Congenital Rubella Syndrome in Fiji, 1995–2010

Setting. A nationwide study in Fiji. Objective. To describe the incidence of congenital rubella syndrome (CRS) and its relationship to the incidence of notified cases of rubella in Fiji from 1995 to 2010. Design. Descriptive, retrospective review of all recorded congenital abnormalities associated with live births in Fiji over 16 years. Results. There were 294 infants who met the criteria for CRS. Of these, 95% were classified as “suspected” cases, 5% were “clinically confirmed,” and none were “laboratory confirmed cases”. There was a significant linear increase over the study period in the incidence of CRS (odds ratio 1.045 per year, 95% CI 1.019 to 1.071, ). There was no significant association between the incidence of CRS and the reported incidence of rubella ( ). Conclusion. There is a rising trend in reports of suspected CRS cases in Fiji. This highlights the need to strengthen surveillance for CRS through improvements in clinical and laboratory diagnosis to confirm or exclude suspected cases. It is also important to ensure high coverage of rubella vaccination in Fiji. 1. Introduction Whilst rubella is usually a mild disease in adults and children, maternal infection with rubella, especially early in pregnancy, can cause severe defects in the developing foetus, resulting in congenital rubella syndrome (CRS). The constellation of anomalies of CRS includes ophthalmic, auditory, cardiac, and craniofacial defects [1]. CRS is common in developing countries, affecting about 110,000 infants annually in these countries [2]. In 2009 there were 121,344 cases of rubella reported from 167 WHO member countries [2]. In addition, 165 cases of CRS were reported to WHO by 123 member countries in the same year [2]. In the Western Pacific Region, the number of rubella cases increased 12-fold from 5475 in 2000 to 73077 in 2009. With rubella a growing problem in the Western Pacific Region, there are concerns that CRS may also be on the rise in this region. The relationship between the incidence of rubella and the incidence of CRS has not been clearly shown, although some studies from resource poor settings, such as Romania, have shown clusters of children with CRS after rubella outbreaks [2]. In Fiji, the incidence of rubella has ranged between 1 and 30 cases per 100,000 population with outbreaks noted in 1995, 2002, 2006, and 2011 [3]. The most recent rubella outbreak, in July 2011, has highlighted the need to carry out surveillance of CRS in Fiji. Vaccination against rubella was introduced in 1975 for females (at 12 years of age), and in 2004 this was extended to