SEROLOGY OF RUBELLA AND SURVEILLANCE OF CONGENITAL RUBELLA SYNDROME IN HANOI WHERE AN OUTBREAK HAS OCCURRED
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Abstract
Congenital rubella syndrome (CRS) is preventable illness but stays frequent in developing countries where rubella vaccination is not incorporated in national program of vaccination. Objectives: This study aimed at obtaining baseline information on acquired immunization status of school girls as well as the rate of susceptibility and rubella infection in pregnant women around a rubella outbreak in Hanoi. Methods@ During and after the rubella outbreak in 2011, sera from 136 school girls were tested for rubella-specifi c IgG (Rs-IgG) and 140 pregnant women were tested for rubella-specifi c IgG and for rubella-specifi c IgM (Rs-IgM) using electro-chemiluminescence immunoassay (ECLIA) (Roche Diagnostic) with cut-off value 10 IU/mL for IgG and 0.3 IU/mL for IgM. During the surveillance period, 113 infants were identifi ed with confi rmed CRS and clinically analyzed. Results: Rs-IgG antibodies was positive in 125/136 (91.9%) school girls and 119/140 (85%) pregnant
women, with strong-to-extreme concentration in 86/136 (63.2%) school girls versus 19/140
(13.6%) in pregnant women (p<0.002). Rs-IgG was negative in 21/140 (15%) and Rs-IgM
antibodies was positive in 27.9% (39/140) pregnant women, of whom 38 (27.1%) a co-existence of Rs-IgG and Rs-IgM were documented. During the surveillance period 113 infants were identifi ed with confi rmed CRS. Clinical manifestations of CRS included low birth weight <2,500g (86%), congenital heart disease (63.7%), hearing impairment (63.7%), ophthalmological involvement (46.9%). Other clinical features included: thrombocytopenia (85%), neonatal purpura (74.3%), splenomegaly (63.7%), hepatomegaly (62.8%) and blueberry muffi n rash (61.1%). During the surveillance period the estimated annual incidence of CRS was 1.13/1,000
live birth (95% CI 0.92-1.34). Conclusion:
This preliminary, baseline per/post epidemic information showed a high rate of acquired
immunization in female adolescents but also high rate of susceptibility and very high rate of
rubella infection in pregnant women, as well as a very high burden of CRS in Vietnam.
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Keywords
Acquired immunization, rubella infection, school girls, pregnant women, congenital rubella syndrome (CRS).
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