 hours.

India is still working on the first strategy, according to the article, which states that the logistics of national antenatal surveys to determine rubella risks would be “daunting” in India, partly due to the costs of testing.

Source: Dewan P, Gupta B. Burden of congenital rubella syndrome (CRS) in India: a systematic review. Indian Pediatr. 2012. 49(5):377-399.

Access the original journal information here:
http://www.indianpediatrics.net/may2012/377.pdf
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

Photo: “Salt-and-pepper” retinopathy of the retina is the common ocular manifestation of congenital rubella. Jonathan Trobe, M.D. – University of Michigan Kellogg Eye Center. 15 August 2011.
Access the original illustration information here: http://en.wikipedia.org/wiki/File:Congenital_Rubella_Syndrome,_Salt_and_Pepper_Retinopathy.jpg

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