title: Developing rubella vaccination policy in Nepal--results from rubella surveillance and seroprevalence and congenital rubella syndrome studies.
abstract: BACKGROUND
  The Government of Nepal is interested in preventing congenital rubella syndrome (CRS). Surveillance data were analyzed and studies conducted to assess the burden of rubella and CRS and aid in developing a rubella vaccination strategy.
  
  
  METHODS
  (1) Analysis of rubella cases reported through measles surveillance, 2004-2009; (2) in 2008, rubella seroprevalence among women 15 to 39 years of age was evaluated; and (3) in 2009, children attending a school for the deaf were examined for ocular defects associated with CRS.
  
  
  RESULTS
  From 2004-2009, there were 3,710 confirmed rubella cases and more than 95% of these cases were less than 15 years of age. Of 2,224 women of childbearing age (WCBA) tested for anti-rubella IgG, 2,020 (90.8%) were seropositive. Using a catalytic infection model, approximately 1,426 infants were born with CRS (192/100,000 live births) in 2008. Among 243 students attending a school for the deaf, 18 (7.4%) met the clinical criteria for CRS.
  
  
  CONCLUSIONS
  Rubella and CRS were documented as significant public health problems in Nepal. A comprehensive approach is necessary, including introducing rubella vaccine in the routine program, assuring immunity among WCBA, strengthening routine immunization, integrating rubella surveillance with measles case-based surveillance, and establishing CRS surveillance.
authors.affiliation: Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
authors.forename: Shyam Raj
authors.initials: SR
authors.lastname: Upreti
authors.forename: Kusum
authors.initials: K
authors.lastname: Thapa
authors.forename: Yasho Vardan
authors.initials: YV
authors.lastname: Pradhan
authors.forename: Geeta
authors.initials: G
authors.lastname: Shakya
authors.forename: Yuddha Dhoj
authors.initials: YD
authors.lastname: Sapkota
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Anand
authors.forename: Thomas
authors.initials: T
authors.lastname: Taylor
authors.forename: Ondrej
authors.initials: O
authors.lastname: Mach
authors.forename: Susan
authors.initials: S
authors.lastname: Reef
authors.forename: Sirima
authors.initials: S
authors.lastname: Pattamadilok
authors.forename: Jayantha
authors.initials: J
authors.lastname: Liyanage
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Connor
authors.forename: Tika
authors.initials: T
authors.lastname: Sedai
authors.forename: Sagar Ram
authors.initials: SR
authors.lastname: Bhandary
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Partridge
authors.forename: William
authors.initials: W
authors.lastname: Schluter
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D012409:Rubella / Q000453:epidemiology* / Q000517:prevention & control*; D012410:Rubella Syndrome, Congenital / Q000453:epidemiology / Q000517:prevention & control; D012411:Rubella Vaccine / Q000008:administration & dosage*; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D012411:Rubella Vaccine