Congenital Rubella Syndrome as a possible cause for persistent thrombocytopenia in early infancy: The Forgotten Culprit

Abstract We present a case of a late preterm intrauterine growth-restricted neonate with isolated and persistent severe thrombocytopenia. At birth, the neonate did not have a complete clinical spectrum of congenital rubella syndrome (CRS) but later developed peculiar findings that helped clinch the diagnosis. The neonate also had interstitial pneumonia and died secondary to superimposed acute viral infection leading to acute respiratory distress syndrome. The serology was positive for IgM antibodies against the rubella virus. The constellation of clinical manifestations of congenital rubella in the presence of positive IgM antibody against rubella and consistent histopathology confirmed the diagnosis of CRS.

Sí­ndrome da rubéola congênita: análise dos casos notificados no Brasil entre 1990 a 2016 / Congenital rubella syndrome: analysis of cases notified in Brazil from 1990 to 2016

Objetivo: analisar os casos de Síndrome da Rubéola Congênita notificados no Brasil durante o período de 1990 a 2016. Método: estudo transversal realizado no Brasil, cuja amostra foi de 122 casos notificados com Síndrome da Rubéola Congênita. Os dados foram disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A coleta de dados foi realizada durante os meses de fevereiro e março de 2021. O tratamento dos dados se deu por análise estatística uni-variada. Resultados: observa-se prevalência no Estado de São Paulo cuja capital apresentou o maior número destas notificações. O ano em que houve prevalência do diagnóstico foi em 2008 e o mês de maior notificação foi dezembro. Todos os pacientes apresentavam idade menor que um ano, sexo feminino, com confirmação final para a doença por meio de critérios laboratoriais, e evolução para a cura. Conclusão: a idade apresentou significância no estudo. A terapêutica mostrou-se eficiente para um melhor prognóstico de cura, bem como a vacinação como medida preventiva.(AU)

Objective: to analyze the cases of Congenital Rubella Syndrome notified in Brazil from 1990 to 2016. Method: cross-sectional study conducted in Brazil, whose sample consisted of 122 cases notified with Congenital Rubella Syndrome. Data were made available by the Departamento de Informática do Sistema Único de Saúde. Data collection was conducted during February and March 2021. The data were processed using univariate statistical analysis. Results: prevalence was observed in the state of São Paulo, whose capital city had the highest number of these notifications. The year in which there was prevalence of the diagnosis was 2008, and the month of greatest notification was December. All patients were less than one year old, female, with final confirmation of the disease through laboratory criteria, and progression to cure. Conclusion: Age was significant in this study. Therapy proved to be efficient for a better prognosis of cure, as well as vaccination as a preventive measure.(AU)

Objetivo: analizar los casos de Síndrome de Rubéola Congénita notificados en Brasil entre 1990 a 2016. Método: estudio transversal realizado en Brasil, cuya muestra fue 122 casos notificados con Síndrome de Rubéola Congénita. Los datos fueron facilitados por el Departamento de Informática del Sistema Único de Salud. La recogida de datos se realizó durante los meses de febrero y marzo de 2021. El tratamiento de los datos se realiza mediante un análisis estadístico univariante. Resultados: se observa una prevalencia en el Estado de São Paulo, cuya capital presenta el mayor número de notificaciones. El año y mes en que se produjo la prevalencia del diagnóstico fue 2008 y diciembre. Todos los pacientes presentaban una edad inferior a un año, sexo femenino, con confirmación final de la enfermedad mediante criterios de laboratorio y evolución para la cura. Conclusión: la edad presentó un significado en el estudio. El tratamiento es eficiente para un mejor pronóstico de curación, así como la vacunación como medida preventiva.(AU)

Seroprevalence of Rubella in a Subfertility Clinic of a Semi Urban Tertiary Care Private Hospital of Eastern India

Introduction: Primary maternal rubella virus infectionduring the first trimester of pregnancy carries a high risk fordevelopment of congenital rubella syndrome. According tothe estimate of World Health Organization, worldwide morethan 100,000 children are born with CRS each year. Mostof these children are born in developing countries. Severalguidelines suggest routine rubella serology testing in womentrying for pregnancy. Objectives: This study was conductedto assess immunity (seroprevalence) to rubella among Indianwomen of childbearing age attending subfertility clinic and toobserve the trend over the years.Material and methods: Women attending subfertility clinichad serum sample tested to determine the seropositivityas part of subfertility work up. Rubella seropositivity wasdetermined by estimating IgG antibodies to rubella virus usingCLIA method.Results: The study period was from January 2011 to December2018. Three hundred and seventy seven women were testedfor estimation of Rubella IgG. Overall seronegativity was29.4%. Interestingly this seronegativity rate was very similarover the study period, demonstrating overall nearly one-thirdof the subfertile women were susceptible to rubella.Conclusion: These observations indicate high rubellasusceptibility among women in the childbearing age grouptrying for pregnancy. There is a need for detection ofseroprevalence in subfertile population in Eastern India; sothat appropriate vaccination can prevent this preventabletragedy of perinatal / neonatal morbidity. Further study isneeded to determine the magnitude of problem in other settings(Government hospital, rural population, low socioeconomicstatus).

Sero-prevalence of unvaccinated adolescent girls susceptible to rubella virus infection seen in a tertiary care hospital of Patna, Bihar, India

Background: Rubella infection occurring during early pregnancy results in congenital rubella syndrome (CRS).  WHO estimates that worldwide more than 100,000 children are born with CRS each year and most of them are in the developing countries. For assessing population immunity against rubella, sero-surveys are generally recommended among adolescent girls and reproductive age female. In India, sero-surveys conducted by different authors have indicated that about 10-30% of adolescent females are susceptible to rubella infection. Adolescent girls are selected because they are at a critical stage of child bearing age and their immunity against Rubella infection is the particular area of interest. objective of this study was to estimate the sero-prevalence of unvaccinated adolescent girls susceptible to Rubella virus infection attending a tertiary care hospital of Patna and then accordingly counsel for vaccination.Methods: A total 150 adolescent girls in the age group of 10-19 years who had not received MMR vaccine were included in the study. Serum IgG antibody titer for rubella was estimated by the ELISA method.Results: A total 65.33% of the adolescent girls were found to be rubella seropositive and (34.67%) were seronegative. The urban adolescent girls had a higher seropositivity of 85.2% as compared to rural adolescent girls.Conclusions: The study indicates that a substantial number of adolescents (34.67%) are seronegative and hence susceptible to rubella infection.

Knowledge, attitude, and practice of care providers about congenital rubella syndrome

Background: Behaviour of healthcare providers when facing an illness is an important part of their struggle. The aim of this study was to assess the level of knowledge, the attitude and the practice of health care providers regarding to the Congenital Rubella Syndrome.Methods: Authors did a descriptive study on the knowledge, the attitude and the practice of healthcare providers about Congenital Rubella Syndrome with 161 healthcare providers working in 8 hospitals in Madagascar. A self-introduced survey was used to collect the data.Results: There were 87% of all healthcare providers included in the study, who said that rubella in the first trimester of pregnancy was the cause of this syndrome for child, 87% knew at least 2 of the 3 major signs of Congenital Rubella Syndrome and more than 80% had a good knowledge of the criteria for diagnosing cases (suspected, clinically confirmed, laboratory confirmed). The referral to a hospital or to a specialist was the most proposed for the management of the case of Congenital Rubella Syndrome. The prescription of an IgG avidity for rubella and advising abortion were the main propositions for mothers having a positive test at the first trimester of pregnancy.Conclusions: A fairly satisfactory level of knowledge of healthcare providers was noted.

Epidemio-clinical aspects of congenital rubella syndrome in Madagascar

Background: Congenital rubella syndrome is the first congenital defect preventable by vaccination. The purpose of this study was to provide basic information on the extent and epidemiology of congenital rubella syndrome in Madagascar.Methods: A retrospective and descriptive study from January 2013 to May 2019 was conducted in 8 hospitals in 2 provinces of Madagascar, Antananarivo and Toliara. The study included children who attended the services selected during the study period and who had the following conditions: children aged of 0 to 59 months, regardless of vaccination status, meeting the World Health Organization clinical criteria for congenital rubella syndrome with or without biological confirmation.Results: Of the 152,304 cases of children of all ages who visited or were hospitalized during the study period, 112 clinically confirmed cases of congenital rubella syndrome were identified. The age group 0 to 11 months involved 60 children (53.6%). Congenital heart disease was found in 83.0% of cases, mental backwardness in 43.7% and microcephaly in 26.8%. Twenty-three among (20.5%) them died. The death was due to cardiac diseases in 16 children.Conclusions: Findings confirm that the diagnosis of congenital rubella syndrome is underestimated in current pediatric practice in Madagascar. The introduction of the rubella vaccine in the Expanded Program on Immunization and the implementation of an effective and sustainable surveillance system for congenital rubella syndrome in the country is a proved effective tool for the prevention of this disease.

Perception of parents of private school students on measles and rubella vaccination campaign in Sambalpur town

Background: In order to eliminate measles and rubella (congenital rubella syndrome) WHO has emphasized on measles and rubella (MR) vaccination campaign and India launched the ambitious MR Campaign with the help of WHO and GAVI. In Odisha the MR campaign was launched on January 29 with a target to cover nearly 1.13 crore children. The objective of the present study is to assess the knowledge of parents regarding measles and rubella infection and to identify the source of information regarding MR campaign. Methods: A cross-sectional study was conducted in Sambalpur City across 10 private schools during February 10 to March 12. Total 440 parents of children aged 5-15 years were given a questionnaire about socio-demographic characteristics, knowledge, attitudes, and behaviors towards MR Campaign. The data were collected subsequently in the next 10 days. Out of 440 parents 408 returned filled up questionnaire. Data were entered into and analyzed by using Microsoft Excel.Results: Out of the 408 respondents 362 (88.7%) parents had knowledge about MR campaign. 156 respondents was aware about importance of rubella vaccine. Parent teacher meeting (PTM) was the leading source of information for these. 388 (95%) respondent’s children had received the vaccine during campaign.Conclusions: Parent-teacher's meeting was the main source of information. However social mobilisation such as street play, miking, rallies by school children and NGOs etc., needs to be taken up for such campaigns in future.

Seroprevalencia de anticuerpos IgG antirubéola y anticitomegalovirus en mujeres entre 16 y 40 años residentes en Tunja, Colombia / Seroprevalence of anti-rubella and anti-cytomegalovirus IgG antibodies in women aged between 16 and 40 years, living in Tunja, Colombia

RESUMEN Objetivo Determinar la seroprevalencia de anticuerpos IgG anti-rubéola y anti-citomegalovirus en un grupo de mujeres entre 16 y 40 años, residentes en Tunja. Métodos Investigación descriptiva de corte transversal, en la cual se incluyeron mujeres de 16 a 40 años, por medio de un muestreo no probabilístico por conveniencia. Las variables sociodemográficas fueron registradas mediante encuesta. Se empleó ensayo inmunoenzimático para la determinación cuantitativa de anticuerpos IgG frente a rubéola y citomegalovirus en suero. La estadística aplicada al estudio se llevó a cabo por medio del programa estadístico SPSS versión 21. Resultados El estudio incluyó un total de 154 mujeres en edad fértil, estableciéndose una seropositividad para IgG anti-rubéola de 96,1% (n=148) (IC 95% 93,0 - 99,1) y anti-citomegalovirus de 90,9% (n=140) (IC 95% 86,3 - 95,4). Conclusión Una de cada diez mujeres en estudio está en riesgo de adquirir una infección primaria por citomegalovirus y una de cada 30 por rubéola. El control prenatal por medio de determinaciones serológicas frente a citomegalovirus y rubéola durante el embarazo es primordial en estos casos.(AU)

ABSTRACT Objective To determine the seroprevalence of anti-rubella and anti-cytomegalovirus IgG antibodies in a group of women aged between 16 and 40 years, residents of Tunja. Methods Descriptive, cross-sectional research in women aged between 16 and 40 years included by means of non- probability sampling for convenience. Sociodemographic variables were recorded by applying a survey. An enzyme immunoassay was used for the quantitative determination of rubella and cytomegalovirus IgG antibodies in serum. The statistical analysis was carried out using the statistical program SPSS version 21. Results The study included 154 women of childbearing age, establishing seropositivity for anti-rubella IgG of 96.1% (n=148) (95%CI: 86.3 - 95.4) Conclusion One in ten women included in the study is at risk of primary cytomegalo-virus infection and one in 30 of rubella infection. Prenatal care using serological determinations of cytomegalovirus and rubella during pregnancy is essential in these cases.(AU)

Vacuna contra sarampión rubeola y paperas y su asociación con autismo: a 20 años de controversia / Vaccine against measles mumps and rubella and its association with autism: 20 years of controversy

Resumen En la presente revisión se ofrecen las pautas éticas que rigen el esquema con que debe ser aplicada la vacuna triple contra Sarampión Rubeola y Paperas. Se hace énfasis en la falta de datos clínicos que hayan asociado esta vacuna con el desarrollo de autismo en niños y se expone con base en evidencia científica los riesgos de la no vacunación en este grupo etario.

Abstract In the present review is offered the ethical guidelines that govern the scheme with which the triple vaccine against Measles Rubella and Mumps must to be applied. It emphasizes the lack of clinical data that have associated this vaccine with the development of autism in children and exposes based on scientific evidence the risks of non-vaccination in this age group.

Congenital rubella syndrome: A brief review of public health perspectives

Congenital rubella syndrome (CRS) is one of the most devastating congenital infections and yet the only one which is vaccine preventable and is a public health challenge for clinicians and policymakers across the developing world including India. The clinical manifestations of CRS include growth retardation, cardiac defects, cataracts, and hearing impairment. The World Health Organization (WHO) estimates that worldwide over 100,000 babies are born with CRS every year despite the availability of safe and inexpensive vaccines, thus highlighting the need for broader vaccination coverage programs. This article briefly reviews the importance of CRS, the proposed strategies for prevention by the WHO, and the 揜ubella initiative� that Government of India is launching in view of the recognition of CRS as a significant problem in India.

Síndrome de TORCH: Enfoque racional del diagnóstico y tratamiento pre y post natal: Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH Syndrome: Rational approach of pre and post natal diagnosis.: Recommendations of the Advisory Committee on Neonatal Infections. Sociedad Chilena de Infectología, 2016

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Síndrome de TORCH: enfoque racional del diagnóstico y tratamiento pre y post natal. Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH syndrome: Rational approach of pre and post natal diagnosis and treatment. Recommendations of the Advisory Committee on Neonatal Infections Sociedad Chilena de Infectología, 2016

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

An outbreak investigation of congenital rubella syndrome in Solomon Islands, 2013

INTRODUCTION: During May 2012, a rubella outbreak was declared in Solomon Islands. A suspected case of congenital rubella syndrome (CRS) was reported from one hospital 11 months later in 2013. This report describes the subsequent CRS investigation, findings and measures implemented. METHODS: Prospective CRS surveillance was conducted at the newborn nursery, paediatric and post-natal wards, and the paediatric cardiology and ophthalmology clinics of the study hospital from April to July 2013. Retrospective case finding by reviewing medical records was also undertaken to identify additional cases born between January and March 2013 for the same wards and clinics. Cases were identified using established World Health Organization case definitions for CRS. RESULTS: A total of 13 CRS cases were identified, including two laboratory-confirmed, four clinically confirmed and seven suspected cases. Five CRS cases were retrospectively identified, including four suspected and one clinically confirmed case. There was no geospatial clustering of residences. The mothers of the cases were aged between 20 and 36 years. Three of the six mothers available for interview recalled an acute illness with rash during the first trimester of pregnancy. DISCUSSION: Additional CRS cases not captured in this investigation are likely. Caring for CRS cases is a challenge in resource-poor settings. Rubella vaccination is safe and effective and can prevent the serious consequences of CRS. Well-planned and funded vaccination activities can prevent future CRS cases.

Using the two-source capture–recupture method to estimate the incidence and case ascertainment of congenital rubella syndrome in Australia, 1993–2013

To verify rubella and CRS elimination, countries need to ensure that their surveillance systems are sufficiently sensitive to capture almost all cases. This study aims to estimate the incidence of CRS in Australia and the sensitivity of CRS case ascertainment in the NNDSS.

Congenital Rubella Syndrome - A Major Review and Update.

Rubella is a major public health problem which is usually a mild rash illness in children and adults. However, it has devastating systemic consequences when rubella virus crosses the placental barrier and infects fetal tissue resulting in congenital rubella syndrome (CRS). Congenital rubella syndrome is an under-recognized public health problem in Bangladesh and the burden of the disease weighs heavily on patients and society; therefore, routine vaccination and other preventative strategies are strongly encouraged. Extensive surveillance studies should be conducted to eliminate CRS from our country. In this review, we will characterize the epidemiology of CRS; describe the patho-phyisiology, clinical features and laboratory testing for the disease, and discuss measures needed for prevention of rubella and CRS

Impact of rubella vaccination on elimination of congenital rubella syndrome in Sri Lanka: progress and challenges.

Rubella infection in pregnancy can lead to pathologies, including miscarriage, stillbirth and congenital rubella syndrome (CRS) in the neonate. Rubella vaccination can prevent all occurrences of CRS. In Sri Lanka, significant outbreaks of CRS occurred in 1994 and 1995, with 275 and 212 reported cases. In 1996, Sri Lanka introduced rubella vaccination for women aged 16–44 years, to stop CRS. Measles–rubella vaccine was introduced into the routine immunization schedule in 2001 and additional campaigns were carried out in 2003 (all 11–15 year olds) and 2004 (all 16–20 year olds). Reported immunization coverage with a single dose of a rubella-containing vaccine has been more than 95% since 2000. Laboratorysupported surveillance for rubella and CRS was started in 1992. Reported rubella cases fell from 364 (incidence 19/million population) in 1999 to 96 cases (incidence 5/million population) in 2002 and further to 12 cases (incidence 0.6/ million population) in 2014. Laboratory-supported CRS surveillance was started in 1990 and the highest number of CRS cases, 275 (incidence 77/100 000 live births), was diagnosed in 1994. Reported CRS cases fell from 22 cases (incidence 7/100 000 live births) in 2002 to 3 cases (incidence <1/100 000 live births) in 2014. Almost 20 years of routine rubella vaccination has resulted in >96% reduction in reported rubella cases and a corresponding >98% reduction in CRS cases. Despite this great achievement, work remains to eliminate rubella and CRS from Sri Lanka.

Congenital rubella syndrome: a matter of concern / Síndrome de rubéola congénita: un motivo de preocupación

Congenital rubella syndrome (CRS), an important cause of severe birth defects, remains a public health problem in a significant number of countries. Therefore, global health experts encourage use of rubella vaccination, with the primary aim of preventing CRS. While large-scale rubella vaccination during the last decade has drastically reduced or eliminated both the virus and CRS in Europe and the Americas, many countries in Africa, South-East Asia, the Eastern Mediterranean, and the Western Pacific have not yet incorporated any type of rubella-containing vaccine into their immunization schedule. As a result, through travel and migration, rubella has been imported into countries that had successfully eliminated the virus, leading to outbreaks and the reestablishment of endemic transmission. The objective of this study was to identify the key factors required for CRS elimination (prevalence reduction, vaccination strategies, and surveillance methods) by reviewing publications in PubMed on rubella and CRS (systematic reviews, country experiences, and position papers from the World Health Organization (WHO) and other intergovernmental organizations). Based on the results of the review, to eliminate rubella and CRS in endemic areas and reduce re-emergence in previously disease-free areas, all countries should carry out two types of mass rubella vaccination campaigns: 1) one single mass national immunization campaign targeting all men and women 5-39+ years old (with the upper age limit depending on the year in which the rubella-containing vaccine was introduced and the epidemiology of rubella in the country) and 2) incorporation of an rubella-containing vaccine in routine childhood immunization programs, including regular vaccination campaigns for 12-month-olds and measles follow-up campaigns. In addition to mass rubella immunization campaigns and routine childhood vaccination programs, the following measures should be taken to help fight rubella and CRS: 1) surveillance of the number of susceptible women of childbearing age, and the emergence of imported cases; 2) coverage of susceptible populations with "second-chance" ("catch-up") campaigns (vaccination of older children and adults who may have missed earlier immunization programs); 3) rapid response to outbreaks; 4) strengthening of CRS surveillance; 5) involvement of the private sector in awareness and vaccination campaigns; and 6) reduction of the number of false-positive laboratory test results.

El síndrome de rubéola congénita (SRC), una causa importante de defectos congénitos graves, sigue siendo un problema de salud pública en un número significativo de países. Por consiguiente, los expertos mundiales en salud promueven el uso de la vacunación antirrubeólica con el objetivo primario de prevenir el SRC. Aunque, durante el último decenio, la vacunación antirrubeólica administrada a gran escala ha reducido drásticamente o eliminado tanto el virus como el SRC en Europa y la Región de las Américas, muchos países de África, Asia Sudoriental, el Mediterráneo Oriental y el Pacífico Occidental aún no han incorporado ningún tipo de vacuna con componente antirrubeólico en su calendario de vacunaciones. Como resultado, y a consecuencia de los viajes y las migraciones, la rubéola se ha importado a países que habían eliminado eficazmente el virus, provocando brotes y el restablecimiento de la transmisión endémica. El objetivo de este estudio fue determinar los factores clave requeridos para la eliminación del SRC (reducción de la prevalencia, estrategias de vacunación y métodos de vigilancia) mediante la revisión de publicaciones aparecidas en PubMed sobre la rubéola y el SRC (revisiones sistemáticas, experiencias de países y documentos de posición de la Organización Mundial de la Salud y otras organizaciones intergubernamentales). Con base en los resultados de la revisión, y con objeto de eliminar la rubéola y el SRC en las zonas endémicas y reducir su reaparición en las zonas previamente libres de la enfermedad, todos los países deben llevar a cabo dos tipos de campañas de vacunación antirrubeólica masivas: 1) una única campaña de vacunación masiva a escala nacional dirigida a todos los hombres y mujeres de 5 a 39 años de edad (el límite superior de edad depende del año de introducción de la vacuna con componente antirrubeólico y de la epidemiología de la rubéola en el país), y 2) la incorporación de una vacuna con componente antirrubeólico en los programas sistemáticos de vacunación infantil, incluidas las campañas regulares de vacunación dirigidas a lactantes de 12 meses de edad y las campañas de seguimiento de las enfermedades exantemáticas. Además de las campañas de vacunación masiva contra la rubéola y los programas sistemáticos de vacunación infantil, se deben aplicar las siguientes medidas para ayudar a combatir la rubéola y el SRC: 1) la vigilancia de las mujeres en edad fecunda susceptibles, y de la aparición de casos importados; 2) la cobertura de las poblaciones vulnerables mediante campañas de "segunda oportunidad" ("puesta al día") (vacunación de niños mayores y adultos a los que no hubieran alcanzado los programas de vacunación anteriores); 3) la respuesta rápida ante los brotes; 4) el fortalecimiento de la vigilancia del SRC; 5) la participación del sector privado en las campañas de concientización y vacunación; y 6) la reducción del número de resultados de pruebas de laboratorio falsamente positivos.

Prenatal diagnosis of congenital rubella infection in São Paulo / Diagnóstico pré-natal de infecção congênita por rubéola, em São Paulo, Brasil

Objective: rubella during the early stages of pregnancy can lead to severe birth defects known as congenital rubella syndrome (CRS). Samples collected from pregnant women with symptoms and suspected of congenital rubella infection between 1996 and 2008 were analyzed. Methods: a total of 23 amniotic fluid samples, 16 fetal blood samples, 1 product of conception and 1 placenta were analyzed by serology and RT-PCR. Results: all patients presented positive serology for IgG / IgM antibodies to rubella virus. Among neonates, 16 were IgG-positive, 9 were IgM-positive and 4 were negative for both antibodies. Of the 25 samples analyzed in this study, 24 were positive by RT-PCR. Changes in ultrasound were found in 15 (60%) of 25 fetuses infected with rubella virus. Fetal death and miscarriage were reported in 10 (40%) of the 25 cases analyzed. The rubella virus was amplified by PCR in all fetuses with abnormal ultrasound compatible with rubella. Fetal death and abortion were reported in 10 of 25 cases analyzed. Conclusion: this study, based on primary maternal rubella infection definitely confirms the good sensitivity and specificity of RT-PCR using amniotic fluid and ultrasound. The results showed that molecular assays are important tools in the early diagnosis of rubella and congenital rubella syndrome. .

Objetivo: a rubéola, durante os primeiros estágios da gravidez, pode levar a graves defeitos congênitos, conhecidos como síndrome da rubéola congênita (SRC). Amostras de gestantes com sintomas e suspeitas da rubéola congênita foram coletadas entre 1996 e 2008. Métodos: um total de 23 amostras de fluido amniótico, 16 amostras de sangue fetal, um produto da concepção e uma placenta foram analisados por sorologia e PCR. Resultados: todas as gestantes apresentaram sorologia positiva para IgG/IgM para o vírus da rubéola. Entre os recém-nascidos, 14 apresentaram anticorpos IgG positivos e 11 foram os anticorpos IgM positivos. Das 25 amostras analisadas neste estudo, 24 eram positivas por RT-PCR. Alterações na ultrassonografia foram encontradas em 15 (60%) dos 25 fetos infectados com o vírus da rubéola. Morte fetal e aborto espontâneo foram reportados em 10 (40%) dos 25 casos analisados. O vírus da rubéola foi amplificado por PCR em todos os fetos que apresentaram alterações na ultrassonografia, compatíveis com a rubéola. Morte fetal e aborto foram relatados em 10 dos 25 casos analisados. Conclusão: os resultados mostraram que os ensaios moleculares são ferramentas importantes para o diagnóstico precoce da rubéola e da síndrome da rubéola congênita. .

Búsqueda retrospectiva del síndrome de rubéola congénita en niños menores de 1 año / Retrospective search for Congenital Rubella Syndrome in Children under one year

Antecedentes: Costa Rica estableció la meta de eliminación del síndrome de rubéola congénita desde el año 2000. Datos oficiales de vigilancia reportan el último caso autóctono confirmado en el 2001. Para evaluar si se logró la meta de eliminación de la enfermedad se analizó, mediante una búsqueda retrospectiva, la calidad de la vigilancia del síndrome para determinar la existencia de casos que no fueron capados por el sistema vigente...

Congenital Rubella Syndrome: An Overview of Clinical Presentations in Bangladeshi Children.

Background: Congenital Rubella Syndrome (CRS) has long been characterized by the triad of deafness, cataract and cardiovascular malformations with or without mental retardation. Objective: This study was conducted to observe the clinical manifestations of CRS in children of Bangladesh. Materials and method: This cross sectional study was carried out in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh and National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. Total 40 cases of CRS were enrolled from indoor and outpatient departments of these two hospitals, who were diagnosed according to standard case definition. Serological test for rubella antibody, chest X-ray, colour Doppler echocardiography, visual examination and hearing assessment were done in relative specialised centres. Results: The mean(±SD) age of the study subjects was 6.6(±5.7) months (range: 0-24 months). Among the subjects, 68% were male and 32% were female. Serum for rubella specific antibody revealed positive IgG in 60% cases and IgM in 28% cases. Neurological problem was the most frequently observed (90%) systemic complication followed by visual problem (83%), congenital hearing loss (80%) and congenital heart disease (78%). Cataract was the commonest (55%) among visual problems and microcephaly (62%) among neurological manifestations. Patent ductus arteriosus (PDA) was the most common (37.5%) isolated structural cardiac defect. Maximum (62.5%) children came from poor socioeconomic status. Maternal onset of infection was commonly detected in 1st trimester of pregnancy. Conclusion: Diagnosis of CRS and recognition of its versatile pattern of clinical presentation are crucial for better prognosis of the affected children.