ICMR-National Institute of Epidemiology, Chennai, India.
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
PLoS Negl Trop Dis. 2020 Feb 3;14(2):e0007982. doi: 10.1371/journal.pntd.0007982. eCollection 2020 Feb.
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.
印度政府致力于在 2020 年消除麻疹和控制风疹/先天性风疹综合征（CRS）。2016 年，在五个哨点建立了 CRS 监测。我们分析了监测数据，以描述印度 CRS 的流行病学情况。
方法/主要发现：我们使用了世界卫生组织推荐的 CRS 监测标准改编的病例定义。疑似患者接受了完整的临床检查，包括心血管系统、眼科检查和听力障碍评估。检测血清中针对风疹的 IgM 和 IgG 抗体。在两年期间纳入的 645 名疑似 CRS 患者中，有 137 名（21.2%）被归类为实验室确诊的 CRS，8 名（1.2%）为先天性风疹感染。实验室确诊 CRS 婴儿的中位年龄为 3 个月。实验室确诊 CRS 患者的常见临床特征包括 108 例（78.8%）结构性心脏缺陷、82 例（59.9%）一种或多种眼部体征（白内障、青光眼、色素性视网膜炎）和 51 例（38.6%）听力障碍。在 2 年期间，有 33 名（24.1%）实验室确诊 CRS 患者死亡。监测在调查充分性、血清学诊断样本采集充分性以及病毒学确认方面均符合质量指标。
结论/意义：约五分之一的疑似 CRS 患者经实验室确诊，表明风疹在印度仍是一个持续存在的公共卫生问题。持续监测将生成数据，以监测该国风疹控制计划的进展情况。
