Abdalla Omayma, Ahmed Nada, El-Hag Mukhtar Hanan Abdo, Reef Susan, Hagan Jose, Grant Gavin
Expanded Program for Immunization, Sudan Ministry of Health, Khartoum P.O. Box 303, Sudan.
Sudan Country Office, World Health Organization, Khartoum P.O. Box 303, Sudan.
Vaccines (Basel). 2024 Dec 23;12(12):1447. doi: 10.3390/vaccines12121447.
BACKGROUND/OBJECTIVES: Congenital rubella syndrome (CRS) is a constellation of serious multi-organ birth defects following rubella virus infection during early pregnancy. Countries in which rubella vaccination has not yet been introduced can have a high burden of this disease. Data on CRS burden and epidemiology are needed to guide the introduction of a rubella vaccine and monitor progress for rubella elimination, but the multi-system nature of CRS manifestations and required specialized testing creates a challenge for conducting CRS surveillance in developing settings such as Sudan. To enhance data quality, we designed and tested a simplified approach for CRS surveillance in Sudan.
Seven CRS surveillance sentinel sites were set up at general pediatric, eye, and cardiology hospitals in Sudan, using standard definitions for reporting and classifying infants with CRS clinical manifestations. Between 2014 and 2017, we evaluated the system using WHO CRS surveillance monitoring indicators, comparing simplified approaches against a comprehensive one. The simplified approaches included (1) an ophthalmic-focused approach; (2) a heart-focused approach; and (3) a cataract-only approach.
Surveillance identified 179 infants with suspected CRS via the comprehensive approach, with 25 infants classified as laboratory-confirmed and 6 as clinically compatible. Surveillance sensitivity was highest for the simplified ophthalmic approach, while cataract-based surveillance had the highest proportion of confirmed cases.
Simplified CRS surveillance, particularly focusing on detecting cataracts, can significantly contribute to monitoring the impact of rubella vaccine introduction. It could serve as an initial step towards comprehensive CRS surveillance, providing robust evidence to support rubella and CRS elimination efforts.
背景/目的：先天性风疹综合征（CRS）是指在妊娠早期感染风疹病毒后出现的一系列严重的多器官出生缺陷。尚未引入风疹疫苗的国家，这种疾病的负担可能很高。需要先天性风疹综合征负担和流行病学数据来指导风疹疫苗的引入，并监测消除风疹的进展情况，但先天性风疹综合征表现的多系统性质以及所需的专门检测给在苏丹等发展中地区开展先天性风疹综合征监测带来了挑战。为提高数据质量，我们设计并测试了一种在苏丹进行先天性风疹综合征监测的简化方法。
在苏丹的普通儿科、眼科和心脏病医院设立了7个先天性风疹综合征监测哨点，采用标准定义对有先天性风疹综合征临床表现的婴儿进行报告和分类。2014年至2017年期间，我们使用世界卫生组织先天性风疹综合征监测监测指标对该系统进行了评估，将简化方法与综合方法进行了比较。简化方法包括：（1）以眼科为重点的方法；（2）以心脏为重点的方法；（3）仅针对白内障的方法。
通过综合方法监测发现179例疑似先天性风疹综合征婴儿，其中25例被分类为实验室确诊，6例临床符合。简化眼科方法的监测敏感性最高，而基于白内障的监测确诊病例比例最高。
简化的先天性风疹综合征监测，特别是侧重于检测白内障，可显著有助于监测风疹疫苗引入的影响。它可作为迈向全面先天性风疹综合征监测的第一步，提供有力证据支持风疹和先天性风疹综合征消除工作。
