title: Active surveillance for congenital rubella syndrome in Yangon, Myanmar.
abstract: OBJECTIVE
  Rubella vaccine is not included in the immunization schedule in Myanmar. Although surveillance for outbreaks of measles and rubella is conducted nationwide, there is no routine surveillance for congenital rubella syndrome (CRS). Therefore, we organized a study to assess the burden of CRS.
  
  
  METHODS
  From 1 December 2000 to 31 December 2002 active surveillance for CRS was conducted among children aged 0-17 months at 13 hospitals and 2 private clinics in Yangon, the capital city. Children with suspected CRS had a standard examination and a blood sample was obtained. All serum samples were tested for rubella-specific IgM; selected samples were tested for rubella-specific IgG and for rubella RNA by reverse transcriptase-polymerase chain reaction (RT-PCR).
  
  
  RESULTS
  A total of 81 children aged 0-17 months were suspected of having CRS. Of these, 18 children had laboratory-confirmed CRS (7 were IgM positive; 7 were RT-PCR positive; and 10 were IgG positive at > 6 months of age). One additional child who tested positive by RT-PCR and whose mother had had rubella during pregnancy but who had a normal clinical examination was classified as having congenital rubella infection. During 2001-02 no rubella outbreaks were detected in Yangon Division. In the 31 urban townships of Yangon Division, the annual incidence was 0.1 laboratory-confirmed cases of CRS per 1000 live births.
  
  
  CONCLUSIONS
  This is the first population-based study of CRS incidence from a developing country during a rubella-endemic period; the incidence of CRS is similar to endemic rates found in industrialized countries during the pre-vaccine era. Rubella-specific IgG tests proved practical for diagnosing CRS in children aged > 6 months. This is one of the first studies to report on the use of rubella-specific RT-PCR directly on serum samples; further studies are warranted to confirm the utility of this method as an additional means of diagnosing CRS.
authors.affiliation: Virology Research Division, Department of Medical Research, Yangon, Myanmar.
authors.forename: Kyaw-Zin
authors.initials: KZ
authors.lastname: Thant
authors.forename: Win-Mar
authors.initials: WM
authors.lastname: Oo
authors.forename: Thein-Thein
authors.initials: TT
authors.lastname: Myint
authors.forename: Than-Nu
authors.initials: TN
authors.lastname: Shwe
authors.forename: Aye-Maung
authors.initials: AM
authors.lastname: Han
authors.forename: Khin-Mar
authors.initials: KM
authors.lastname: Aye
authors.forename: Kay-Thi
authors.initials: KT
authors.lastname: Aye
authors.forename: Kyaw
authors.initials: K
authors.lastname: Moe
authors.forename: Soe
authors.initials: S
authors.lastname: Thein
authors.forename: Susan E
authors.initials: SE
authors.lastname: Robertson
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D011159:Population Surveillance; D012410:Rubella Syndrome, Congenital / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*