Rubella outbreak in a Rural Kenyan District, 2014: documenting the need for routine rubella immunization in Kenya

BMC Infectious Diseases

Elizabeth Kiptoo¹  Yusuf Ajack²  Dickens Onyango²  Ian Njeru² 

[1] Department of Health, Nakuru County, Nakuru, Kenya;Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya

关键词: Congenital Rubella Syndrome;    Outbreak;    Rubella;   

Others  :  1230330
DOI  :  10.1186/s12879-015-0989-6

 received in 2014-09-07, accepted in 2015-06-18,  发布年份 2015

【 摘 要 】

Background

Rubella infection has been identified as a leading cause of birth defects commonly known as Congenital Rubella Syndrome (CRS). Kenya does not currently have a rubella immunization program nor a CRS surveillance system. In 2014, a rubella outbreak was reported in a rural district in Kenya. We investigated the outbreak to determine its magnitude and describe the outbreak in time, place and person. We also analyzed the laboratory-confirmed rubella cases from 2010 to 2014 to understand the burden of the disease in the country.

Methods

The Rubella outbreak was detected using the case-based measles surveillance system. A suspected case was a person with generalized rash and fever while a confirmed case was a person who tested positive for rubella IgM. All laboratory-confirmed and epidemiologically linked cases were line listed. The measles case-based surveillance database was used to identify rubella cases from 2010 to 2014.

Results

A total of 125 rubella cases were line listed. Fifty four percent of cases were female. Case age ranged from 3 months to 32 years with a median of 4 years. Fifty-one percent were aged less than 5 years, while 82 % were aged less than 10 years. Six percent of the cases were women of reproductive age. All cases were treated as outpatients and there were no deaths. The number of confirmed rubella cases was 473 in 2010, 604 in 2011, 300 in 2012, 336 in 2013 and 646 in 2014.

Conclusions

Analysis of Kenya rubella data shows that rubella is endemic throughout the country, and many outbreaks may be underestimated or undocumented. Six percent of all the cases in this outbreak were women of reproductive age indicating that the threat of CRS is real. The country should consider initiating a CRS surveillance system to quantify the burden with the goal of introducing rubella vaccine in the future.

【 授权许可】

   
2015 Njeru et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

【 参考文献 】

• [1]Kancherla V, Oakley GP, Brent RL. Urgent global opportunities to prevent birth defects. Semin Fetal Neonatal Med. 2014; 19(3):153-60.
• [2]Li S, Moore CA, Li Z, Berry RJ, Gindler J, Hong SX, Liu Y, Mulinare J, Wong LY, Gu HQ et al.. A population-based birth defects surveillance system in the People’s Republic of China. Paediatr Perinat Epidemiol. 2003; 17(3):287-93.
• [3]Johnson KC, Rouleau J. Temporal trends in Canadian birth defects birth prevalences, 1979–1993. Can J Public Health. 1997; 88(3):169-76.
• [4]Powell-Griner E, Woolbright A. Trends in infant deaths from congenital anomalies: results from England and Wales, Scotland, Sweden and the United States. Int J Epidemiol. 1990; 19(2):391-8.
• [5]Druschel C, Hughes JP, Olsen C. Mortality among infants with congenital malformations, New York State, 1983 to 1988. Public Health Rep. 1996; 111(4):359-65.
• [6]Gregg NM. Congenital cataract following German measles in the mother. Epidemiol Infect 1991. 1941; 107(1):iii-xiv.
• [7]Cutts FT, Vynnycky E. Modelling the incidence of congenital rubella syndrome in developing countries. Int J Epidemiol. 1999; 28(6):1176-84.
• [8]Lee JY, Bowden DS. Rubella virus replication and links to teratogenicity. Clin Microbiol Rev. 2000; 13(4):571-87.
• [9]Givens KT, Lee DA, Jones T, DM I. Congenital rubella syndrome: ophthalmic manifestations and associated systemic disorders. Br J Ophthalmol. 1993; 77(6):358-63.
• [10]Huang LM, Lee BW, Chan PC, Povey M, Henry O. Immunogenicity and safety of combined measles-mumps-rubella-varicella vaccine using new measles and rubella working seeds in healthy children in Taiwan and Singapore: a phase II, randomized, double-blind trial. Hum Vaccin Immunother. 2013; 9(6):1308-15.
• [11]Czajka H, Schuster V, Zepp F, Esposito S, Douha M, Willems P. A combined measles, mumps, rubella and varicella vaccine (Priorix-Tetra): immunogenicity and safety profile. Vaccine. 2009; 27(47):6504-11.
• [12]Cutts FT, Robertson SE, Diaz-Ortega JL, Samuel R. Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 1: Burden of disease from CRS. Bull World Health Organ. 1997; 75(1):55-68.
• [13]Rubella vaccines. WHO position paper. Wkly Epidemiol Rec. 2000; 75:161-72.
• [14]Controlling rubella and preventing congenital rubella syndrome - global progress, 2009. Wkly Epidemiol Rec. 2010; 85(42):413-8.
• [15]Robertson SE, Featherstone DA, Gacic-Dobo M, Hersh BS. Rubella and congenital rubella syndrome: global update. Rev Panam Salud Publica. 2003; 14(5):306-15.
• [16]Robertson SE, Cutts FT, Samuel R, Diaz-Ortega JL. Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella. Bull World Health Organ. 1997; 75(1):69-80.
• [17]Anderson RM, May RM. Vaccination against rubella and measles: quantitative investigations of different policies. J Hyg (Lond). 1983; 90(2):259-325.
• [18]Fogel A et al.. The impact of rubella epidemics on pregnant women, proof for the necessity of pre-marital screening and vaccination. Dev Biol Stand. 1979; 43:349-53.
• [19]Miller CL, Miller E, Waight PA. Rubella susceptibility and the continuing risk of infection in pregnancy. Br Med J. 1987; 294:1277-8.
• [20]Kombich JJ, Muchai PC, Tukei P, Borus PK. Rubella seroprevalence among primary and pre- primary school pupils at Moi’s Bridge location, Uasin Gishu District, Kenya. BMC Public Health. 2009; 9:269. BioMed Central Full Text
• [21]Kombich JJ, Muchai PC, Borus PK. Seroprevalence of natural rubella antibodies among antenatal attendees at Moi Teaching and Referral Hospital, Eldoret, Kenya. J Immunol Tech Infect Dis. 2012; 1(1):1-4.
• [22]Sequeira E, Lakhani S, Tukei P, Kaptich D. Rubella immunity in pregnant women in Nairobi, Kenya. J Obstet Gynaecol East Cent Africa. 1982; 1(2):93-5.
• [23]Ramamurty N, Murugan S, Raja D, Elango V. Mohana, Dhanagaran D: Serosurvey of rubella in five blocks of Tamil Nadu. Indian J Med Res. 2006; 123(1):51-4.
• [24]Nardone A, Tischer A, Andrews N, Backhouse J, Theeten H, Gatcheva N, Zarvou M, Kriz B, Pebody RG, Bartha K et al.. Comparison of rubella seroepidemiology in 17 countries: progress towards international disease control targets. Bull World Health Organ. 2008; 86(2):118-25.
• [25]Goodson JL, Masresha B, Dosseh A, Byabamazima C, Nshimirimana D, Cochi S, Reef S. Rubella epidemiology in Africa in the prevaccine era, 2002–2009. J Infect Dis. 2011; 204 Suppl 1:S215-25.
• [26]Gupta SN, Gupta NN. An outbreak of rubella in a hilly district of Kangra-Chamba, Himachal Pradesh, India, 2006. Indian J Pediatr. 2009; 76(7):717-23.
• [27]Hahne S, Macey J, van Binnendijk R, Kohl R, Dolman S, van der Veen Y, Tipples G, Ruijs H, Mazzulli T, Timen A et al.. Rubella outbreak in the Netherlands, 2004–2005: high burden of congenital infection and spread to Canada. Pediatr Infect Dis J. 2009; 28(9):795-800.
• [28]Hahne S, Ward M, Abbink F, van Binnendijk R, Ruijs H, van Steenbergen J, Timen A, de Melker H. Large ongoing rubella outbreak in religious community in the Netherlands since September 2004. Euro Surveill. 2005; 10(3):E050303.2.
• [29]van der Veen Y, Hahne S, Ruijs H, van Binnendijk R, Timen A, van Loon AM, de Melker H. Rubella outbreak in an unvaccinated religious community in the Netherlands leads to cases of congenital rubella syndrome. Euro Surveill. 2005; 10(11):E051124.3.
• [30]Paradowska-Stankiewicz I, Czarkowski MP, Derrough T, Stefanoff P: Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections. Euro Surveill. 2013;18(21).
• [31]Ujiie M, Nabae K, Shobayashi T. Rubella outbreak in Japan. Lancet. 2014; 383(9927):1460-1.
• [32]Yusof AB, Selvanesan S, Norizah I, Zuridah H, Kumarasamy V, Mariam M, Chua KB. Rubella outbreak amongst residential students in a military vocational school of Malaysia. Med J Malaysia. 2006; 61(3):296-301.
• [33]Sugishita Y, Takahashi T, Hori N, Abo M. Ongoing rubella outbreak among adults in Tokyo, Japan, June 2012 to April 2013. Western Pac Surveill Response J. 2013; 4(3):37-41.
• [34]Global measles and rubella strategic plan 2012–2020. WHO, Geneva, Switzerland; 2012.