title: Unseen blindness, unheard deafness, and unrecorded death and disability: congenital rubella in Kumasi, Ghana.
abstract: OBJECTIVE
  Although rubella serosusceptibility among women of reproductive age in West Africa ranges from 10% to 30%, congenital rubella syndrome has not been reported. In Ghana, rubella immunization and serologic testing are unavailable. Our objectives were to identify congenital rubella syndrome cases, ascertain rubella antibody seroprevalence during pregnancy, and recommend strategies for congenital rubella syndrome surveillance.
  
  
  METHODS
  Congenital rubella syndrome cases were identified through prospective surveillance and retrospective surveys of hospital records. A rubella serosurvey of pregnant urban and rural women was performed.
  
  
  RESULTS
  Eighteen infants born within a 5-month period met the congenital rubella syndrome case definitions, coinciding with a 9-fold increase in presentation of infantile congenital cataract. The congenital rubella syndrome rate for this otherwise unrecorded rubella epidemic was conservatively estimated to be 0.8 per 1000 live births. A postepidemic rubella immunity rate of 92.6% was documented among 405 pregnant women; susceptibility was significantly associated with younger age (P = .000) and ethnicity (northern tribes, P = .024).
  
  
  CONCLUSIONS
  Congenital rubella syndrome occurs in Ghana but is not reported. Information about congenital rubella syndrome and rubella in sub-Saharan Africa is needed to evaluate inclusion of rubella vaccine in proposed measles control campaigns.
authors.affiliation: Department of Child Health, School of Medical Sciences, University of Science and Technology, Kumasi, Ghana, West Africa. fzl8@cdc.gov
authors.forename: J E
authors.initials: JE
authors.lastname: Lawn
authors.forename: S
authors.initials: S
authors.lastname: Reef
authors.forename: B
authors.initials: B
authors.lastname: Baffoe-Bonnie
authors.forename: S
authors.initials: S
authors.lastname: Adadevoh
authors.forename: E O
authors.initials: EO
authors.lastname: Caul
authors.forename: G E
authors.initials: GE
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D012410:Rubella Syndrome, Congenital / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires
chemical_list: D007074:Immunoglobulin G