title: Surveillance of congenital rubella and rubella infections in pregnancy in EU/EEA countries, 2012: Current status and future perspective to monitor elimination.
abstract: BACKGROUND
  Rubella elimination and congenital rubella syndrome (CRS) prevention are targets for achievement by 2015 in the WHO-EURO Region. This paper describes the existing surveillance systems for CRS and rubella in pregnancy in order to critically interpret the findings in relation to the 2012 WHO-EURO surveillance guidelines.
  
  
  METHODS
  In 2012 we conducted a survey to collect information on surveillance of CRS and rubella in pregnancy in 29 EU/EEA countries. Questionnaires explored the characteristics of the surveillance systems, case definition, epidemiological investigation and follow-up of cases, reference laboratories and types of tests performed.
  
  
  RESULTS
  Twenty-eight countries had surveillance systems for CRS, mostly nationwide, mandatory, passive and case-based; 23 collected information on the origin of the infection; 11 reported asymptomatic infections; 6 required zero-reporting. Case definitions varied among countries, although 24 used the EU definition. Laboratories reported cases in 18 countries. Twenty countries collected information on pregnancy within the rubella surveillance system and 5 had specific surveillance for rubella in pregnancy. Two countries did not monitor outcomes of suspected infections in pregnancy; infants with CRS were monitored in all the remaining countries; asymptomatic infected infants in 15; stillbirths and fetal deaths in 13; therapeutic and spontaneous abortions in 8 and 7. Twenty-seven countries had a national reference laboratory for CRS and rubella in pregnancy; genotyping was performed in 15.
  
  
  CONCLUSIONS
  The current surveillance systems allow adequate CRS monitoring in EU. Further efforts are needed to improve their quality, including uniform case definitions, collection of information on the origin of infection, and promotion of reporting from laboratories. Follow-up of pregnant women with suspected infection should be strengthened because it is an entry point for CRS, including detection of fetal deaths, stillbirths and abortions. Laboratory capacity for confirming congenital rubella infections and infections in pregnancy is good in EU, however the use of genotyping should be encouraged.
authors.affiliation: Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: cristina.giambi@iss.it.
authors.forename: C
authors.initials: C
authors.lastname: Giambi
authors.affiliation: Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: cmontanno@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Montaño-Remacha
authors.affiliation: Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: lucia.pastore.celentano@ecdc.europa.eu.
authors.forename: L Pastore
authors.initials: LP
authors.lastname: Celentano
authors.affiliation: Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: Tarik.Derrough@ecdc.europa.eu.
authors.forename: T
authors.initials: T
authors.lastname: Derrough
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012409:Rubella / Q000151:congenital* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Congenital rubella; Elimination; Europe; Monitoring; Pregnancy; Surveillance