title: Incidence of rubella in a state in North-western Nigeria: a call for action.
abstract: BACKGROUND
  Rubella cases are often under-reported, especially in many developing countries, owing to inadequate attention and weak funding of elimination strategies, despite being an epidemic-prone disease. Based on available data, this paper, therefore, seeks to bring the attention of public health practitioners, researchers and policy makers to threats of rubella in our environment, and also recommend measures to mitigate the threats.
  
  
  METHODS
  The authors conducted a retrospective cross-sectional study in which the laboratory results of febrile-rash-illness cases in Kebbi State, Northwest Nigeria, from January 1, 2014 to December 31, 2015 were analysed, using descriptive statistics and chi-square test. We obtained the data set through the routine Integrated Disease Surveillance System and Response being conducted in Nigeria.
  
  
  RESULTS
  A total of 413 febrile-rash-illness cases were reported and investigated in Kebbi State from 2014 to 2015, 5 (3.5%) tested positive for rubella IgM in 2014 while 7(2.6%) tested positive in 2015. There was no statistically significant difference in the incidence of rubella between 2014 and 2015 (p> 0.05). Rubella infection was mainly found in children less than 5 years of age with peak incidence period during the hot season (between February and April). There was no significant sex bias in this study. However, our practice experiences in this environment suggest a systematic under-reporting and under-diagnosis of febrile- rash-illnesses.
  
  
  CONCLUSIONS
  There was no statistically significant difference in the incidence of rubella in children in our setting for the 2-years studied. However, there is a potential for increase in the transmission of the disease due to non-availability of routine childhood vaccination against rubella and the systematic under-reporting of suspected cases and weak laboratory support. In order to better appreciate the burden of rubella infection, there may be a need to undertake a prevalence survey, and simultaneously, strengthening case-based surveillance in Northwestern Nigeria. Further, WHO should support national government in accelerating the introduction of rubella-containing vaccine to stem the potential spread of this infectious disease.
authors.affiliation: Immunisation, Vaccines and Emergencies, World Health Organisation, Nigeria.
authors.forename: Semeeh Akinwale
authors.initials: SA
authors.lastname: Omoleke
authors.affiliation: Immuisation and Disease Control Unit, State Primary Health, Care Development Agency, Kebbi State, Nigeria.
authors.forename: Henry Chukwuebuka
authors.initials: HC
authors.lastname: Udenenwu
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011634:Public Health; D012189:Retrospective Studies; D012409:Rubella / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D012411:Rubella Vaccine / Q000008:administration & dosage / Q000600:supply & distribution*
chemical_list: D012411:Rubella Vaccine
keywords: Kebbi State; MMR/RCV vaccine; Nigeria; Rubella; WHO; febrile-rash-illnesses; surveillance