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Chimhuya S, Manangazira P, Mukaratirwa A, Nziramasanga P, Berejena C, Shonhai A, Kamupota M, Gerede R, Munyoro M, Mangwanya D, Tapfumaneyi C, Byabamazima C, Shibeshi EM, Nathoo KJ. Trends of rubella incidence during a 5-year period of case based surveillance in Zimbabwe. BMC Public Health 2015; 15:294. [PMID: 25885586 PMCID: PMC4391168 DOI: 10.1186/s12889-015-1642-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rubella is a disease of public health significance owing to its adverse effects during pregnancy and on pregnancy outcomes. Women who contract rubella virus during pregnancy may experience complications such as foetal death or give birth to babies born with congenital rubella syndrome. Vaccination against rubella is the most effective and economical approach to control the disease, and to avoid the long term effects and high costs of care for children with congenital rubella syndrome as well as to prevent death from complications. Zimbabwe commenced rubella surveillance in 1999, despite lacking a rubella vaccine in the national Expanded Programme on Immunization, as per the World Health Organization recommendation to establish a surveillance system to estimate the disease burden before introduction of a rubella vaccine. The purpose of this analysis is to describe the disease trends and population demographics of rubella cases that were identified through the Zimbabwe national measles and rubella case-based surveillance system during a 5-year period between 2007 and 2011. METHODS Data from the Zimbabwe National Measles Laboratory for the 5-year study period were analysed for age, sex, district of origin, seasonality, and rubella IgM serostatus. RESULTS A total of 3428 serum samples from cases of suspected measles in all administrative districts of the country were received by the laboratory during this period. Cases included 51% males and 49% females. Of these, 2999 were tested for measles IgM of which 697 (23.2%) were positive. Of the 2302 measles IgM-negative samples, 865 (37.6%) were rubella IgM-positive. Ninety-eight percent of confirmed rubella cases were children younger than 15 years of age. Most infections occurred during the dry season. CONCLUSIONS The national case-based surveillance revealed the disease burden and trends of rubella in Zimbabwe. These data add to the evidence for introducing rubella-containing vaccine into the national immunization programme.
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Affiliation(s)
- Simbarashe Chimhuya
- Department of Paediatrics and Child Health, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
| | - Portia Manangazira
- Epidemiology and Disease Control Directorate, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Arnold Mukaratirwa
- Medical Microbiology Department, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
| | - Pasipanodya Nziramasanga
- Medical Microbiology Department, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
| | - Chipo Berejena
- Medical Microbiology Department, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
| | - Annie Shonhai
- Medical Microbiology Department, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
| | - Mary Kamupota
- Expanded Programme of Immunization, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Regina Gerede
- Expanded Programme of Immunization, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Mary Munyoro
- Expanded Programme of Immunization, World Health Organization, Harare, Zimbabwe.
| | - Douglas Mangwanya
- Laboratory Services Directorate, Ministry of Health and Child Care, Harare, Zimbabwe.
| | | | - Charles Byabamazima
- Immunization and Vaccines Development, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe.
| | - Eshetu Messeret Shibeshi
- Immunization and Vaccines Development, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe.
| | - Kusum Jackison Nathoo
- Department of Paediatrics and Child Health, University of Zimbabwe-College of Health Sciences, Mazoe Street, A178, Avondale, Harare, Zimbabwe.
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Manikkavasagan G, Bukasa A, Brown KE, Cohen BJ, Ramsay ME. Oral fluid testing during 10 years of rubella elimination, England and Wales. Emerg Infect Dis 2011; 16:1532-8. [PMID: 20875277 PMCID: PMC3294398 DOI: 10.3201/eid1610.100560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Surveillance of rubella in England and Wales has included immunoglobulin M testing of oral (crevicular) fluid from reported case-patients since 1994. The need for laboratory confirmation to monitor rubella elimination is emphasized by poor sensitivity (51%, 95% confidence interval 48.9%–54.0%) and specificity (55%, 95% confidence interval 53.7%–55.6%) of the clinical case definition. During 1999–2008, oral fluid from 11,709 (84%) of 13,952 reported case-patients was tested; 143 (1.0%) cases were confirmed and 11,566 (99%) were discarded (annual investigation and discard rate of clinically suspected rubella cases was 2,208/100,000 population). Incidence of confirmed rubella increased from 0.50 to 0.77/1 million population when oral fluid testing was included. Oral fluid tests confirmed that cases were more likely to be in older, unvaccinated men. Testing of oral fluid has improved ascertainment of confirmed rubella in children and men and provided additional information for assessing UK progress toward the World Health Organization elimination goal.
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Oliveira MJC, Cordeiro MT, Costa FM, Murakami G, Silva AMSD, Travassos RC, Magalhães V. [Frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and rubella in the State of Pernambuco between 2001 and 2004]. Rev Soc Bras Med Trop 2009; 41:338-44. [PMID: 18853004 DOI: 10.1590/s0037-86822008000400004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 08/05/2008] [Indexed: 11/21/2022] Open
Abstract
This study had the aim of investigating the frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and/or rubella in the state of Pernambuco, Brazil. A total of 1,161 serum samples collected between 2001 and 2004 were tested for these four viral diseases, using enzyme immunoassays to detect IgM antibodies. Out of this total, 276 (23.8%) samples were positive for one of the four viral diseases analyzed. There were 196 positive cases (16.9%) for dengue, 38 (3.3%) for erythema infectiosum (parvovirus B19), 32 (2.8%) for rubella and 10 (0.9%) for measles. Among the suspected cases of measles and rubella, dengue infection was the most frequent, followed by parvovirus B19. The similarity of the clinical manifestations among rash diseases contributes towards making it difficult to diagnose measles, rubella, dengue and erythema infectiosum on clinical grounds alone. It must be emphasized that the four tests used were insufficient for diagnosing 76.2% of the febrile and rash diseases notified. This is the first study bringing evidence of human parvovirus B19 circulation in Pernambuco.
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Affiliation(s)
- Maria José Couto Oliveira
- Programa de Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil.
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Vijayalakshmi P, Rajasundari TA, Prasad NM, Prakash SK, Narendran K, Ravindran M, Muthukkaruppan VR, Lalitha P, Brown DWG. Prevalence of eye signs in congenital rubella syndrome in South India: a role for population screening. Br J Ophthalmol 2007; 91:1467-70. [PMID: 17947267 DOI: 10.1136/bjo.2007.114629] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Congenital rubella syndrome (CRS) resulting from maternal rubella infection, especially in the first trimester, affects an estimated 100 000 infants each year worldwide. Immunisation has reduced its occurrence in the developed world, though it remains a problem in countries with poor immunisation coverage. This population-based study was aimed at screening children below 5 years of age for ocular signs suspicious of CRS. METHODS Suspected CRS cases were recruited from hospital and outreach services of the Aravind Eye Care System over a 24-month period. Clinical confirmation was based on the fulfilment of the World Health Organization (WHO) definition, and laboratory confirmation was based on a positive test for IgM antibody. RESULTS Children under 5 years of age (n = 51 548) with ocular complaints were screened for eye signs suspicious of CRS; CRS compatible signs were detected in 1.92% (1090) children. Of these suspects (299), 27.42% were subsequently confirmed clinically according to WHO definition, and (46) 4.2% were serologically (Laboratory) confirmed. Of all the eye signs evaluated for screening, cataracts were the most sensitive (80.43%). CONCLUSIONS Cataracts among children have a high sensitivity for detecting CRS in India. It is the only clinical eye finding that has a high enough sensitivity and specificity to be useful as a screening tool for CRS.
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