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Durowade KA. Epidemiological Pattern of Rubella in Africa: A Review of Selected Sub-Saharan African Countries. Niger Med J 2022; 63:340-347. [PMID: 38867753 PMCID: PMC11165323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Rubella, (German measles) is vaccine-preventable and a viral disease of public health importance. It presents with mild febrile rash illness, attendant congenital sequel and foetal death. This paper seeks to do a review of the epidemiology of rubella in selected sub-Saharan African countries. This is a review of literatures involving data triangulation of rubella surveillance data. World Health Organization (WHO)rubella surveillance data (2015-2018) available online was used to present the seasonal/time-variation. Data was extracted from the site into Microsoft Excel over three months period (October-December, 2018). Univariate data analysis was done using SPSS-23 and data were presented with appropriate tables and charts to show the trend. Epidemiologic findings showed that periodicity of rubella varies across countries in Africa with seasonal variation across the four sub-regions. In the West Africa sub-region, sharp increases occurred in reported cases in January with peaks in March-April. In Nigeria, a West African country, available data showed that seasonal peak occurs in the first four months (Jan-April) of the year with most of the burden among those below fifteen years of age, affects both sexes and incidence cuts across both rural and urban areas. However, in the Central sub-region, spikes generally occur between February and March with troughs in September to November. In the East sub-region, dual peaks occur in March-April and in September-October; in the South sub-region, unique annual seasonality with few cases reported in January-June each year. The peak incidence of rubella has been observed to be a function of the seasonal peaks/variation in Africa. Therefore, the knowledge of this seasonal variation can be leveraged upon by Governments to control the disease through scaling up of awareness creation and surveillance during the identified peaks and beyond.
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Affiliation(s)
- Kabir Adekunle Durowade
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria and Federal Teaching Hospital, Ido-Ekiti, Nigeria
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Pagonendji MS, Gouandjika-Vasilache I, Charpentier E, Sausy A, LE Faou A, Duval RE, Hübschen JM. Rubella epidemiology in the Central African Republic, 2015-2016 and molecular characterization of virus strains from 2008-2016. Int J Infect Dis 2021; 111:303-309. [PMID: 34450282 DOI: 10.1016/j.ijid.2021.08.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Rubella cases in the Central African Republic (CAF) are currently identified during measles surveillance. This study aimed to investigate rubella epidemiology between 2015 and 2016 and to provide baseline genotype data for monitoring future rubella control efforts. METHODS 831 measles IgM negative or equivocal sera from 2015/2016 were tested for rubella IgM antibodies and 350 rubella IgM positive sera collected between 2008 and 2016 were selected for PCR and sequencing. RESULTS 411 of the 831 sera (49.5%) were rubella IgM positive and most cases (n=391, 95.1%) occurred between January and April. Most patients were between 5 and 9 years old (50.2%) and more than half of the rubella cases (56.7%) originated from the capital Bangui. Genotype information was obtained for 37 of the 350 selected rubella IgM-positive specimens, with the majority of the patients originating from Bangui (n=24, 64.9%) and sequences covering all years except 2009. Phylogenetic analysis identified genotypes 1E (n=12), 1G (n=5) and 2B (n=20), with 2B being detected from 2014 onwards. CONCLUSIONS Our study confirmed the important role of rubella as a rash and fever disease in CAF and provided comprehensive data on rubella epidemiology and the first information on rubella genotypes in the country.
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Affiliation(s)
- Marilou S Pagonendji
- Enteric viruses and Measles Laboratory, Institut Pasteur de Bangui, BP 923, Central African Republic
| | | | - Emilie Charpentier
- Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette, Luxembourg
| | - Aurélie Sausy
- Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette, Luxembourg
| | - Alain LE Faou
- Université de Lorraine, EA3452, CITHEFOR, Faculté de Pharmacie and Faculté de Médecine, F-54000 Nancy, France
| | | | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, L-4354 Esch-sur-Alzette, Luxembourg..
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Tushabe P, Bwogi J, Abernathy E, Birungi M, Eliku JP, Seguya R, Bukenya H, Namuwulya P, Kakooza P, Suppiah S, Kabaliisa T, Tibanagwa M, Ampaire I, Kisakye A, Bakainaga A, Byabamazima CR, Icenogle JP, Bakamutumaho B. Descriptive epidemiology of rubella disease and associated virus strains in Uganda. J Med Virol 2020; 92:279-287. [PMID: 31598987 PMCID: PMC7004003 DOI: 10.1002/jmv.25604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
Abstract
Rubella virus causes a mild disease; however, infection during the first trimester of pregnancy may lead to congenital rubella syndrome (CRS) in over 80% of affected pregnancies. Vaccination is recommended and has been shown to effectively reduce CRS incidence. Uganda plans to introduce routine rubella vaccination in 2019. The World Health Organization recommends assessing the disease burden and obtaining the baseline molecular virological data before vaccine introduction. Sera collected during case-based measles surveillance from January 2005 to July 2018 were tested for rubella immunoglobulin M (IgM) antibodies. Sera from confirmed rubella outbreaks from January 2012 to August 2017 were screened using real-time reverse-transcription polymerase chain reaction (RT-PCR); for positive samples, a region within the E1 glycoprotein coding region was amplified and sequenced. Of the 23 196 suspected measles cases serologically tested in parallel for measles and rubella, 5334 (23%) were rubella IgM-positive of which 2710 (50.8%) cases were females with 2609 (96.3%) below 15 years of age. Rubella IgM-positive cases were distributed throughout the country and the highest number was detected in April, August, and November. Eighteen (18%) of the 100 sera screened were real-time RT-PCR-positive of which eight (44.4%) were successfully sequenced and genotypes 1G and 2B were identified. This study reports on the seroprevalence and molecular epidemiology of rubella. Increased knowledge of former and current rubella viruses circulating in Uganda will enhance efforts to monitor the impact of vaccination as Uganda moves toward control and elimination of rubella and CRS.
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Affiliation(s)
| | | | - Emily Abernathy
- Division of Viral Diseases, National Center for Immunization and Respiratory DiseasesUnited States Centers for Disease Control and PreventionAtlantaGeorgia
| | - Molly Birungi
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | - James P. Eliku
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | - Henry Bukenya
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | | | - Suganthi Suppiah
- Division of Viral Diseases, National Center for Immunization and Respiratory DiseasesUnited States Centers for Disease Control and PreventionAtlantaGeorgia
| | | | - Mayi Tibanagwa
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | | | | | - Charles R. Byabamazima
- WHO Inter‐Country Support Team Office For Eastern and Southern Africa (IST/ESA)HarareZimbabwe
| | - Joseph P. Icenogle
- Division of Viral Diseases, National Center for Immunization and Respiratory DiseasesUnited States Centers for Disease Control and PreventionAtlantaGeorgia
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Mazaba ML, Siziya S, Monze M, Cohen D. Epidemiology of acute rubella infection in Zambia during the pre-vaccination period (2005-2016) as a baseline for monitoring rubella epidemiology in the post-rubella vaccine introduction era. BMC Infect Dis 2020; 20:101. [PMID: 32013873 PMCID: PMC6998197 DOI: 10.1186/s12879-020-4806-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rubella is highly under reported in Zambia as in most sub-Saharan countries despite being a disease of major public health concern especially among women of childbearing age. In September 2016, Zambia introduced a combined measles-rubella vaccine in children 0-14 years. In this study, we estimated the proportion positive for acute rubella among suspected but negative measles cases between 2005 and 2016 and determined its correlates for monitoring rubella epidemiology post-rubella vaccine introduction. METHODS In a retrospective study, 4497 measles IgM negative serum samples from 5686 clinically suspected measles cases were examined for rubella IgM antibodies using the Siemens, Enzygnost® ELISA kit at the national measles laboratory. Data on demographics, year and month of onset were extracted from the surveillance data. Multivariate logistic regression analysis using backward variable selection was conducted to determine independent predictors for acute rubella. The magnitude of association was estimated using adjusted odds ratio with a 95% confidence interval. RESULTS Overall, a proportion of 29.2% (1313/4497) affecting mostly those between 5 and 24 years was determined. Only age, province, month and year were independently associated with acute rubella. The regional proportions varied from 21.8-37.3% peaking in the month of October. Persons in the age group 10-14 years (Adjusted Odds Ratio [AOR] = 2.43; 95% CI [2.01-2.95]) were more likely while those aged < 1 year less likely (AOR = 0.31; 95% CI [021-0.48]) to have acute rubella compared to those aged 25 years or older. Persons in 2010 were less likely (AOR = 0.12; CI [0.05, 0.28]) to have acute rubella compared to those in 2016. While acute rubella was more likely to occur between July and November compared to December, it was less likely to occur between February and May. CONCLUSIONS Rubella virus was circulating in Zambia between 2005 and 2016 affecting mostly persons in the age group 5-24 years peaking in the hot dry season month of October. Although vaccination against rubella has been launched, these baseline data are important to provide a reference point when determining the impact of the vaccination program implemented.
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Affiliation(s)
- Mazyanga L Mazaba
- The Health Press - Zambia, Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia. .,Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia.
| | - Seter Siziya
- Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Mwaka Monze
- Virology Unit, University Teaching Hospital, Ministry of Health, Lusaka, Zambia
| | - Daniel Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Woyessa AB, Ali MS, Korkpor TK, Tuopileyi R, Kohar HT, Dogba J, Baller A, Monday J, Abdullahi S, Nagbe T, Mulbah G, Kromah M, Sesay J, Yealue K, Nyenswah T, Gebrekidan MZ. Rubella transmission and the risk of congenital rubella syndrome in Liberia: a need to introduce rubella-containing vaccine in the routine immunization program. BMC Infect Dis 2019; 19:813. [PMID: 31533658 PMCID: PMC6751791 DOI: 10.1186/s12879-019-4464-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
| | - Mohammed Seid Ali
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Tiala K. Korkpor
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Roland Tuopileyi
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Henry T. Kohar
- Republic of Liberia Ministry of Health, Monrovia, Liberia
| | - John Dogba
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - April Baller
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Julius Monday
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Suleman Abdullahi
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Thomas Nagbe
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Gertrude Mulbah
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Mohammed Kromah
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Jeremy Sesay
- World Health Organization Country office for Liberia, Monrovia, Liberia
| | - Kwuakuan Yealue
- World Health Organization Country office for Liberia, Monrovia, Liberia
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Farra A, Loumandet TN, Pagonendji M, Manirakiza A, Manengu C, Mbaïlao R, Ndjapou S, Lefaou A, Gouandjika-Vasilache I. Epidemiologic profile of measles in Central African Republic: A nine year survey, 2007-2015. PLoS One 2019; 14:e0213735. [PMID: 30893336 PMCID: PMC6426189 DOI: 10.1371/journal.pone.0213735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/27/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Measles remains a major public health problem in many developing countries in which vaccination coverage is poor, as is the case in the Central African Republic (CAR). At the beginning of the 2000s, a surveillance system was established in the country, and samples from suspected cases are regularly tested in the laboratory for serological confirmation. Since 2007, when case-by-case monitoring with standardized laboratory databases and monitoring, was set up, no assessment have been performed. Therfore, 9 years later it seemed appropriate to make a first assessment. The aim of the study reported here was to describe the epidemiology of measles in the CAR on the basis of surveillance and laboratory data. METHOD A descriptive retrospective study was conducted, based on the databases of the measles surveillance programme and of the Institut Pasteur laboratory in Bangui during the period 2007-2015. RESULTS During this study period, the surveillance programme notified 3767 cases. Of these, 2795 (75%) were sent for laboratory confirmation, and 24.6% (687/2795) were confirmed serologically. Of the 1797 cases of measles declared during this period by the surveillance programme, 1110 (61.8%) were confirmed clinically or by epidemiological linkage. The majority of confirmed cases (83.7%; 575/687) occurred in children under 10 years, over half of whom (44.2%; 304/687) were aged 1-4 years. Epidemics occurred regularly between 2011 and 2015, with > 10% of laboratory-confirmed cases. The rate of laboratory investigation was < 80% between 2011 and 2013 but nearly 100% in the other years. CONCLUSION Measles remains a common, endemic illness in the CAR. Improved detection will require better measles surveillance, increased vaccination coverage, revision of the investigation forms to include the WHO case definition and training of the health personnel involved in case-finding in the field.
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Affiliation(s)
- Alain Farra
- National Mycobacteriology Laboratory, Institut Pasteur of Bangui, Bangui, Central African Republic
- Enteric Virus and Measles Laboratory, Institut Pasteur of Bangui, Bangui, Central African Republic
| | | | - Marilou Pagonendji
- Enteric Virus and Measles Laboratory, Institut Pasteur of Bangui, Bangui, Central African Republic
| | | | - Casimir Manengu
- World Health Organization Focal Point for Immunization, Vaccines and Emergencies, Bangui, Central African Republic
| | - Raphaël Mbaïlao
- Expanded Programme on Immunization, Ministry of Health, Bangui, Central African Republic
| | - Severin Ndjapou
- Epidemiological Surveillance Service, Ministry of Health, Bangui, Central African Republic
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Masresha B, Shibeshi M, Kaiser R, Luce R, Katsande R, Mihigo R. Congenital Rubella Syndrome in The African Region - Data from Sentinel Surveillance. JOURNAL OF IMMUNOLOGICAL SCIENCES 2018; Suppl:146-150. [PMID: 30957103 PMCID: PMC6446990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Rubella is a mild febrile rash illness caused by the rubella virus. The most serious consequence of rubella is congenital rubella syndrome (CRS), which occurs if the primary rubella infection occurs during early pregnancy, with subsequent infection of the placenta and the developing fetus. METHODS WHO supported countries to set up sentinel surveillance for CRS using standard case definitions, protocols, and case classification scheme. This descriptive analysis summarises the data from 5 countries which have been regularly reporting. RESULTS A total of 383 suspected cases of CRS were notified from the 5 countries as of December 2016, of which 52 cases were laboratory confirmed and 67 were confirmed on clinical grounds.The majority (43%) of confirmed CRS cases were in the age group 6 - 11 months. The most common major clinical manifestation (Group A) among the confirmed cases is congenital heart disease (72%) followed by cataracts (32%) and glaucoma (10%). DISCUSSION AND CONCLUSIONS The number of years of reporting from these sentinel sites is too short to describe trends in CRS occurrence across the years. However, the limited surveillance data has yielded comparable information with other developing countries prior to introduction of rubella vaccine. As more countries introduce rubella vaccine into their immunisation programs, there is a need to ensure that all rubella outbreaks are thoroughly investigated and documented, to expand sentinel surveillance for CRS in more countries in the Region, and to complement this with retrospective record reviews for CRS cases in selected countries.
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Affiliation(s)
- Balcha Masresha
- WHO Regional Office for Africa. Brazzaville, Congo,Correspondence: Dr. Balcha G Masresha, WHO Regional Office for Africa, Brazzaville, Congo; Telephone No: +263 77 503 5369;
| | - Messeret Shibeshi
- WHO Inter-country Support Team for East and Southern Africa. Harare, Zimbabwe
| | - Reinhard Kaiser
- Formerly with the WHO Inter-country Support Team for East and Southern Africa. Harare, Zimbabwe
| | - Richard Luce
- WHO Inter-country Support Team for Central Africa. Libreville, Gabon
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