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Background: Rubella is an infection caused by rubella virus (RV) and is generally regarded as a mild childhood disease. The disease continues to be of public health importance mainly because when the infection is acquired during early pregnancy, it often results in fetal abnormalities, which are classified as congenital rubella syndrome (CRS). An accurate diagnosis of rubella is thus of pivotal importance for proper treatment. Objective: The aim of the study was to produce a recombinant multiepitope protein (rMERUB) for the diagnosis of rubella, based on conserved immunodominant epitopes of glycoprotein E1 and E2. Methods: A synthetic gene was designed and cloned into vector pET21a with a 6xHis tag at the C-terminal for affinity purification and overexpressed in Escherichia coli cells. Biophysical analysis of rMERUB was performed by circular dichroism. Biological activity was assessed using an in-house ELISA assay. Results: Expression in Escherichia coli showed a ~22 kDa protein that was purified and used to per-form structural assays and an IgG ELISA. Structural analyses reveal that rMERUB has a β leaf pattern that promotes the exposure of epitopes, thus allowing antibody recognition. Evaluation of 33 samples (22=positive; 11=negative) was performed using in-house ELISA and this was compared with a com-mercial kit. The sensitivity was 100% (95% CI: 85-100) and specificity 90.91% (95% CI: 62-99). Excellent agreement (Kappa index = 0.9) was obtained between ELISA assays. Conclusions: The careful choice of epitopes and the high epitope density, coupled with simple-step purification, pinpoints rMERUB as a promising alternative for rubella diagnosis, with potential for the development of a diagnostic kit.

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

In Japan, several rubella outbreaks in adults have erupted due to insufficient immunity against rubella virus (RUBV). Although selective immunization is being promoted in addition to a routine rubella vaccine program as a rubella eradication strategy, serosurveillance against RUBV needs to be implemented in the generations corresponding to the transition period of vaccination. In this study, a survey of anti-rubella immunoglobulin G (IgG) antibody titers was conducted among young adults involved in the transitional periods of the routine rubella vaccine program. Serosurveillance was performed in 370 healthy young adults aged 18-20 years, and their serum samples were analyzed using an enzyme immunoassay to determine rubella-specific IgG antibody titers. Although multiple regression analysis revealed significant differences only in medical history, more than 90% of participants exhibited seropositivity, excluding those who received single-dose vaccine alone. Based on elapsed periods after the last vaccination, rubella-specific IgG antibody titers in less than a 6-year period were higher compared to that in the more than 10-year period. Although almost all study participants in the transitional period had seropositivity, the results may indicate that the persistence of seropositivity is related to past rubella outbreaks.

Objetivo: analisar os casos de Sí­ndrome da Rubéola Congênita notificados no Brasil durante o perí­odo de 1990 a 2016. Método: estudo transversal realizado no Brasil, cuja amostra foi de 122 casos notificados com Sí­ndrome da Rubéola Congênita. Os dados foram disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. A coleta de dados foi realizada durante os meses de fevereiro e março de 2021. O tratamento dos dados se deu por análise estatí­stica uni-variada. Resultados: observa-se prevalência no Estado de São Paulo cuja capital apresentou o maior número destas notificações. O ano em que houve prevalência do diagnóstico foi em 2008 e o mês de maior notificação foi dezembro. Todos os pacientes apresentavam idade menor que um ano, sexo feminino, com confirmação final para a doença por meio de critérios laboratoriais, e evolução para a cura. Conclusão: a idade apresentou significância no estudo. A terapêutica mostrou-se eficiente para um melhor prognóstico de cura, bem como a vacinação como medida preventiva.

Rubella is a contagious disease caused by rubella virus leading to adverse outcomes among pregnant women including abortions, low birth weight, stillbirths and congenital rubella syndrome (CRS) in the baby. If not pregnant, the clinical manifestations are mild and self-limiting. In this hospital based cross-sectional study, 1985 blood samples were collected from females attending outpatient services of various hospitals to serologically detect Rubella infection. Rubella antibodies namely Immunoglobulin M (IgM)/Immunoglobulin G (IgG) were detected through enzyme linked immunosorbent assay (ELISA) or by identifying virus through polymerase chain reaction (PCR). From the total enrolled participants, 1951 samples were tested with age ranging from 16 to 38 years. Among the positive samples, about 60% patients had IgG antibodies as compared to less than 1% IgM and 0.40% by PCR. Out of 1951 samples, 7/849 (0.82%) and 651/1070 (60.8%) had IgM & IgG rubella antibodies respectively. The odds of having abortion was [OR-13.14 (4.94–34.97)] among anti-rubella positive and primi-gravida [OR-43.6 (5.9–322)] women. Therefore, vaccination of women against rubella before planning of pregnancy or at adolescence seems to be the need of hour to avoid the ill consequences during pregnancy as well as for the new born baby.

Following a rubella outbreak in 2011, Vietnam implemented a mass measles-rubella vaccination campaign for children aged 1–14 years in 2014–2015, further expanding the target age to 16–17 years in 2016; routine vaccination was introduced in 2014. However, there was concern that a substantial proportion of women of child-bearing age were still susceptible to rubella, with the fear of congenital rubella emergence. Thus, we conducted a prospective cohort study in Nha Trang, Vietnam, from 2017–2018 to investigate pregnant women’s susceptibility to rubella infection, the incidence of congenital rubella infection, and factors associated with susceptibility. Cord blood was tested for rubella-specific immunoglobulin M (IgM) and IgG; neonatal saliva and cord blood specimens were examined for rubella-RNA. We analyzed 2013 mother-baby pairs. No baby was rubella-IgM or rubella-RNA positive. Overall, 20.4% of mothers were seronegative (95% confidence interval, 18.6%–22.1%). The seronegativity was significantly low among mothers aged

Congenital Rubella Syndrome (CRS) is a constellation of multi-system abnormalities and each problem has significant anaesthetic implications. These patients pose various challenge to anesthesiologists like unanticipated difficult airway, uncorrected cardiac lesions, etc. Anesthetic for cochlear implant in child with CRS has not been reported. Anaesthetic management in an infant with PS should be based on decrease in pulmonary vascular resistance (PVR), avoidance of tachycardia with sinus rhythm, myocardial depression, systemic hypotension and adequate intra vascular volume. Here we report the anaesthetic management of a 5 year aged child with congenital rubella syndrome - post device closure of Patent ductus arteriosus, bilateral cataract surgery with moderate branch pulmonary artery stenosis and mental retardation posted for cochlear implant. Keywords: Congenital rubella syndrome, pulmonary artery stenosis, difficult airway, cochlear implant, patent ductus arteriosus.

Rubella virus infection poses a great threat to the foetus whose mother acquires the infection. This study was therefore carried out to determine the seroprevalence of rubella virus IgM antibodies among the pregnant women attending Federal Teaching Hopsital, Ido Ekiti. One hundred and ninety two (192) sera were collected from pregnant women and screened for rubella virus IgM antibodies. A structured questionnaire was administered to subjects to obtain socio-demographic data. The sera samples were analysed using Enzymes Immunosorbent Assay (EIA) IgM rubella kit. Out of 192 pregnant women screened, 6(3.1%) subjects were sero-positive. Age group 31-35years recorded the highest prevalence 3(1.56%). Pregnant women with tertiary education had the highest prevalence of 4(2.08%) among different educational level; civil servants have a prevalence of 4(2.08%) compared with other occupational status. However, prenatal screening and post-partum is highly encouraged to detect congenital rubella syndrome. There is also a need to include rubella screening as part of the routine procedure for the expectant mother.

Elimination, in the context of measles, rubella and congenital rubella syndrome (CRS), refers to the absence of endemic measles/rubella virus transmission in a region or other defined geographic area for at least 12 months, in the presence of a high-quality surveillance system that meets targets of key performance indicators. In 1994, Canada and other countries of the World Health Organization (WHO) region of the Americas committed to the objectives of measles elimination by 2000 and rubella and CRS by 2010. Canada met these targets: eliminating measles transmission in 1998; rubella transmission in 2005; and endemically-acquired CRS in 2000. The WHO region of Americas was declared free of endemic rubella/CRS in 2015 and endemic measles in 2016. At the request of the Pan American Health Organization (PAHO), Canada’s elimination status of measles, rubella and CRS was verified in 2012 and again in 2017. Prior to submission to PAHO, the verification reports were reviewed, approved and endorsed by Canada’s National Certification Committee (NCC). The NCC is a group of experts who are not directly involved with the management of vaccine preventable diseases or immunization program implementation at the national level, but who have the expertise to assist in ensuring that Canada is meeting PAHO’S goals of elimination and eradication. Members are responsible for reviewing Canada’s current mechanisms of surveillance and progress towards elimination of targeted vaccine preventable diseases in Canada. Members have expertise in the fields of public health, infectious diseases and/or laboratory sciences.

Background: Rubella is an acute viral disease that often attacks vulnerable children and young adults throughout the world. Even though it only causes mild clinical illness, concern in the health world arises from its teratogenic potential resulting in congenital rubella syndrome (CRS). The most common abnormalities of CRS are hearing loss or deafness, eye defects and congenital heart defects. Purpose: To determine the profiles of age and sex in congenital rubella syndrome patients with congenital heart disease in Dr Soetomo Regional Public Hospital for the period of 2016-2018. Methods: This type of research was a descriptive study by collecting data on the age and sex in congenital rubella syndrome patients with congenital heart disease in Dr Soetomo Regional Public Hospital retrospectively through medical records of patients for the period of 2016-2018. Results: The most age group of congenital rubella syndrome patients with congenital heart disease in Dr Soetomo Regional Public Hospital for the period of 2016-2018 was the toddler (0

Rubella occurs worldwide, causing approximately 100,000 cases annually of congenital rubella syndrome, leading to severe birth defects. Better targeting of public health interventions is needed to achieve rubella elimination goals. To that end, we measured the epidemiological characteristics and seasonal dynamic patterns of rubella and determined its association with meteorological factors in Shaanxi Province, China. Data on rubella cases in Shaanxi Province from 2005 to 2018 were obtained from the Chinese National Notifiable Disease Reporting System. The Morlet wavelet analysis was used to estimate temporal periodicity of rubella incidence. Mixed generalized additive models were used to measure associations between meteorological variables (temperature and relative humidity) and rubella incidence. A total of 17,185 rubella cases were reported in Shaanxi during the study period, for an annual incidence of 3.27 cases per 100,000 population. Interannual oscillations in rubella incidence of 0.8–1.4 years, 3.8–4.8 years, and 0.5 years were detected. Both temperature and relative humidity exhibited nonlinear associations with the incidence of rubella. The accumulative relative risk of transmission for the overall pooled estimates was maximized at a temperature of 0.23°C and relative humidity of 41.6%. This study found that seasonality and meteorological factors have impact on the transmission of rubella; public health interventions to eliminate rubella must consider periodic and seasonal fluctuations as well as meteorological factors.

BackgroundNeonatal-onset glaucoma (NOG) is a severe form of childhood glaucoma and is not always due to primary congenital glaucoma (PCG). Due to advances in neonatal care, the incidence of NOG is rising, but it remains an under-reported entity. The objective of the paper was to study the clinical profiles, surgical and visual outcomes of NOG at least 1 year following early surgery.MethodsProspective interventional cohort study at a tertiary care referral centre. Babies with NOG, who presented between January 2013 and December 2017, had a history suggestive of disease onset within 1 month of birth, and underwent surgery by 3 months of age, were prospectively enrolled. Those who completed a 1-year follow-up after surgery were analysed.Results94 eyes of 53 babies were analysed. 35 (66%) had PCG. Neonatal congenital ectropion uveae, congenital rubella syndrome, Peter’s anomaly and Sturge-Weber syndrome comprised the non-PCG group. The mean age at presentation and surgery was 24.8±21.9, and 36.7±29.9 days. Additional glaucoma surgery was required in 43 of the 94 eyes (45.7%). PCG had significantly better outcomes than other glaucomas at all time points. 28.3% of eyes had good vision (LogMar (0–0.5)), 34.7% had moderate visual impairment (LogMar 0.7–1.0) and 16% were blind (LogMar ConclusionOur study shows that NOG does not always have a dismal prognosis. A small but significant proportion could have other underlying conditions than PCG. Timely surgery and rigorous amblyopia therapy resulted in good outcomes in terms of intraocular pressure control and vision in this cohort.

La rubéola, es una enfermedad exantemática benigna transferible que se ha extendido por todo el mundo, y es conocida también como Sarampión alemán. Esta es causada por el virus de la rubéola que posee un ARN de cadena única de la familia Togaviridae género Rubivirus, y se alberga únicamente en los humanos como huéspedes naturales. Esta enfermedad suele ser bastante leve en adultos y niños. Sin embargo, es peligrosa cuando una mujer embarazada (principalmente durante el primer y segundo trimestre) sufre la primoinfección lo cual constituye un riesgo para las condiciones de vida del bebe al desarrollar posiblemente Síndrome de Rubéola Congénita (SRC), lo cual puede resultar en discapacidades serias para el feto o el neonato. En este documento se busca examinar la situación y los avances científicos de la vigilancia epidemiológica de la Rubéola y el Síndrome de Rubéola Congénita SRC en Latinoamérica, reportados en estudios descriptivos y exploratorios. Esta revisión se empleó el método sistemático y de meta análisis (PRISMA), a través de una búsqueda exhaustiva en la base de datos de Scopus, NICE, Google Scholar y BMC Medidicine para los artículos publicados entre 2009 y 2020. Se obtuvieron 376 documentos de los cuales 28 cumplieron con los criterios, 8 de estos fueron rechazados, 3 duplicados y 17 aceptados. Se registró que a fines del año 2015, la Organización Mundial de Salud OMS proclamó la Región de las Américas libre de transmisión endémica de rubéola.

Summary Background As of 2018, the rubella vaccine had been incorporated into the national immunisation schedule of 168 countries, representing 87% of the world's population. Countries have used different strategies to reduce the burden of congenital rubella syndrome (CRS), such as vaccinating only females. Given the different strategies, and that 26 countries still had not introduced the vaccine, we analysed global rubella surveillance data to understand rubella epidemiology and the effect of vaccination. Methods In this ecological analysis, we evaluated surveillance data on rubella cases that had been reported to WHO from 2007 to 2018, by age, vaccination history, and onset year. Cases were classified as either being vaccine eligible or ineligible on the basis of the country's vaccination strategy and the birth year of the person. We required all cases be confirmed by laboratory testing or that they were epidemiologically linked, and we excluded cases defined only by clinical symptoms. Incidence per million people was calculated by use of World Population Prospects data. Findings Between Jan 1, 2007, and Dec 31, 2018, from data reported to WHO as of Jan 3, 2020, there were 139 486 reported rubella cases, of which 15 613 (11%) were vaccine eligible. Annual incidence ranged from 13·9 cases per million in 2007 to 1·7 cases per million in 2018. In all years, absolute and proportional global incidence were higher among vaccine ineligible cohorts than eligible cohorts. In vaccine ineligible cohorts, 87 666 (74%) of 118 308 cases were in children younger than 15 years, compared with 8423 (54%) of 15 613 cases in vaccine eligible cohorts. Vaccine ineligible women of reproductive age (WRA) had a higher incidence than vaccine eligible WRA, except in 2011–12. Interpretation Vaccination has been successful in decreasing the burden of rubella, regardless of the strategy used. WRA remain at risk, but the risk is higher in those countries that have yet to introduce the vaccine. These countries should introduce the rubella-containing vaccine as soon as possible, to eliminate rubella, and to prevent the morbidity and mortality associated with CRS. Funding None.

Rubella is an important infectious, vaccine-preventable etiology of congenital defects. The aim of the study was to develop a prediction nomogram to assess the probability of an infant being at risk for congenital rubella based on demographics and ophthalmological findings. This was a cross-sectional sentinel surveillance study conducted at 5 centers spanning pan-India and involved 1134 infants. The diagnosis of rubella was made using standard guidelines. For the construction of the prediction model, laboratory-confirmed cases were grouped as “at-risk” (AR) infants and the discarded cases into “not at risk” (NAR) infants. Univariate analysis (p value cut-off < 0.05) followed by multivariate binary logistic regression model development was performed. The average (median) age of the suspected CRS infants was 3 (IQR 1–6) months, and the average (mean) age of their mothers was 25.8 ± 4.1 years. Out of the total infants, 81 (7.3%) died, 975 (88%) were alive, and 55 (5.0%) were lost to follow-up. The final model showed that the odds of cataract, retinopathy, glaucoma, microcornea, and age of the infant at presentation were 3.1 (2.2–4.3), 4.9(2.3–10.4), 2.7(1.1–5.9), 2.3(1.1–4.7), and 1.1 (1–1.1), respectively, for the AR infant as compared to NAR infant. AUC of final model was 0.68 (95% CI Delong, 0.64–0.72). Bootstrapping for calibration of the model showed satisfactory results. Nomogram, along with a web version, was developed. The developed nomogram would have a wide community-based utilization and will help in prioritizing attention to high-risk children, thereby avoiding loss to follow-up.

On 12 February 2015, a local health department (LHD) in Shizuoka prefecture identified two reported rubella cases in its jurisdiction as employees of the same company. As other employees at the company resided both inside and outside of the health department’s jurisdiction, it began collaborating with two additional LHDs and the National Institute of Infectious Diseases to investigate and respond to the outbreak, which subsequently identified cases in two additional companies. We obtained epidemiological, clinical, and outbreak response information from the national epidemiological surveillance of infectious disease system’s database, the local health departments, and the associated companies. One specimen for genetic sequencing was collected from each of the three companies. The outbreak included a total of twenty-five cases, with seventeen confirmed and eight probable cases from three companies. Among them, 24 (96%) were male, 22 (88%) were employees of one company (Company X), and none had rubella vaccination history. The median age was 45 years (interquartile range: 40–51). Epidemiological information did not reveal the source of infection nor transmission route. All rubella viruses sequenced from the three specimens were classified into genotype 1E. The nucleotide sequences in the 739 bp-window region were completely identical in two specimens, with only one nucleotide difference in the third specimen. According to phylogenetic analysis, these strains were closely related to the Southeast and East Asian lineage. This rubella outbreak at three companies, ranging in size from small- to medium-size, in Japan occurred among unvaccinated employees aged at least 30 years, most of whom were male. Virologic analyses suggest all cases were infected with the same viral strain imported from Southeast Asia. Similar to these companies, most employees at small- and medium-size businesses in Japan are males with no vaccination history for rubella, which poses a serious risk for associated cases of congenital rubella syndrome (CRS).

The WHO Regional Verification Commission certified in 2017 that Korea was the first country in the WHO Western Pacific Region to achieve rubella elimination. A suspected congenital rubella syndrome (CRS) was reported to the Korea Centers for Disease Control and Prevention in August 2017. The mother of a new-born had visited Vietnam during her pregnancy. CRS was confirmed based on the detection of rubella-specific IgM and rubella RNA in the urine and throat swab. Rubella virus isolated from the throat swab was classified as genotype 2B, and a phylogenetic analysis indicated that this genotype had been imported from Vietnam. This is the first report of CRS confirmed using virus isolation in Korea. Laboratory surveillance plays a critical role in the elimination of rubella through the provision of laboratory testing data, and characterisation of circulating strains.

Background: The infection of rubella in pregnancy is worrisome due to the fact that it causes miscarriages, congenital defects, and Congenital Rubella Syndrome (CRS). The purpose of this study was to determine the status of Rubella IgG antibody levels both during the antenatal and postnatal periods among pregnant women nonimmune to rubella and the incidence of exposure to rubella in pregnancy. Methods: This was a prospective cohort study that included 4770 pregnant, who attended the obstetric clinics and delivered in Women’s Specialized Hospital, King Fahad Medical City, between January and December 2015. The study utilized the following measures for rubella screening tests (IgG and IgM) during the antenatal and postnatal period. Pregnant women with recent rubella infection (IgM antibody positive), history of rubella infection, or had immunity against rubella (IgG antibody concentration ≥10 IU/ml) were excluded from the study. Results: The prevalence of pregnant women nonimmune to rubella was 6.3% (n = 301). The majority (93.7%) were immune (IgG antibody concentration ≥10 IU/ml). No patients tested positive for rubella (IgM +ve). Overall, The Median (IQR) Rubella (IgG) in the antenatal period (6.3 (8.30–5.00) IU/m) was significantly less in comparison to the postnatal period (5.0 (6.40–5.00) IU/m). The difference was statistically significant, p

Background For several variants of quasi-moyamoya disease, cerebral revascularization treatment is as effective as it is for the more typical cases of moyamoya disease. Here, we examined a case of moyamoya disease with concurrent congenital rubella syndrome (CRS). On the basis of concurrent underlying disease, the patient was considered to have quasi-moyamoya disease and was treated with cerebral revascularization. Case Description A 36-year-old female presented with a large cerebral infarction. She was diagnosed with quasi-moyamoya disease on the basis of clinical and imaging features. The ischemic symptoms and cognitive dysfunction improved after combined direct and indirect revascularization. Conclusions To our knowledge, this is the first known report of moyamoya disease with concurrent CRS. We treated this patient with revascularization as typical for other quasi-moyamoya conditions including Down syndrome. This case emphasizes the effectiveness of revascularization treatment for moyamoya disease with concurrent CRS for the prevention of ischemic stroke and improvement of cognitive function, despite existing cerebral infarction.

Hearing loss in newborns or congenital deafness can be caused by the development of several parts of the auditory system. Congenital deafness is often associated with infections, such as Toxoplasmosis, Rubella, Cytomegalovirus (CMV), and Herpes (TORCH). Deafness is very difficult to be early detected. Therefore, simple but fast methods are needed. Early detection is based on the Newborn Hearing Screening (NHS) program. Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR) checks are raw materials for early detection. Congenital deafness often occurs with pregnancy infections with viruses such as Rubella. Rubella infection during pregnancy, especially during the first trimester, often causes Congenital Rubella Syndrome (CRS). Rubella infection often occurs with other causes, such as Toxoplasma, CMV, and Herpes. A Serological test can be used as one of the diagnostics of this infection. This study used single Rubella IgG and IgM antibodies and double antibodies test as a marker for the infection. The authors wanted to correlate the serological examination of this infection with the auditory function. Rubella infection was detected with single serological anti-Rubella IgG and IgM and double multiple Rubella and TORCH serological tests. Also, the auditory function was assessed using the OAE and AABR test in this research. The result showed 35 (77.7%) patients with positive Rubella serological tests among 45 NICU patients at Dr. Soetomo Hospital. There were number of patients was 12 (34.2%) patients with a single positive serological test and 23 (65.7%) patients with positive multiple TORCH serological tests. The number of patients with Rubella negative infection was 10 (22.2%). There were 11 (31.4%) patients of positive Rubella infections with positive hearing loss and 24 (68.6%) patients with negative hearing loss. From the results of the study, 35 patients were at high risk of disturbance and the statistical analysis showed that there were no significant serological differences in Rubella positive with hearing loss (p=0.087). Hearing loss in NICU infants has a high risk of factors causing Rubella infection and other related causes. In most Rubella positive serological tests IgG was found, which can be due to maternal factors. Serology tests need to be repeated for confirmation under the surveillance program. How to follow-up the patients and define the next laboratory test after six months remain a great challenge. The efforts need to be strengthened in surveillance programs.

Background: Rubella continues to be a leading cause of vaccine-preventable congenital birth defects and permanent organ damage, especially in developing countries. For women who are infected with the rubella virus (RV) before conception or during the first trimester of pregnancy, the unborn child has up to a 90% probability of developing congenital rubella syndrome. There are limited data on the seroprevalence of the rubella virus among pregnant women in Sub-Saharan Africa. Therefore, the aim of this study was done to determine the pooled seroprevalence of rubella among pregnant women in Sub-Saharan Africa. Methods: The PRISMA guidelines protocol was followed to write the systematic review and meta-analysis. Published studies were searched in Medline, PubMed, Google scholar, advance google and Cochrane Library. The search terms on the databases are: “rubella”OR “rubeo*”, “rubella”AND“seroepidemiology”, “seroprevalen *” OR “prevalen*”, “seroprevalen *” OR “seroimmun*”, “rubella antibod*”AND “pregnan*”, “seroprevalen *” AND “sub-Saharan Africa”.The heterogeneity of studies was weighed using Cochran’s Q test and I(2) test statistics. Publication bias was assessed by using Egger’s and Begg’s test. Results: Twenty-eight studies were included in this meta-analysis. The pooled seroprevalence of anti-RV IgG among pregnant women in Sub-Saharan African was 89.0% (95%CI: 84.6–92.3), and the pooled prevalence of anti-RV IgM among pregnant women in Sub-Saharan Africa was 5.1% (95%CI: 2.6–9.9). Conclusion: This meta-analysis showed that seronegativity and acute infection with RV among pregnant women in sub-Saharan Africa is high compared to other studies and the WHO threshold among women of child-bearing age. This finding calls for primary health care providers to make the community aware of this rubella-susceptible group and its healthcare burden, with the desired outcome that sub-Saharan Africa countries would introduce an implementation strategy for rubella vaccination of pregnant women and women of child-bearing age.

BACKGROUND Maternal infections during pregnancy, particularly with rubella virus, were reported to increase the risk of diabetes in children. Widespread vaccination has decreased the number of infants with congenital rubella syndrome in the United States, although it remains a problem in developing countries. Because vaccine hesitancy has recently increased, we investigated the association between congenital infections with subsequent diabetes risk in children in the United States. METHODS Using data from a nationwide private health insurer for years 2001-2017, 1 475 587 infants were followed for an average of 3.9 years (maximum 16.5 years). Information was obtained regarding congenital infections (rubella, cytomegalovirus, other congenital infections) and perinatal infections, as well as for the development of diabetes mellitus and diabetic ketoacidosis. RESULTS There were 781 infants with congenital infections and 73 974 with perinatal infections. Diabetes developed in 3334 children. The odds of developing diabetes for infants with congenital rubella infection were 12-fold greater (P = .013) and, for infants with congenital cytomegalovirus infection, were 4-fold greater (P = .011) than infants without congenital or perinatal infection. Infants with other congenital infections had 3-fold greater odds of developing diabetes (P = .044). Results were similar for diabetes ketoacidosis. Infants with other perinatal infections had 49% greater odds of developing diabetes during the follow-up period (P

Rubella remains an important pathogen worldwide, with many cases of congenital rubella syndrome per year. Rubella vaccination is included in the vaccination program of many countries. WHO has set goals for the elimination of measles and rubella and prevention of congenital rubella syndrome by 2020. Worldwide, the rubella vaccine is highly effective and safe, and as a result, endemic rubella transmission has been halted in the Americas since 2009. Incomplete rubella vaccination programs result in continuous disease transmission, as evidenced by major recent outbreaks in some countries around the world. In this review, we present the rubella control, elimination and eradication policies and a brief review of the rubella laboratory diagnosis.

ObjectiveThere are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria.DesignA population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4–15 years were clinically assessed for CP.ResultsThe estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1–3 and 88 (22.7%) of level 4–5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP.ConclusionThe profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.

INTRODUCTION. Rubella is the disease subject to the elimination programme coordinated by the World Health Organization (WHO). Generally, rubella is an infection of mild course among children but in the case of pregnant women, who are not immunized, the probability of the occurrence of severe congenital abnormalities (congenital rubella syndrome) may amount to 95%. The strategy of the countries belonging to the WHO European Region is directed to the interruption of the rubella virus transmission in the environment in order to prevent the cases of congenital rubella syndrome (CRS). OBJECTIVES. The aims of the present article are to analyze the epidemiological situation of rubella in Poland in 2018 and to discuss the rubella vaccination coverage. MATERIAL AND METHODS. The epidemiological situation of rubella in Poland was analyzed on the basis of publications: “Infectious diseases and poisonings in Poland in 2018” and “Vaccinations in Poland in 2018”. RESULTS. In 2018, there was a decrease in the number of rubella cases - with registered 437 cases (in 2017 – 476 cases) - and a decline in incidence (from 1.2 per 100 000 to 1.1). The highest incidence rate, regardless of gender and the environment, was observed among children aged 0-4 years (9.8 per 100,000). In 2018, no cases of congenital rubella syndrome were registered. SUMMARY AND CONCLUSIONS. In 2018, there was a decrease in the number of rubella cases. In Poland Rubella is reported exclusively on the basis of the clinical picture. The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland.

Background Congenital rubella syndrome (CRS) is a fatal disease causing severe congenital defects. Indonesia had the highest CRS cases in the world in 2016 with a commitment to achieve elimination of rubella disease by 2020, through the campaign and introduction of measles rubella (MR) national vaccination program in 2017 and 2018. This study aimed to describe the impact of the national vaccination campaign by conducting surveillance of CRS cases and comparing the incidence of new CRS cases before and after the MR vaccination campaign. Methods From July 2015 to July 2020, we conducted surveillance of CRS in Yogyakarta. Suspected patients underwent complete clinical examinations. Serology was tested for the presence of IgM and IgG antibodies against rubella. Descriptive analysis was used to characterize the demographic and clinical characteristics of the cases before and after the MR vaccination campaign. Results The study involved 229 infants who were suspected for CRS. Laboratory-confirmed cases were found in 47 of them (20.86%). Most of the laboratory-confirmed cases (55.3%) were reported among 1-5 months old infants. Common clinical features among laboratory-confirmed cases included structural heart defects in 43 (91.4%). There was a significant decrease (60.9%) of CRS incidence from 0.39 per 1000 live births in the precampaign era to 0.08 in the postcampaign era (P = 0.00). Conclusion There has been a significant declining number of CRS cases based on pre- and post-MR vaccination campaign in Yogyakarta, Indonesia. An effective surveillance system will help monitor the number of CRS cases.

Background The WHO European Region targets the elimination of measles, rubella, and the congenital rubella syndrome and welcomes mumps elimination via the joint MMR vaccine. In a push towards this elimination goal, Germany introduced a recommendation on MMR vaccination for adults in 2010 to prevent increasing numbers of measles cases among adults and to strengthen herd immunity. Methods The prevalence of anti-measles, -mumps, and -rubella IgG antibodies was analysed in 7,115 participants between the ages of 18 and 79 years in the German Health Interview and Examination Survey. Risk factors of seronegativity of adults born 1970 or later were determined. Findings The seroprevalence of anti-measles IgG antibodies was more than 97% in adults born before 1965 and less than 90% in adults born afterwards. Prevalence and GMTs declined with later years of birth. Seronegativity was associated with two-sided migration background and region of residence in East Germany. For anti-mumps IgG antibodies, the seroprevalence was less than 90% in almost all age groups. Prevalence and GMTs declined with later years of birth. Seronegativity was not associated with any socio-demographic factor. Anti-rubella IgG seropositivity was found in more than 90% of adults born before 1985. GMTs declined in younger age groups. Seronegativity was associated with birth between 1980 and 1993 and male gender. High socio-economic status lowered the odds of being seronegative. Interpretation These data reinforce the implementation of the vaccination recommendation for adults and provide the basis for further evaluation of this measure. Funding The Federal Ministry of Health, Germany.

Background Rubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps. In response and aiming at rubella elimination by 2020, the government introduced countermeasures comprising supplementary immunization activities for voluntary testing of adult non-healthcare-related workers and vaccination of susceptible individuals. However, as of October 2020, rubella immunity testing and vaccination rates remained low. This study was conducted to identify factors associated with adults voluntarily confirming their rubella immune status, to help develop effective promotion activities for hard-to-reach and left-behind populations. Methods In this cross-sectional study, a general population sample of non-healthcare workers aged 20-49 years in Japan completed an online survey in November 2020. Univariate analysis was performed to examine associations of specific actions taken to confirm rubella immune status with social background characteristics, knowledge of rubella, and attitude to testing and vaccination. Log binomial regression analysis was performed to explore the associations following adjustment for social background characteristics. Results Among 1,854 respondents (927 men, 927 women), only 23.4% of men and 39.4% of women in their 20s to 40s have taken some action related to rubella prevention. Three major factors were associated with the targeted population having taken voluntary action: (1) knowing about testing for confirmation of immunity status (adjusted odds ratio [AOR] 4.29 men, 2.89 women), the rubella outbreak in 2013 among men in their 20s to 40s (AOR 2.79 men, 1.64 women), and congenital rubella syndrome (AOR 1.89 men, 3.10 women); (2) having acquaintances who were vaccinated against or tested for rubella (AOR 2.98 men, 1.95 women); and (3) having a positive attitude toward influenza vaccination (AOR 2.48 men, 1.83 women). Marriage, desire for pregnancy, and having children were weakly associated with taking action. Conclusions Currently, insufficient voluntary action is being taken by high-risk adult populations to close the identified immunity gaps. In this last mile to rubella elimination, our findings and suggested potential interventions via annual health check-ups and occupational health and public health initiatives could prove helpful in developing further countermeasures that actively promote and implement supplementary immunization activities targeting all adult generations.

The review is devoted to an analysis of the genetic diversity of the rubella virus. Historical and geographical data of the circulation of various genotypes of the rubella virus were presented. The tendency to reduce the genetic diversity of the virus in the world as a result of the rubella elimination programs have been shown.

Background. Rubella is a vaccine-preventable disease associated with a significant morbidity and adverse pregnancy outcomes, mainly if acquired in the first trimester of pregnancy with serious consequences to the fetus. Despite increased episodes of rubella epidemics (127 outbreaks in 2009–2015), rubella national vaccination is not yet introduced in Ethiopia. In January 2018, an increase of fever and rash cases was reported in Kuyu District of Oromia. We investigated the outbreak to confirm rubella, determine risk factors, and guide interventions. Methods. We identified rubella cases from health centers and conducted a case-control study (1 case : 2 controls) with 150 participants, from March 12 to 15, 2018. Cases were people who presented with fever and rash or laboratory-confirmed cases. Controls were age matched (P value P<0.05 with AOR and 95% CI by multivariate logistic regression. Results. We identified 50 cases (with no death), and out of them, seven (14%) were confirmed cases (rubella IgM positive). The mean age of the cases was 6 ± 3 years and of the controls was 8 ± 4 years. Family size >5 (AOR = 2.4; 95% CI: 1.5–4.11), not well-ventilated living room (AOR = 4.7; 95% CI: 3.43–8.12), history of contact with rash people (AOR = 2.2; 95% CI: 1.6 3.5), no history of diarrhea in the last 14 days (AOR = 0.8; 95% CI: 0.6–0.9), and no history of vitamin A supplementation (AOR = 2.9; 95% CI: 1.7–2.6) were significant factors for rubella infection. Conclusions. We identified rubella outbreak in the rural area. Crowded living condition, large family size, not receiving vitamin A in the last 6 months, and contact with people with symptoms of rubella were factors that drove the outbreak, while not having diarrhea in the last 14 days was the protective factor. We recommended the introduction of rubella immunization national programs and advocated the policy on rubella vaccine and strengthening surveillance for congenital rubella syndrome and rubella.

A 71-year-old woman with congenital rubella syndrome (CRS) presented with prolonged cough. No physical findings suggested the presence of any connective tissue diseases. Chest computed tomography showed ground-glass opacities and consolidations in the bilateral lower lobes. She had elevated serum Krebs von den Lungen-6, hypoxemia and positive serum anti-Jo-1 antibody. Bronchoalveolar lavage fluid revealed lymphocytosis with a decreased CD4/CD8 ratio. A transbronchial lung biopsy specimen revealed organizing pneumonia. Based on a diagnosis of interstitial pneumonia with autoimmune features (IPAF), systemic corticosteroids were administered, and a good outcome was obtained. A possible relationship between CRS and IPAF is herein discussed.

Congenital rubella syndrome is rare in high-income countries. A 19-year-old pregnant female, who recently immigrated to the United States, presented to clinic for prenatal care at 21 weeks of gestational age. Prenatal ultrasound demonstrated twin gestations with a cleft lip present in twin B. Ultrasound at 36 weeks of gestational age demonstrated fetal demise in twin A and growth restriction in twin B. Twin B was delivered via emergency C-section due to fetal distress. The viable neonate demonstrated multiple abnormalities including microcephaly, patent ductus arteriosus, atrial septal defect, cardiomegaly, pulmonary edema, congenital polar cataracts, congenital adrenal hyperplasia, thyroiditis, cleft palate/lip, and abnormal hearing.

Background:according to the world health organization (WHO) Indonesia’ Immunization program has a goal of reducing Immune-preventable disease and mortality rates. Immunization efforts have been held in Indonesi since 1956. Beginning in 1977, Immunization efforts were expanded into an immunization development program in the prevention of immunization of disease infections (pd3i) such as immunodeficiency, diphtheria, pertusis, measles, tetanus, polio, hepatitis, pneumonia, rotavirus, congenital rubella syndrome, human papillomas. The goal of this studyis to find out what parent’s awareness of the immunization of emergency Bella in the madrassa ibtidayah al-kautsar palembang in 2018. This method of research uses the quantitative descriptive research design, the sample was taken using the 34-parent sampling of madrasah iftidaiyah al-kautsar who is nagaswidak area of labor center. Data analysis using a Univariate analysis, the study was performed in January 2019. The vast majority of 34 respondents were known to have 20 ( 58,8%) when 11(32,4%) had a good knowledge of immunization, while 11(32,4%) had sufficient knowledge and 3(8,8%) had little knowledge. Suggestions: it is hoped that studies could use more varied variables and cover more broader research, so tah research on disease disease and disease could be constantly improved.

Background Although the administration of the measles-mumps-rubella (MMR) vaccine has been widespread in the United States for decades, gaps in vaccine coverage still persist for various reasons. The maintenance of herd immunity against rubella virus (RV) is important to controlling the spread and resurgence of rubella and congenital rubella syndrome. Methods In this study, we sought to assess the seroprevalence of RV-specific antibodies in an adult population from a defined geographic area in Olmsted County, MN, and the surrounding municipalities, with relatively high vaccine coverage and no documented evidence of circulating RV in the past 24 years. Rubella-specific IgG antibodies were measured by ELISA in a large set of serum samples (n = 1393) obtained from the Mayo Clinic Biobank. This cohort was 80.2% female and ranged from 20 to 44 years of age. Results In total, 97.8% of subjects were seropositive for rubella-specific IgG antibodies, with a median titer of 40.56 IU/mL, suggesting a high degree of immunization; however, 2.2% of subjects were found to be seronegative. Interestingly, 25.1% of subjects were seropositive but had titers lower than 25 IU/mL, indicating either a population of low responders or individuals that could potentially be at risk of waning immunity. No significant associations or differences were found between RV-specific titers and demographic variables such as age, sex, or body mass index (BMI). Conclusions A high rate of seropositivity for rubella was found among this young adult cohort, but a significant percent of the cohort had lower titers that may indicate poor initial vaccine response and potential risk if their antibody titers decline.

Objectives: A rubella epidemic has been ongoing in Japan since August 2018. In the present study, we aimed to predict the likely size of a congenital rubella syndrome (CRS) epidemic during 2018–19. Methods: The expected number of CRS cases was estimated using an integral equation based on age-specific incidence of rubella among adult women, the time delay from gestational age of infection to diagnosis of CRS, and distribution of the mothers’ age at delivery. We used epidemic data during 2012–14 to parameterize the model and applied this in the prediction for 2018–19. Results: In analyzing the 2012–14 epidemic data, the mean delay from the mother’s infection to diagnosis was estimated at 24.2 weeks (95% confidence interval (CI): 20.7, 28.1). Applying the parameterized model, together with the more than 480 rubella cases in women in 2018 as well as delayed mother’s age at delivery in 2017, we determined that the expected number of CRS cases would be 9.7 (95% CI: 6.5, 12.5) cases. As the epidemic is ongoing, the cumulative number of CRS cases could potentially reach 96.8 (95% CI: 65.3, 125.5) cases, if rubella cases in adult women rose to 10 times the number by week 49 in 2018. Conclusions: CRS is expected to occur an average of 24 weeks following the mother’s infection with rubella virus. Accounting for an increase to 650 cases in women by week 5 in 2019, the expected number of CRS cases during 2018–19 has already exceeded 13 cases, as of week 5 in 2019. Keywords: Rubella virus, Statistical model, Forecasting, Outbreak, Epidemiology, Prediction, Japan

Background Serological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. Methods Dried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). Results Overall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). Conclusion Seroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.

While generally mild in children, rubella infection during pregnancy can lead to miscarriage, foetal death or congenital rubella syndrome. Rubella vaccination is not yet available as a part of routine immunisation in Sudan, and the burden of infection is unknown. Using the clinical case definition adopted by the World Health Organisation, a total of 123 children suspected of having of measles were enrolled in this study during January-December 2017 in Gadarif Hospital, Eastern Sudan. Those cases whose sera were negative for measles IgM antibodies were tested for rubella IgM antibody. A confirmed rubella case was a person who tested positive for rubella IgM. Sera were analysed for IgM specific antibodies against measles virus and rubella virus using enzyme-linked immunosorbent assay. Among the total 123 children suspected to have measles, 92 (74.8%) children were positive for measles IgM antibodies. Of the 31 children who had measles IgM antibodies negative, 20 (16.3%) children were seropositive for rubella IgM antibodies. Implementation of a surveillance system will provide the improved estimates of rubella virus and estimated the burden of congenital rubella syndrome. Such information is necessary and it is an important step for future policy decisions for vaccine delivery strategies.

The only rubella vaccine available in North America is the RA27/3 strain (isolated from the kidney of a rubella-infected fetus and attenuated) licensed in 1979, which substituted HPV77/DE5 strain vaccine due to concerns about waning immunity. The first dengue vaccine (Dengvaxia CYDTDV) was first registered in Mexico in December, 2015, which is a live recombinant tetravalent dengue vaccine. Rubella vaccine was applied since 1969, but tetravalent dengue vaccine is being used in large scale nowadays. In the past, based on unavailable information regarded to rubella vaccine, mathematical models were used to design vaccination schemes in order to avoid congenital rubella syndrome (CRS). Currently, knowing that vaccine does not result in CRS, rubella vaccination is modelled as usual childhood infection. This experience of updated biological knowledge that influenced mathematical modellings of rubella vaccination is taken into account to reflect about the tetravalent dengue vaccine. We also address a discussion about the security of vaccination strategies.

Congenital rubella syndrome (CRS) results from maternal rubella virus infection in early pregnancy. Abnormal neuroimaging findings have been analyzed in a small number of CRS patients in the past; however, their clinical significance has been poorly addressed. Therefore, we have investigated the neuroimaging findings of 31 patients with CRS from previous studies. The most common finding was parenchymal calcification, which was observed in 18 of 31 patients (58.1%). A multivariable logistic regression model showed that it was associated with psychomotor or mental retardation (p = 0.018), suggesting that parenchymal calcification in CRS could be a prognostic factor.

In 2005, the Regional Committee of the World Health Organization (WHO) European Region (EUR) passed a resolution calling for the regional elimination of measles, rubella, and congenital rubella syndrome (CRS) (1). In 2010, all 53 countries in EUR* reaffirmed their commitment to eliminating measles, rubella, and CRS (2); this goal was included in the European Vaccine Action Plan 2015-2020 (3,4). Rubella, which typically manifests as a mild febrile rash illness, is the leading vaccine-preventable cause of birth defects. Rubella infection during pregnancy can result in miscarriage, fetal death, or a constellation of malformations known as CRS, which usually includes one or more visual, auditory, or cardiac defects (5). The WHO-recommended measles and rubella elimination strategies in EUR include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine (MRCV) through routine immunization services; 2) providing measles and rubella vaccination opportunities, including supplementary immunization activities (SIAs), to populations susceptible to measles or rubella; 3) strengthening surveillance by conducting case investigations and confirming suspected cases and outbreaks with laboratory results; and 4) improving the availability and use of evidence to clearly communicate the benefits and risks of preventing these diseases through vaccination to health professionals and the public (6). This report updates a previous report and describes progress toward rubella and CRS elimination in EUR during 2005-2019 (7). In 2000, estimated coverage with the first dose of a rubella-containing vaccine (RCV1) in EUR was 60%, and 621,039 rubella cases were reported (incidence = 716.9 per 1 million population). During 2005-2019, estimated regional coverage with RCV1 was 93%-95%, and in 2019, 31 (58%) countries achieved ≥95% coverage with the RCV1. During 2005-2019, approximately 38 million persons received an RCV during SIAs in 20 (37%) countries. Rubella incidence declined by >99%, from 234.9 cases per 1 million population (206,359 cases) in 2005 to 0.67 cases per 1 million population (620 cases) by 2019. CRS cases declined by 50%, from 16 cases in 2005 to eight cases in 2019. For rubella and CRS elimination in EUR to be achieved and maintained, measures are needed to strengthen immunization programs by ensuring high coverage with an RCV in every district of each country, offering supplementary rubella vaccination to susceptible adults, maintaining high-quality surveillance for rapid case detection and confirmation, and ensuring effective outbreak preparedness and response.

Background Structural congenital heart defects (CHD) take a huge toll of congenital defects in children in India. Limited information is available regarding modifiable risk factors for its causation. This study was planned with an aim to determine the prevalence of congenital rubella infection in Indian infants with structural CHD’s. Methodology This cross-sectional, observational study was conducted at a tertiary care hospital in Northern India over 1 year period (1 July 2016 to 30 June 2017). Infants Results A total of 80 infants (M : F = 56 : 24), having mean age 69.4 (±56.5) days; were enrolled. In these infants, prevalence of congenital rubella infection (either infant’s IgM rubella positive or infant’s IgG rubella titers higher than mother’s) was 8.75% (7/80). A total of 12.5% of studied mothers were seronegative for rubella IgG antibodies. Statistically significant association was found between the occurrence of congenital rubella and cataract (p = 0.0039), splenomegaly (p = 0.007) and microcephaly (p = 0.0084) in infants having structural CHD. Conclusions Congenital rubella syndrome still remains an important modifiable cause for structural CHD in India. Sincere efforts for rubella elimination via further strengthening current vaccination strategy would help in decreasing burden of structural CHD in India.

Rubella virus (RUBV), a rubivirus, is an airborne human pathogen that generally causes mild measles-like symptoms in children or adults. However, RUBV infection of pregnant women can result in miscarriage or congenital rubella syndrome (CRS), a collection of long-term birth defects, including incomplete organ development and mental retardation. Worldwide vaccination campaigns have significantly reduced the number of RUBV infections, but RUBV continues to be a problem in countries with low vaccination coverage. Furthermore, the recent discovery of pathogenic rubiviruses in other mammals emphasizes the spillover potential of rubella-related viruses to humans. In the last decade, our understanding of RUBV has been significantly increased by virological, biochemical, and structural studies, providing a platform to begin understanding the life cycle of RUBV at the molecular level. This review concentrates on recent work on RUBV, focusing on the virion; its structural components; and its entry, fusion, and assembly mechanisms. Important features of RUBV are compared with those of viruses from other families. We also use comparative genomics, manual curation, and protein homology modeling to highlight distinct features of RUBV that are evolutionarily conserved in the nonhuman rubiviruses. Since rubella-like viruses may potentially have higher pathogenicity and transmissibility to humans, we also propose a framework for utilizing RUBV as a model to study its more pathogenic cousins.

Rubella is generally a mild disease, but infection during pregnancy can cause congenital rubella syndrome. Thailand has implemented a two-dose MMR vaccination policy since 2010. This study aimed to describe the seroprevalence rate of rubella among children and adolescents in Thailand. We conducted a cross-sectional study of 132 healthy children (aged 3-9 years) who had received 2 doses of rubella vaccine and 424 adolescents (aged 10-18 years) who were expected to receive at least 1 dose of rubella vaccine. Stored serum samples from healthy children and recently drawn serum samples from adolescents were tested for rubella IgG antibody using a commercial enzyme-linked immunosorbent assay (ELISA) kit (EUROIMMUN). Seroprotection was defined as a rubella IgG level ≥ 10 IU/mL. The rubella seroprevalence rate among children and adolescents who had 2 documented doses of MMR was 97.0% (95 %CI 92.5-99.2%) and 85.4% (95% CI 78.8-90.6%, p

Background: Maternal infection with rubella in the first trimester of pregnancy can result in developmental abnormalities in fetus such as hearing loss, heart abnormalities, impaired vision, and mental retardation. Methods: This Multi-stage prospective/cross sectional study was carried out in three stages in three educational hospitals in Tehran (Rasoul akram, Akbar Abadi and Firoozabadi), during 2011-2012: In first stage, 186 infants at birth day. Rubella antibodies (IgG&IgM) in cord blood was evaluated by Eliza method. In second stage, 89 infants suspected INTRA UTERINE INFECTION and in third stage 165 infants with SNHL were selected . Age matched control group were selected and examined concurrently. Rubella antibodies (IgG&IgM) compared between cases and healthy matched infants. Results: In first stage, significant correlation was found between vaccination history and rubella immunization of mothers (P value = 0.001). None of those with a history of vaccination had positive IgM. In second stage, confirmed CRS (positive IgM) was found in 4.4% of total CRS suspected cases (5 /89). The positive RT–PCR detected in 1.5% of total CRS suspected cases (1/89). Except a positive correlation between abnormal neurologic findings and positive IgM in Confirmed CRS cases, other clinical findings were not related to serologic tests. In third stage, the highest frequency for Positive Rubella-IgM observed in the SNHL cases Conclusion: Active CRS surveillance is recommended strongly even in country with full rubella vaccination. Without active CRS surveillance ;CRS especially, mild infection ( not classic form) such as IUGR(intrauterine growth retardation), hearing loss, heart abnormalities, impaired vision, and mental retardation even in developed country might be missed . The necessity to add a booster vaccine dose to the national vaccination program 8 years after the last vaccination should be evaluated if needed. In addition, follow-up of safety status and studies to evaluate the success of the program may be necessary and is recommended.

Introduction:Rubella viral infection in pregnant women is a Global Public Health concern as it has a devastating effect on developing foetus causing adverse foetal outcome or Congenital Rubella Syndrome (CRS). Aim: To recognise the proportion of pregnant women susceptible to Rubella infections so as to discern the risk of CRS. Materials and Methods: A prospective cross-sectional study was conducted on 90 rural pregnant women attending the Tertiary Care Centre, from September 2019-December 2019. Informed consent was obtained and a comprehensive structured questionnaire was noted regarding the sociodemographic details and reproductive history. Five mL of venous blood was tested for the presence of anti-rubella IgG using Enzyme-Linked Immunosorbent Assay (ELISA) kits. Data analysis were conducted using Statistical Package for Social Sciences version 15.0. Results: The mean age of the population was 23.26±5 years. Overall, seroprevalence was 88.9% (80/90). Immunity was higher (100%) in women of 30-35 years age, 100% in lower upper class, 93.3% with higher education, 90.9% with second trimester, 90.3% multigravida and 90.5% parity. It was also observed that in all the women with low immunity (11.1%) had a history of adverse foetal outcome. Conclusion: A significant proportion of pregnant females are still susceptible to rubella virus infection shows that rubella is endemic in the study area, so antenatal screening for rubella should be mandatory and rubella vaccination in adolescent girls and women of child bearing age is the only way to reduce the menace of CRS in India.

This is a case of a four-month-old female infant who presented with clinical manifestations of congenital rubella syndrome (CRS) — bilateral cataracts, poorly-dilating pupils, microcorneas, salt and pepper retinopathies seen after cataract extractions, bilateral sensorineural hearing loss, patent ductus arteriosus, microcephaly, history of blueberry spots and low birth weight, and positive serum IgM and IgG tests for rubella. The patient’s mother also had prenatal rubella infection. However, the patient also presented with additional set of clinical findings not seen in recent patients with CRS and not commonly reported in literature: visual acuities of poor to no dazzle, bilateral choroidal thickening on ocular ultrasound that spontaneously resolved, optic nerve inflammation that became atrophic, vessel tortuosities seen after cataract extractions, bilateral subependymal cysts with lenticulostriate vasculopathy in basal ganglia, basal ganglia hyperintensity suggestive of calcification, and jaundice. These findings plus the overlapping clinical manifestations with CRS and the positive IgM and IgG for cytomegalovirus (CMV) made us consider a congenital CMV co-infection. CRS already causes significant childhood morbidity. Getting co-infected with CMV in utero worsens morbidity and makes management more difficult. This case presented a congenital co-infection of rubella and CMV and discussed the added challenges in their diagnosis and management.

Congenital cytomegalovirus (CMV) infection (cCMV) is challenging to differentiate from congenital rubella syndrome (CRS) clinically. Virus detection and serological tests are needed. However, they are often not readily available or are expensive. This is a case of a five-month-old male with bilateral cataracts. He was jaundiced at birth and started having seizure episodes at one month of age. He was also diagnosed with right inguinal hernia and had abnormal bilateral hearing tests. Both eyes were noted to have leukocoria at two months of age. There was dazzle on both eyes and sclerae were anicteric. Examination revealed dense cataracts on both eyes, but their ocular ultrasound results were essentially normal. Due to the bilateral hearing loss and bilateral cataracts, CRS was initially considered despite the absence of heart abnormality since there were reported CRS cases without the complete triad. However, possible coinfection or another disease was considered due to the presence of jaundice, seizures, and hernia, which were never seen in our previous CRS patients nor were reported in the literature. The patient underwent cataract extraction on both eyes without intraocular lens implantation (IOL) as recommended for CRS cataracts to prevent severe inflammation. TORCH (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) test was negative for rubella but positive for CMV. As such, the patient would have benefitted from early IOL implantation. The patient was then referred to a national medical center for possible treatment. However, since the patient already tested negative for CMV polymerase chain reaction (PCR) there, systemic antiviral therapy was no longer initiated. This case presented the challenge of clinically differentiating cCMV and CRS.

Background: Rubella is an infectious viral disease that caused by the Rubella virus. The incidence of rubella infection in women during pregnancy leads to complications for fetus development and cause congenital rubella syndrome or fetal death. This study aimed to determine the prevalence rate of rubella among reproductive-age women in Al-Mahweet, Yemen. Methods: A cross sectional study was conducted among females attending healthcare centers and schools from July 2007 to June 2008. Blood samples were collected individually from 270 females aged 15-35 years and the rubella virus IgG antibody was quantitated by enzyme-linked immunosorbent assay (ELISA). The needed data were collected by using a pretested questionnaire and analyzed by statistical program. Results: Overall, 197(73%) had IgG-positive antibody to rubella and 73(27%) had IgG-negative antibody to rubella. The highest rate of anti-rubella IgG was among females aged 15-25 years and the lowest was among the females aged 31-35 years. Similarly, the higher rate was among females living in urban area compared to females from rural area. The statistically significant difference was found between most educational levels and positive results of anti-rubella IgG. With regard to marital status, the most frequent of rubella antibody was 72.3%, 73.1%, and 75.0%, respectively, recorded among single, married, and divorced females. The non-pregnant women had (73.7%) more incidence to rubella IgG antibody than pregnant (66.7%). 82.2% of IgG- positive women had no history of stillbirth and 65% had a history of stillbirth. Conclusions: Most of the enrolled females had immunity against rubella virus, but still a significant percentage were susceptible to rubella infection. Thus, it is essential to introduce of rubella vaccine to control and prevent the rubella virus circulating among the community. Peer Review History: Received 20 July 2020; Revised 11 August; Accepted 22 August, Available online 15 September 2020 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Name: Dr. (Mrs) Amaka A. Mgbahurike Affiliation: University of PortHarcourt, Nigeria E-mail: amaka_mgbahurike@yahoo.com Name: Dr. Tamer Elhabibi Affiliation: Egyptian Russian University, Egypt E-mail: Tamer_elhabibi@yahoo.com Name: Rawaa S. Al-Kayali Affiliation: Aleppo university, biochemistry and microbiology department, Syria E-mail: Rawah67@hotmail.com Name: Rola jadallah Affiliation: Arab American University, Palestine E-mail: rolla.jadallah@aaup.edu Comments of reviewer(s): Similar Articles: THE ASSOCIATION OF EPSTEIN-BARR VIRUS ANTIBODIES WITH RHEUMATOID ARTHRITIS AMONG YEMENI PATIENTS IN SANA’A CITY SEROPREVALENCE OF ANTI-MANNOSE BINDING LECTIN AUTOANTIBODIES IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SANA'A CITY- YEMEN

The Australian Paediatric Surveillance Unit (APSU) has been prospectively collecting national data on rare childhood conditions since 1993, with monthly reporting of cases by paediatricians. In this report we describe annual results from studies for ten communicable diseases and complications of communicable diseases that were conducted using APSU surveillance in 2019 and place these in an historic context. Results are reported on acute flaccid paralysis, congenital cytomegalovirus infection, neonatal herpes simplex virus infection, perinatal exposure to HIV, paediatric HIV infection, severe complications of seasonal influenza, juvenile onset recurrent respiratory papillomatosis (JoRRP), congenital rubella syndrome, congenital varicella syndrome and neonatal varicella infection. APSU provides rich clinical data to complement data collected from other surveillance systems and to improve understanding and response to rare childhood infections.

Although rubella is usually a mild, febrile illness, and up to 50% of rubella infections are asymptomatic, congenital rubella syndrome (CRS) can occur in the developing fetus of a pregnant woman infected with rubella virus (RV) in early pregnancy. After a rubella outbreak from early 2012 to late 2013 in Japan, another outbreak re-emerged from mid-2018 in the Tokyo metropolitan area and other large cities. In 2018, and up to epidemiological week (EW) 25 in 2019, more than 4000 rubella cases had been reported. Three CRS cases were also reported up to EW 24. Seroepidemiological surveys among Japanese residents indicated that the susceptible pocket to RV in male adults aged 30-50 years, as determined in 2013, remained unchanged in 2018. To reduce the number of male adults sensitive to RV, in early 2019, Japan's Ministry of Health, Labour and Welfare decided to implement routine immunization of male adults aged 40-57 years between 2019 and 2021. These male adults have been determined to have low anti-RV antibodies, and were therefore designated as the target population for this routine immunization (as category A). Although one-third of male patients with rubella reported in 2018 were in their 20 s and 30 s, these younger generations were not included in the target population for routine immunization against rubella, because they had already received a routine vaccination. Rubella vaccination is also required for male adults aged 20-40 years to diminish the susceptible pocket.