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1. Congenital rubella syndrome surveillance in India, 2016–21: Analysis of five years surveillance data

Author

Devika Shanmugasundaram, Sanjay Verma, Kuldeep Singh, Bhagirathi Dwibedi, Shally Awasthi, S. Mahantesh, Himabindu Singh, Sridhar Santhanam, Nivedita Mondal, Geetha S, Priya Sreenivasan, Shikha Malik, Manish Jain, Rajlakshmi Viswanathan, Shalini Tripathi, Bhupeshwari Patel, Gajanan Sapkal, R. Sabarinathan, Mini P. Singh, R.K. Ratho, Vijaylakshmi Nag, Ravishekhar Gadepalli, Tapas Kumar Som, Baijayantimala Mishra, Amita Jain, M. Ashok, Devara Sudha Madhuri, V Sudha Rani, Asha Mary Abraham, Deepa John, Rahul Dhodapkar, A. Syed Ali, Debasis Biswas, Deepashri Pratyeke, Ashish Bavdekar, Jayant Prakash, Varsha Singh, Nidhi Prasad, Jaydeb Ray, Agniva Majumdar, Shanta Dutta, Nivedita Gupta, Manoj Murhekar, Akhil Sharma, Aniruddha Ghosh, Arun Alexander, Arun Baranwal, Avinash Anantharaj, Adhisivam Bethou, Dolat S. Shekhawat, G. Kiruthika, Jagat Ram, Madhu Gupta, Mamatha Gowda, Manoj K Rohit, Nabaneeta Dash, Naveen Sankhyan, Nidhi Kaushal, Niranjan Hunasanahalli Shivanna, Nirupama Kasturi, P. Prem Kumar, Parul Chawla Gupta, Pradeep Kumar Gunasekaran, Pratibha Singh, Praveen Kumar, Sanjay Kumar Munjal, Siddharth Agarwal, Suhani Manasa, Suruchi Shukla, Urvashi Nehra, Valsan P Verghese, Varuna Vyas, and Vikas Gupta

Subjects
Congenital Rubella Syndrome, Surveillance, India, Science (General), Q1-390, Social sciences (General), H1-99
Abstract

Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016–2021 from 14 sentinel sites to describe the epidemiology of CRS. Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. Results: During 2016–21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6–16.2), cataract (OR = 7.8, 95% CI: 5.4–11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3–13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2–12.2) and glaucoma (OR = 3.1, 95% CI: 1.2–8.1). Nomogram, along with a web version, was developed. Conclusions: Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.

Published
2023
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2. Epidemiology of Congenital Rubella Syndrome (CRS) in India, 2016-18, based on data from sentinel surveillance.

Author

Manoj Murhekar, Sanjay Verma, Kuldeep Singh, Ashish Bavdekar, Naveen Benakappa, Sridhar Santhanam, Gajanan Sapkal, Rajlakshmi Viswanathan, Mini P Singh, Vijaya Lakshmi Nag, Sadanand Naik, Munivenkatappa Ashok, Asha Mary Abraham, Devika Shanmugasundaram, R Sabarinathan, Valsan Philip Verghese, Suji George, Ravinder Kaur Sachdeva, Jyoti Kolekar, S Manasa, Jagat Ram, Madhu Gupta, Manoj K Rohit, Praveen Kumar, Parul Chawla Gupta, R K Ratho, Sanjay Kumar Munjal, Urvashi Nehra, Daisy Khera, Neeraj Gupta, Nidhi Kaushal, Pratibha Singh, Ravisekhar Gadepalli, Neelam Vaid, Sandeep Kadam, Sanjay Shah, S Mahantesh, Vykuntaraju K Gowda, Pradeep Haldar, M K Aggarwal, and Nivedita Gupta

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BACKGROUND:Government of India is committed to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. In 2016, CRS surveillance was established in five sentinel sites. We analyzed surveillance data to describe the epidemiology of CRS in India. METHODOLOGY/PRINCIPAL FINDINGS:We used case definitions adapted from the WHO-recommended standards for CRS surveillance. Suspected patients underwent complete clinical examination including cardiovascular system, ophthalmic examination and assessment for hearing impairment. Sera were tested for presence of IgM and IgG antibodies against rubella. Of the 645 suspected CRS patients enrolled during two years, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. The median age of laboratory confirmed CRS infants was 3 months. Common clinical features among laboratory confirmed CRS patients included structural heart defects in 108 (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy) in 82 (59.9%) and hearing impairment in 51. (38.6%) Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. Surveillance met the quality indicators in terms of adequacy of investigation, adequacy of sample collection for serological diagnosis as well as virological confirmation. CONCLUSIONS/SIGNIFICANCE:About one fifth suspected CRS patients were laboratory confirmed, indicating significance of rubella as a persistent public health problem in India. Continued surveillance will generate data to monitor the progress made by the rubella control program in the country.

Published
2020
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3. 108. Immune Status of Indian Pediatric Health Care Workers against Various Vaccine Preventable Diseases

Author

Sanjay Verma, Ravinder Kaur Sachdeva, Vidushi Mahajan, Amit Rawat, Urvashi Nehra, Vignesh Subramani, Monika Jassal, and Bhavneet Bharti

Subjects
Infectious Diseases, Oncology
Abstract

Background Health care workers (HCWs) possess a potential risk to acquire and spread various infections. This study was planned to assess the immune status of HCWs in pediatric departments of two tertiary care hospitals in Northern India. Methods In this cross-sectional study, HCW’s (Indians), working in pediatric departments of these hospitals, over 6-months period (July18-Dec18) were enrolled after taking written consent and their 5-ml venous blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Serum were tested for antibodies against diphtheria-toxin (DT), pertussis-toxin (PT), measles, mumps, rubella, varicella, hepatitis-B (HbsAb) and hepatitis-A using commercial IgG (quantitative) ELISA kits. Results A total of 160 HCW’s (M:F=77:83), having mean age 30.6±7.8 years, were enrolled. Out of them 106 (66.3%) were resident doctors, 31 (19.4%) nursing-staff, 18 (11.3%) faculty members, 3 (1.9%) research-staff and 2 (1.3%) paramedical-staff. In our study, antibodies (IgG) against DT were between 0.01 to 0.1 IU/ml in 78.1% (120/160); requiring a Tdap booster; while 7 out of 125 had titers < 0.01 IU/ml, which needed 3-doses of primary vaccination. Antibodies (IgG) against PT < 30 IU/ml were seen in 60.6% (97/160), which were considered as seronegative, as per kit recommendations. A total of 3% (5/160), 13.1% (21/160), 10% (16/160), 17.5% (28/160) had titers < 12 IU/ml for IgG antibodies against measles, mumps, rubella and varicella respectively; were considered unprotected. A total of 25% (40/160) had Anti-HBs antibody titers < 20 mIU/ml; which were low, therefore were advised to take one booster dose of Hep-B vaccine. A total of 15.6% (25/160) had IgG antibodies against hepatitis-A < 10 mIU/ml; were unprotected. Conclusion Alarming proportions of pediatric-HCWs had low antibody titres against DT (78.1%) and PT (60.6%), necessitating a dose of Tdap. A total of 10%, 17.5% and 15.6% lacked protective antibodies against rubella, varicella and hepatitis-A. A quarter of screened population had low anti-Hbs titres, requiring boosting of immunity. Our study emphasizes the urgent need for improving immunization status of pediatric HCW’s; as they continue to remain susceptible to various vaccine preventable infectious diseases. Disclosures All Authors: No reported disclosures.

Published
2022

4. Epidemiology of Congenital Rubella Syndrome (CRS) in India, 2016-18, based on data from sentinel surveillance

Author

Mini P Singh, Suji George, Kuldeep Singh, Jagat Ram, Jyoti Kolekar, Daisy Khera, Munivenkatappa Ashok, R. Sabarinathan, Asha Mary Abraham, Nidhi Kaushal, Radha K. Ratho, Valsan Philip Verghese, Devika Shanmugasundaram, Ashish Bavdekar, Sridhar Santhanam, Manoj V Murhekar, Madhu Gupta, Neelam Vaid, S. S. Naik, Pradeep Haldar, Ravisekhar Gadepalli, Naveen Benakappa, Sandeep Kadam, Manoj Kumar Rohit, Mallika Aggarwal, Urvashi Nehra, S Mahantesh, Vijaya Lakshmi Nag, Sanjay Verma, Praveen Kumar, Rajlakshmi Viswanathan, Gajanan N. Sapkal, Sanjay Shah, Vykuntaraju K Gowda, Parul Chawla Gupta, Pratibha Singh, S. Manasa, Sanjay Munjal, Nivedita Gupta, Ravinder Kaur Sachdeva, and Neeraj Gupta

Subjects
0301 basic medicine, Male, Pediatrics, Viral Diseases, Epidemiology, RC955-962, Otology, Deafness, Antibodies, Viral, Serology, Geographical Locations, Families, 0302 clinical medicine, Arctic medicine. Tropical medicine, Medicine and Health Sciences, Hearing Disorders, Children, medicine.diagnostic_test, Heart, Clinical Laboratory Sciences, Clinical Laboratories, Infectious Diseases, Female, Sample collection, Anatomy, Public aspects of medicine, RA1-1270, Infants, Research Article, Adult, medicine.medical_specialty, Asia, Adolescent, Infectious Disease Control, 030231 tropical medicine, Rubella Syndrome, Congenital, India, Physical examination, Disease Surveillance, Rubella, Measles, 03 medical and health sciences, Young Adult, Diagnostic Medicine, Ocular System, medicine, otorhinolaryngologic diseases, Humans, Congenital rubella syndrome, business.industry, Public health, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, Biology and Life Sciences, medicine.disease, 030104 developmental biology, Immunoglobulin M, Otorhinolaryngology, Age Groups, Infectious Disease Surveillance, People and Places, Cardiovascular Anatomy, Eyes, Population Groupings, business, Sentinel Surveillance, Head
Abstract

Background Government of India is committed to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. In 2016, CRS surveillance was established in five sentinel sites. We analyzed surveillance data to describe the epidemiology of CRS in India. Methodology/Principal findings We used case definitions adapted from the WHO-recommended standards for CRS surveillance. Suspected patients underwent complete clinical examination including cardiovascular system, ophthalmic examination and assessment for hearing impairment. Sera were tested for presence of IgM and IgG antibodies against rubella. Of the 645 suspected CRS patients enrolled during two years, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. The median age of laboratory confirmed CRS infants was 3 months. Common clinical features among laboratory confirmed CRS patients included structural heart defects in 108 (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy) in 82 (59.9%) and hearing impairment in 51. (38.6%) Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. Surveillance met the quality indicators in terms of adequacy of investigation, adequacy of sample collection for serological diagnosis as well as virological confirmation. Conclusions/Significance About one fifth suspected CRS patients were laboratory confirmed, indicating significance of rubella as a persistent public health problem in India. Continued surveillance will generate data to monitor the progress made by the rubella control program in the country., Author summary Rubella infection during the first trimester of pregnancy can affect the fetus, resulting in spontaneous abortion, stillbirth or an infant born with a combination of birth defects known as congenital rubella syndrome (CRS). Government of India is committed to eliminate measles and control rubella/CRS and has completed nationwide immunization campaigns using measles-rubella vaccine targeting children aged 9 months to 14 years. A case-based surveillance for CRS is one of the strategies for achieving elimination. The Indian Council of Medical Research and the Ministry of Health and Family Welfare initiated surveillance for CRS in five sentinel sites to estimate the disease burden. During 2016–18, the surveillance sites enrolled 645 suspected CRS patients, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. Common clinical features among laboratory confirmed CRS patients included structural heart defects (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy (59.9%)) and hearing impairment (38.6%). Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. The surveillance data indicated significance of rubella as persistent public health problem in India.

Published
2020

5. Sentinel surveillance for congenital rubella syndrome — India, 2016–2017

Author

Radha K. Ratho, Sanjay Munjal, Asha Mary Abraham, Urvashi Nehra, Vijaya Lakshmi Nag, Ravinder Kaur Sachdeva, R. Sabarinathan, Nivedita Gupta, Kuldeep Singh, Asha Benakappa, Sanjay Verma, Neelam Vaid, Manoj Kumar Rohit, Parul Chawla Gupta, Rajlakshmi Viswanathan, Naga Raj, Gururajrao N Deshpande, Ashish Bavdekar, Sandeep Kadam, Gajanan N. Sapkal, Sanjay Shah, Ishani Jhamb, Deepa John, Garima Goyal, Valsan Philip Verghese, S. Manasa, Swetha Sara Philip, Jagat Ram, S Mahantesh, Shyama Choudhary, S. S. Naik, Anjali Lepcha, Ashish Tiwari, Praveen Kumar, Suji George, Sridhar Santhanam, Manoj V Murhekar, Chandrashekhar G. Raut, Mini P Singh, and Pratibha Singh

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Health (social science), Adolescent, Epidemiology, Health, Toxicology and Mutagenesis, Rubella Syndrome, Congenital, MEDLINE, India, medicine.disease_cause, Measles, Rubella, Miscarriage, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Health Information Management, Pregnancy, 030225 pediatrics, otorhinolaryngologic diseases, medicine, Humans, Full Report, 030212 general & internal medicine, Congenital rubella syndrome, business.industry, Infant, Newborn, Infant, Rubella virus, General Medicine, medicine.disease, Rubella Infection, Female, business, Sentinel Surveillance
Abstract

Rubella infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). The 11 countries in the World Health Organization (WHO) South-East Asia Region are committed to the elimination of measles and control of rubella and CRS by 2020. Until 2016, when the Government of India's Ministry of Health and Family Welfare and the Indian Council of Medical Research initiated surveillance for CRS in five sentinel sites, India did not conduct systematic surveillance for CRS. During the first 8 months of surveillance, 207 patients with suspected CRS were identified. Based on clinical details and serologic investigations, 72 (34.8%) cases were classified as laboratory-confirmed CRS, four (1.9%) as congenital rubella infection, 11 (5.3%) as clinically compatible cases, and 120 (58.0%) were excluded as noncases. The experience gained during the first phase of surveillance will be useful in expanding the surveillance network, and data from the surveillance network will be used to help monitor progress toward control of rubella and CRS in India.

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