congenical rubella syndrome surveillance in combodia

CONGENITAL RUBELLA SYNDROMESURVEILLANCE IN CAMBODIA Preliminary results Dr.LORN TRY Patrich General Pediatrician Kampong-Cham Provincial Hospital,Cambodia Email: ltpt12@hotmail.com Dr.LT

CONGENITAL RUBELLA SYNDROME

SURVEILLANCE IN

CAMBODIA

(Preliminary results)

Dr.LORN TRY Patrich

General Pediatrician

Kampong-Cham Provincial Hospital,Cambodia

Email: ltpt12@hotmail.com

Dr.LT Patrich,General Pediatrician

• CRS is characterized by multiple defects, particularly to the brain, heart, eyes and ears  congenital heart diseases,

hearing impairment , visual impairment and mental

retardation

• Treating the illness and disabilities associated with CRS is very costly

• Even well treated, many cases may not fully recovered

• Surveillance of congenital rubella syndrome (CRS) requires a

comprehensive system to detect suspected CRS cases in

infants who present to different health services

• Most developed countries have established surveillance of CRS with national disease notification program

• In developing countries, CRS cases are likely to be

under-reported especially where a high proportion of births occur at

home and neonatal and infant deaths are often unreported

• In Cambodia data from EPI and NIPH in 2011: total of 480 lab

confirmed rubella cases

• Around 20% of these cases aged > 15 years some pregnant

women are infected, and their children will be born with

congenital rubella syndrome (CRS)

• As of 2009, 67% of WHO member states have introduced

Rubella vaccines into their routine childhood program

• In Western Pacific Region, 81% of the 37 member countries and areas have introduced Rubella Vaccine

• However, RV has not yet been introduced into Cambodia

Dr.LT Patrich,General Pediatrician

Objectives of surveillance

• To identify and document the burden of CRS cases in the two sentinel hospitals : NPH and Kampong-Cham Provincial Hospital

• To monitor the effectiveness of rubella vaccination

programs.

• Takeo

• Retrospective studies

• Between 1.September 2011 and 30.July 2012 (11 Months)

• Age < 12 Months

• 2 Sentinels sides : NPH and Kg Cham hospital

Inclusion criteria

• Detects at least : Two of the complications listed in (A) OR One in (A) and one in (B):

– Congenital heart disease - Purpura

– Cataract(s) - Splenomegaly

– Hearing impairment - Microcephaly

– Congenital glaucoma - Developmental delay

– Pigmentary retinopathy - Meningoencephalitis

- Radiolucent bone disease

- Jaundice within 24 hours after birth

Dr.LT Patrich,General Pediatrician

Key data to be collected

in the investigation form

• Infant’s identification

• Patient's date of birth, Sex, name of parents, address, phone number of parents

• Date of notification, name and phone

number of notificator/investigator

• Date of investigation

• Clinical signs and symptoms

• Maternal history : age, febrile rash illness or

exposure to febrile rash illness during this pregnancy, vaccine history

• Six months, We have Identified 20

suspected cases of CRS (NPH=9, Kg-Cham Hospital=11) using WHO recommended

case definition (inclusion criteria)

RESULTS, SEX (6 M) [N0 = 19 ( NPH= 9, Kg-Cham= 11]

Dr.LT Patrich,General Pediatrician

Age ( N0 = 20)

BIRTH WEIGH ( N 0 =20)

Birth weigh Percentage

< 1500 g 1 (5%)

1500 – 2000 g 9 (45%)

> 2000 – 2500 g 9 (45%)

> 2500 g 1 (5% )

Dr.LT Patrich,General Pediatrician

CLINICAL SIGNS ( N 0 = 20)

RISK FACTOR ( N 0 = 20)

Mother has rash illness during pregnancy 18(90%)

Expose during pregnancy 9 (45%)

Dr.LT Patrich,General Pediatrician

• CRS is a major public health problems in Cambodia

• 20 CRS cases are identified during a 6 month period from Sept 2011 to Feb 2012

• Most frequent Congenital heart disease(75%) and

Cataract (60%)

• Most frequent Mother has rash illness during

pregnancy in first trimester (90%)

• Hearing loss present at birth is often not detected until

a later age.

• Should EPI consider Introduction of Rubella Vaccine

1 Prof.EAP Tek CHHENG Ex.President Cambodian pediatric

association (CPA)

2 Dr Houng Vuthy Ex Member of council CPA

3 Dr.Hav Rathneary EX Member of Council CPA

4 Dr.Chham Samnang EX Member of Council CPA

5 Assis.Pro.Sao sokun wathna National Pediatric Hospital

6 Dr.Phe Chan Sokhamony Kampong-Cham provincial

Hospital

7 Dr.RICHARD JOHN WILLIAM (CAM) WHO

Dr.LT Patrich,General Pediatrician

1 BMC Infectious Diseases, Congenital rubella syndrome in Iran

, 2005, BMC Infectious Diseases 2005, 5:44 doi:10.1186/1471-2334-5-44

2 BMC Public Health 2009, 9:269, Rubella seroprevalence among primary

and pre- primary school pupils at Moi's Bridge location, Uasin Gishu

District, Kenya, BioMed Central, BMC Public Health 2009, 9:269

doi:10.1186/1471-2458-9-269

3 Berger et al BMC Public Health 2011, 11:340, Congenital rubella

syndrome and autism,spectrum disorder prevented by rubella,

vaccination - United States, 2001-2010.

4 Ortega García et al Prenatal exposure of a girl with autism spectrum

disorder to ‘horsetail’ (Equisetum arvense) herbal remedy and alcohol: a case report Journal of Medical Case Reports 2011, 5:129.

5 Guidelines for surveillance of congenital rubella syndrome and rubella

Field test version, May 1999, DEPARTMENT OF VACCINES AND

BIOLOGICALS, World Health Organization, Geneva 1999

(www.who.int/gpv-documents)