Congenital Rubella Syndrome Surveillance in South Africa Using a Sentinel Site Approach: A Cross-sectional Study

Nkengafac Villyen Motaze; Jack Manamela; Sheilagh Smit; Helena Rabie; Kim Harper; Nicolette duPlessis; Gary Reubenson; Melantha Coetzee; Daynia Ballot; David Moore; James Nuttall; Lucy Linley; Lloyd Tooke; Jeannette Kriel; Ute Hallbauer; Christopher Sutton; Pravi Moodley; Diana Hardie; Ahmad Haeri Mazanderani; Felicity Goosen; Thanda Kyaw; Dave Leroux; Akhtar Hussain; Radhika Singh; Christopher Kelly; Graham Ducasse; Michelle Muller; Magdaleen Blaauw; Mohlabi Hamese; Tumelo Leeuw; Omphile Mekgoe; Philemon Rakgole; Norman Dungwa; Thulisile Maphosa; Kgomotso Sanyane; Wolfgang Preiser; Cheryl Cohen; Melinda Suchard

doi:10.1093/cid/ciy758

Congenital Rubella Syndrome Surveillance in South Africa Using a Sentinel Site Approach: A Cross-sectional Study

Clin Infect Dis. 2019 May 2;68(10):1658-1664. doi: 10.1093/cid/ciy758.

Authors

Nkengafac Villyen Motaze^{1

2}, Jack Manamela¹, Sheilagh Smit¹, Helena Rabie³, Kim Harper⁴, Nicolette duPlessis⁵, Gary Reubenson⁶, Melantha Coetzee⁷, Daynia Ballot⁸, David Moore⁹, James Nuttall¹⁰, Lucy Linley¹¹, Lloyd Tooke¹², Jeannette Kriel¹³, Ute Hallbauer¹³, Christopher Sutton¹⁴, Pravi Moodley¹⁵, Diana Hardie¹⁶, Ahmad Haeri Mazanderani¹, Felicity Goosen¹⁷, Thanda Kyaw¹⁸, Dave Leroux¹⁹, Akhtar Hussain²⁰, Radhika Singh²¹, Christopher Kelly²², Graham Ducasse²³, Michelle Muller²⁴, Magdaleen Blaauw²⁵, Mohlabi Hamese²⁶, Tumelo Leeuw²⁷, Omphile Mekgoe²⁸, Philemon Rakgole²⁹, Norman Dungwa³⁰, Thulisile Maphosa³¹, Kgomotso Sanyane³², Wolfgang Preiser³³, Cheryl Cohen^{1

34}, Melinda Suchard^{1

35}

Affiliations

¹ National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
² Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
³ Department of Pediatrics, Tygerberg Hospital, Stellenbosch University, South Africa.
⁴ Department of Pediatrics, Frere Hospital, East London, South Africa.
⁵ Department of Pediatrics, Kalafong Hospital, University of Pretoria, South Africa.
⁶ Department of Pediatrics and Child Health, Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, South Africa.
⁸ Department of Pediatrics and Child Health, Charlotte Maxeke Academic Hospital, Johannesburg.
⁹ Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Department of Pediatrics, Red Cross War Memorial Children's Hospital, South Africa.
¹¹ Department of Pediatrics, Mowbray Maternity Hospital, South Africa.
¹² Department of Pediatrics, Groote Schuur Hospital, University of Cape Town, South Africa.
¹³ Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
¹⁴ Department of Pediatrics and Child Health, Polokwane Hospital, University of Limpopo, South Africa.
¹⁵ Department of Virology, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, South Africa.
¹⁶ Division of Medical Virology, Groote Schuur Hospital, University of Cape Town, South Africa.
¹⁷ Department of Pediatrics, Cecilia Makiwane Hospital, East London, South Africa.
¹⁸ Department of Virological Pathology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
¹⁹ Department of Pediatrics, New Somerset Hospital, University of Cape Town, South Africa.
²⁰ Department of Pediatrics, Prince Mshiyeni Memorial Hospital, Durban.
²¹ Department of Pediatrics, King Edward VIII Hospital, Durban.
²² Department of Pediatrics, Inkosi Albert Luthuli Hospital, Durban.
²³ Department of Pediatrics, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
²⁴ Department of Pediatrics, Kimberley Hospital, South Africa.
²⁵ Department of Pediatrics and Neonatology, Dr Harry Surtie Hospital, Upington, South Africa.
²⁶ Department of Pediatrics and Child Health, Mankweng Hospital, University of Limpopo, South Africa.
²⁷ Department of Pediatrics, Mafikeng Provincial Hospital, South Africa.
²⁸ Department of Pediatrics, Klerksdorp Hospital, South Africa.
²⁹ Department of Pediatrics, Job Shimankana Tabane Hospital, Rustenburg, South Africa.
³⁰ Department of Pediatrics, Witbank Hospital, South Africa.
³¹ Department of Pediatrics, Rob Fereirra Hospital, Nelspruit, South Africa.
³² Department of Pediatrics, Dr George Mukhari Hospital, Sefako Makgatho University, Pretoria, South Africa.
³³ Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service Tygerberg, South Africa.
³⁴ Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa.
³⁵ Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Congenital rubella syndrome (CRS) includes disorders associated with intrauterine rubella infection. Incidence of CRS is higher in countries with no rubella-containing vaccines (RCV) in their immunization schedules. In the World Health Organization African region, RCVs are being introduced as part of the 2012-2020 global measles and rubella strategic plan. This study aimed to describe the epidemiology of confirmed CRS in South Africa prior to introduction of RCVs in the immunization schedule.

Methods: This was a descriptive study with 28 sentinel sites reporting laboratory-confirmed CRS cases in all 9 provinces of South Africa. In the retrospective phase (2010 to 2014), CRS cases were retrieved from medical records, and in the prospective phase (2015 to 2017) clinicians at study sites reported CRS cases monthly.

Results: There were 42 confirmed CRS cases in the retrospective phase and 53 confirmed CRS cases in the prospective phase. Most frequently reported birth defects were congenital heart disease and cataracts. The median age of mothers of CRS cases was 21 years in the retrospective phase (range: 11 to 38 years) and 22 years in the prospective phase (range: 15 to 38 years).

Conclusion: Baseline data on laboratory-confirmed CRS will enable planning and monitoring of RCV implementation in the South African Expanded Programme on Immunization program. Ninety-eight percent of mothers of infants with CRS were young women 14-30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV.

Keywords: birth defects; congenital rubella syndrome; rubella; rubella-containing vaccines; surveillance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Antibodies, Viral / blood*
Cross-Sectional Studies
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Medical Records
Pregnancy
Pregnancy Complications, Infectious / epidemiology
Pregnancy Complications, Infectious / prevention & control*
Pregnancy Complications, Infectious / virology
Prospective Studies
Qualitative Research
Retrospective Studies
Rubella Syndrome, Congenital / epidemiology*
Rubella Syndrome, Congenital / prevention & control*
Rubella virus
Sentinel Surveillance*
South Africa
Young Adult

Substances

Antibodies, Viral