title: Hospital-based surveillance of congenital rubella syndrome in Indonesia.
abstract: Congenital rubella syndrome (CRS) has serious consequences, such as miscarriage, stillbirth, and severe birth defects in infants, resulting from rubella virus infection during pregnancy. However, rubella vaccine has not yet been implemented in Indonesia. This study aimed (1) to estimate the incidence of CRS in Indonesia, (2) describe the clinical features of CRS at our referral hospital, and (3) pilot a CRS surveillance system to be extended to other hospitals. We conducted a 4-month prospective surveillance study of infants aged <1 year with suspected CRS in 2013 at an Indonesian hospital. Infants with suspected CRS were examined for rubella-specific IgM antibody or rubella IgG antibody levels. Of 47 suspected cases of CRS, 11/47 (23.4%), 9/47 (19.1%), and 27/47 (57.5%) were diagnosed as laboratory-confirmed, clinically compatible, and discarded CRS, respectively. The most common defects among laboratory-confirmed CRS cases were hearing impairment (100%), congenital cataracts (72.7%), microcephaly (72.7%), and congenital heart defects (45.5%).
  
  
  CONCLUSIONS
  The number of laboratory-confirmed CRS cases among Indonesian infants is high. Furthermore, hearing impairment is the most common clinical feature of CRS in infants. Our findings indicate the importance of implementation of rubella vaccine in Indonesia. Conducting hospital-based surveillance of CRS in other hospitals in Indonesia may be appropriate. What is Known: •Congenital rubella syndrome (CRS) has serious consequences in infants resulting from rubella virus infection during pregnancy. •The incidence of CRS in most developed countries has greatly decreased since implementation of rubella vaccination. •Rubella vaccine has not yet been implemented in many developing countries. What is New: •The number of laboratory-confirmed CRS cases among Indonesian infants was high. •Implementation of rubella vaccine into immunization programs in Indonesia is important because of the high number of CRS cases. •Our study highlights the need for ongoing prospective surveillance of CRS in Indonesia.
authors.affiliation: Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia. herini_es@ugm.ac.id.
authors.forename: Elisabeth Siti
authors.initials: ES
authors.lastname: Herini
authors.affiliation: Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
authors.lastname: Gunadi
authors.affiliation: Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
authors.forename: Agung
authors.initials: A
authors.lastname: Triono
authors.affiliation: Pediatric Research Office, Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
authors.forename: Asal Wahyuni Erlin
authors.initials: AW
authors.lastname: Mulyadi
authors.affiliation: World Health Organization (WHO) Indonesia Representative, Jakarta, Indonesia.
authors.forename: Niprida
authors.initials: N
authors.lastname: Mardin
authors.affiliation: World Health Organization (WHO) Indonesia Representative, Jakarta, Indonesia.
authors.lastname: Rusipah
authors.affiliation: Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
authors.forename: Yati
authors.initials: Y
authors.lastname: Soenarto
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Reef
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012410:Rubella Syndrome, Congenital / Q000175:diagnosis / Q000453:epidemiology*; D012411:Rubella Vaccine; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012411:Rubella Vaccine; C040901:rubella antibodies
keywords: Congenital rubella syndrome; Hospital-based surveillance; Immunization; Indonesia; Vaccine