Dataset Information

Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data.

ABSTRACT:

Background

In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS.

Method

We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model.

Results

During 2016-21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6-16.2), cataract (OR = 7.8, 95% CI: 5.4-11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3-13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2-12.2) and glaucoma (OR = 3.1, 95% CI: 1.2-8.1). Nomogram, along with a web version, was developed.

Conclusions

Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.

SUBMITTER: Shanmugasundaram D

PROVIDER: S-EPMC10209330 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data.

Shanmugasundaram Devika D Verma Sanjay S Singh Kuldeep K Dwibedi Bhagirathi B Awasthi Shally S Mahantesh S S Singh Himabindu H Santhanam Sridhar S Mondal Nivedita N S Geetha G Sreenivasan Priya P Malik Shikha S Jain Manish M Viswanathan Rajlakshmi R Tripathi Shalini S Patel Bhupeshwari B Sapkal Gajanan G Sabarinathan R R Singh Mini P MP Ratho R K RK Nag Vijaylakshmi V Gadepalli Ravishekhar R Som Tapas Kumar TK Mishra Baijayantimala B Jain Amita A Ashok M M Madhuri Devara Sudha DS Rani V Sudha VS Abraham Asha Mary AM John Deepa D Dhodapkar Rahul R Syed Ali A A Biswas Debasis D Pratyeke Deepashri D Bavdekar Ashish A Prakash Jayant J Singh Varsha V Prasad Nidhi N Ray Jaydeb J Majumdar Agniva A Dutta Shanta S Gupta Nivedita N Murhekar Manoj M Sharma Akhil A Ghosh Aniruddha A Alexander Arun A Baranwal Arun A Anantharaj Avinash A Bethou Adhisivam A Shekhawat Dolat S DS Kiruthika G G Ram Jagat J Gupta Madhu M Gowda Mamatha M Rohit Manoj K MK Dash Nabaneeta N Sankhyan Naveen N Kaushal Nidhi N Shivanna Niranjan Hunasanahalli NH Kasturi Nirupama N Kumar P Prem PP Gupta Parul Chawla PC Gunasekaran Pradeep Kumar PK Singh Pratibha P Kumar Praveen P Munjal Sanjay Kumar SK Agarwal Siddharth S Manasa Suhani S Shukla Suruchi S Nehra Urvashi U Verghese Valsan P VP Vyas Varuna V Gupta Vikas V

Heliyon 20230509 5

<h4>Background</h4>In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS.<h4>Method</h4>We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of l ...[more]

PMID: 37251844

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Project description:Summary Background The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016–22. Methods Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as ‘Simple’ or ‘Complex’ as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15–2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42–2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26–3.30). Interpretation Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding 10.13039/501100007334Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.

Project description:Rubella vaccines have been used to prevent rubella and congenital rubella syndrome (CRS) in several World Health Organization (WHO) regions. Mathematical modelling studies have simulated introduction of rubella-containing vaccines (RCVs), and their results have been used to inform rubella introduction strategies in several countries. This systematic review aimed to synthesize the evidence from mathematical models regarding the impact of introducing RCVs. We registered the review in the international prospective register of systematic reviews (PROSPERO) with registration number CRD42020192638. Systematic review methods for classical epidemiological studies and reporting guidelines were followed as far as possible. A comprehensive search strategy was used to identify published and unpublished studies with no language restrictions. We included deterministic and stochastic models that simulated RCV introduction into the public sector vaccination schedule, with a time horizon of at least five years. Models focused only on estimating epidemiological parameters were excluded. Outcomes of interest were time to rubella and CRS elimination, trends in incidence of rubella and CRS, number of vaccinated individuals per CRS case averted, and cost-effectiveness of vaccine introduction strategies. The methodological quality of included studies was assessed using a modified risk of bias tool, and a qualitative narrative was provided, given that data synthesis was not feasible. Seven studies were included from a total of 1393 records retrieved. The methodological quality was scored high for six studies and very high for one study. Quantitative data synthesis was not possible, because only one study reported point estimates and uncertainty intervals for the outcomes. All seven included studies presented trends in rubella incidence, six studies reported trends in CRS incidence, two studies reported the number vaccinated individuals per CRS case averted, and two studies reported an economic evaluation measure. Time to CRS elimination and time to rubella elimination were not reported by any of the included studies. Reported trends in CRS incidence showed elimination within five years of RCV introduction with scenarios involving mass vaccination of older children in addition to routine infant vaccination. CRS incidence was higher with RCV introduction than without RCV when public vaccine coverage was lower than 50% or only private sector vaccination was implemented. Although vaccination of children at a given age achieved slower declines in CRS incidence compared to mass campaigns targeting a wide age range, this approach resulted in the lowest number of vaccinated individuals per CRS case averted. We were unable to conduct data synthesis of included studies due to discrepancies in outcome reporting. However, qualitative assessment of results of individual studies suggests that vaccination of infants should be combined with vaccination of older children to achieve rapid elimination of CRS. Better outcomes are obtained when rubella vaccination is introduced into public vaccination schedules at coverage figures of 80%, as recommended by WHO, or higher. Guidelines for reporting of outcomes in mathematical modelling studies and the conduct of systematic reviews of mathematical modelling studies are required.

Dataset Information

Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data.

Background

Method

Results

Conclusions

Publications

Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data.

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