The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment
DOI:
https://doi.org/10.5365/wpsar.2017.8.1.006Abstract
Introduction: In line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), the Philippines introduced rubella-containing vaccines (RCV) in the national routine immunization program in 2010. We attempted to estimate the burden of CRS in the country prior to nationwide programmatic use.
Methods: We performed a retrospective chart review in four tertiary hospitals. Children born between January 1, 2009 and December 31, 2014 identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Laboratory-confirmed cases meeting the clinical case definition of CRS were confirmed CRS cases. Cases that met the clinical case definition of CRS but without laboratory confirmation were considered as probable CRS cases.
Results: We identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100,000 live births. The estimated national burden of CRS was 20-31 cases per 100,000 annually.
Discussion: This is the first attempt to assess the national CRS burden. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.
References
McLean H, Redd SB, Abernathy E, Icenogle JP, Wallace G. Rubella. In: Roush SW, Baldy LM, eds. Vaccine Preventable Diseases Surveillance Manual. Atlanta, Georgia: Centers for Disease Control and Prevention 2012.
McLean H, Redd SB, Abernathy E, Icenogle JP, Wallace G. Congenital Rubella Syndrome. In: Roush SW, ed. Vaccine Preventable Diseases Surveillance Manual. Atlanta, Georgia: Centers for Disease Control and Prevention; 2012.
Robertson SE, Featherstone DA, Gacic-Dobo M, Hersh BS. Rubella and congenital rubella syndrome: global update. Rev Panam Salud Publica. 2003;14(5):306-315.
Lawn JE, Reef S, Baffoe-Bonnie B, Adadevoh S, Caul EO, Griffin GE. Unseen blindness, unheard deafness, and unrecorded death and disability: Congenital rubella in Kumasi, Ghana. Am J Pub Health. 2000;90(10):1555-1561.
Thant KZ, Oo WM, Myint TT, et al. Active surveillance for congenital rubella syndrome in Yangon, Myanmar. Bull World Health Org. 2006;84(1):12-20.
World Health Organization. Rubella vaccine: WHO position paper. Weekly Epidemiol Rev. 2011;86:301-316.
Vynnycky E, Adams EJ, Cutts FT, et al. Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review. PLoS One. 2016;11(3):e0149160.
World Health Organization. Expanded Program for Immunization: Regional Framework for Implementation of the Global Vaccine Action Plan in the Western Pacific - 65th session of the World Health Organization Regional Committee for the Western Pacific Manila, Philippines: World Health Organization; October 16 2014. WPR/RC65.R5.
World Health Organization. 24th Meeting of the Technical Advisory Group on Immunization and Vaccine Preventable Diseases in the Western Pacific Region. Manila: Western Pacific Regional Office;2015.
Department of Vaccines and Biologicals. WHO-recommended standards for surveillance of selected vaccine-preventable diseases. Geneva, Switzerland: World Health Organization; 2008.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases. Washington D.C.: Public Health Foundation; 2015.
Reef S, Plotkin S, Cordero JF, et al. Preparing for elimination of congenital rubella syndrome (CRS): Summary of a workshop on CRS elimination in the United States. Clin Infect Dis. 2000;31:85-95.
Wolff SM. The ocular manifestation of congenital rubella: A prospective study of 328 cases of congenital rubella. J Pediatr Ophthalmol Strabismus. 1973;10:101-141.
Bloom S, Rguig A, Berraho A, et al. Congenital rubella syndrome burden in Morocco: a rapid retrospective assessment. The Lancet. 2005;365(9454):135-141.
PhilHealth. Stats & Charts 1st Semester 2015. 2015; http://www.philhealth.gov.ph/about_us/statsncharts/snc2015_1st.pdft/. Accessed 15 May, 2016.
Philippine Statistics Authority. Live Births: Philippines 2014. 2015; https://psa.gov.ph/content/live-births-philippines-2014. Accessed April 2, 2016.
Adam O, Ali AK, Hubschen JM, Muller CP. Identification of congenital rubella syndrome in Sudan. BMC infectious diseases. 2014;14:305.
Toda K, Reef S, Tsuruoka M, et al. Congenital rubella syndrome (CRS) in Vietnam 2011-2012--CRS epidemic after rubella epidemic in 2010-2011. Vaccine. 2015;33(31):3673-3677.
Lopez AL, Raguindin PFN, Silvestre MA, Fabay XCJ, Vinarao AB, Manalastas R. Rubella and Congenital Rubella Syndrome in the Philippines: A Systematic Review. International Journal of Pediatrics. 2016;2016:8.
Vynnycky E, Adams E, Cutts F, et al. Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review. PLoS One. 2016;11(3).
Family Health Office - Expanded Program for Immunization. The Philippine Immunization Program Strategic Plan for 2015-2019. Manila: Department of Health, Republic of the Philippines;2015.
WHO-UNICEF. WHO and UNCEF estimates of national immunization coverage. 2016; https://data.unicef.org/wp-content/uploads/country_profiles/Philippines/Immunization_phl.pdf. Accessed 30 November, 2016.
World Health Organization and Department of Health. Health Service Delivery Profile: Philippines. 2012; http://www.wpro.who.int/health_services/health_service_delivery_profiles/en/. Accessed Dec 5, 2015.
Chiong C, Ostrea E, Jr., Reyes A, Llanes EG, Uy ME, Chan A. Correlation of hearing screening with developmental outcomes in infants over a 2-year period. Acta Otolaryngol. 2007;127(4):384-388.
Chiong CM, Villanueva EM. Cochlear implantation in chronic otitis media. Acta Med Philipp. 2012;46(3):21-26.
Epidemiology Bureau. Measles-Rubella Cases, Morbidity Week 42 Measles-Rubella Cases, Monthly Report 2016; http://www.doh.gov.ph/sites/default/files/statistics/MEASLESRUBELLA42_compressed.pdf. Accessed 29 December, 2016.
WHO. Introducing rubella vaccine into National Immunization Programmes. 2015; http://www.who.int/immunization/documents/who_ivb_15.07/en/. Accessed 24 October, 2016.