The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment

Abstract

IntroductionIn line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), phased introduction of rubella-containing vaccines (RCV) in the Philippines’ routine immunization programme began in 2010. We estimated the burden of CRS in the country before widespread nationwide programmatic RCV use.MethodsWe performed a retrospective chart review in four tertiary hospitals. Children born between 1 January 2009 and 31 December 2014 and identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Cases that met the clinical case definition of CRS were classified as either confirmed (with laboratory confirmation) or probable (without laboratory confirmation). Cases that did not fulfil the criteria for either confirmed or probable CRS were excluded from the analysis.ResultsWe identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100 000 live births. The estimated national burden of CRS was 20 to 31 cases per 100 000 annually.DiscussionThis is the first attempt to assess the national CRS burden using in-country hospital data in the Philippines. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.

The Cost of Managing Congenital Rubella Syndrome in a Tertiary Government Hospital in Northern Luzon, Philippines

“…All cases were probable CRS due to the absence of laboratory diagnosis required in the case definition set by the WHO and CDC for confirmed CRS cases. 1,11 The parents or guardians of the patients were interviewed on the cost incurred particularly NMRE during their Out-Patient Department consultations and admissions. Two parents provided detailed lists of their expenses.…”

“…Despite the introduction of rubella-containing vaccine (RCV) in the country a decade ago, congenital rubella syndrome (CRS) cases are still seen in the Philippines. 1 Due to the COVID-19 pandemic, vaccine coverage dropped further and prenatal care was also affected. 2,3 The effects will be significantly felt by infants born to unvaccinated or unprotected mothers infected with rubella during pregnancy.…”

“…The national incidence of CRS was estimated at 20-31 cases per 100,000 live births annually, ranging from 18 to 201. 1 Despite this, there is still no program directed to vaccinating women of reproductive age. 1 Infants with CRS require both specialized medical intervention for its clinical manifestations and closer care and additional spending from the parents/caregivers for the infants' medical and other needs.…”

“…1 Despite this, there is still no program directed to vaccinating women of reproductive age. 1 Infants with CRS require both specialized medical intervention for its clinical manifestations and closer care and additional spending from the parents/caregivers for the infants' medical and other needs. 4,5 This further increases the already high out-of-pocket (OOP) expenses with our current health system.…”

Long-term outcomes of survivors of neonatal insults: A systematic review and meta-analysis

“…Globally, the most common NNI include sepsis, congenital meningitis, hypoxic-ischemic encephalopathy (HIE), preterm birth, neonatal jaundice (NNJ), cytomegalovirus infection (CMV), herpes, congenital rubella, and toxoplasmosis [8]. Children who survive NNI are likely to develop adverse long-term outcomes such as neurocognitive impairment, developmental delay, hearing and visual impairment, cerebral palsy, and behavioral and emotional problems [9][10][11][12][13][14][15]. For instance, children who survived CMV were reported to develop sensorineural hearing loss and neurodevelopmental impairment [9], while congenital rubella is associated with hearing impairment [16,17].…”