Congenital Rubella Syndrome Screening for Newborn in Yogyakarta, Indonesia

Abstract

Background Rubella infection in pregnancy can cause congenital rubella syndrome (CRS), and one common defect of CRS is hearing loss. However, hearing screening is not routinely performed in Indonesia. While the number of reported cases of CRS in Indonesia is increasing, it is still difficult to identify all CRS cases. This study aims to identify CRS cases through a newborn hearing screening.

Materials and Methods This descriptive study was conducted at Dr. Sardjito Hospital, Yogyakarta, Indonesia. The subjects were recruited from September 1, 2013 to November 19, 2013. The study period was from September 1, 2013 to January 31, 2014. Newborn subjects underwent the first otoacoustic emissions (OAEs) test. Subjects with the first OAEs test REFER results underwent the second OAEs test 2 months later. Subjects with REFER result in the second OAEs test then underwent auditory brainstem response (ABR) and detection of rubella IgM in blood serum.

Result There were 151 subjects who underwent the first OAEs test. Ninety subjects (60%) had REFER results, but only 29 subjects underwent the second OAEs test. In the second OAEs test, 9/151 (5%) subjects were REFER. There were 6/151 (3.9%) subjects who underwent ABR and all subjects had sensory neural hearing loss. Of them, one subject was positive for rubella IgM with a titer of 11.86 at 2.5 months of age. We found nine suspected CRS cases, one clinically-confirmed and one laboratory-confirmed CRS case. The incidence of laboratory-confirmed CRS was 1/151 (6.62/1,000) live births.

Conclusion Due to the low incidence we found and the cost of screening, we recommend to strengthen surveillance of CRS. All infants less than 1 year of age with suspected CRS should be checked with rubella IgM to identify CRS cases. While universal newborn hearing screening is not mandatory in Indonesia, targeted newborn hearing screening should be performed to detect children with permanent congenital hearing loss due to CRS.

Keywords

congenital rubella syndrome - newborn - screening - hearing loss

• References

• 1 World Health Organization. Global Measles and Rubella Strategic Plan: 2012–2020. Available at: http://apps.who.int/iris/bitstream/10665/44855/1/9789241503396_eng.pdf . Accessed August 28, 2013
• 2 Van Bang N, Van Anh NT, Van VT. , et al. Surveillance of congenital rubella syndrome (CRS) in tertiary care hospitals in Hanoi, Vietnam during a rubella epidemic. Vaccine 2014; 32 (52) 7065-7069
• 3 Sugishita Y, Shimatani N, Katow S, Takahashi T, Hori N. Epidemiological characteristics of rubella and congenital rubella syndrome in the 2012-2013 epidemics in Tokyo, Japan. Jpn J Infect Dis 2015; 68 (02) 159-165
• 4 Reef SE, Plotkin S, Cordero JF. , et al. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31 (01) 85-95
• 5 Herini ES, , Gunadi, Triono A. , et al. Hospital-based surveillance of congenital rubella syndrome in Indonesia. Eur J Pediatr 2017; 176 (03) 387-393
• 6 US Preventive Services Task Force. Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics 2008; 122 (01) 143-148
• 7 Rundjan L, Amir I, Suwento R, Mangunatmadja I. Skrining Gangguan Pendengaran pada Neonatus. Sari Pediatr 2005; 6 (04) 149-154
• 8 American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120 (04) 898-921
• 9 Feigin RD, Cherry JD. , eds. Frequency and main characteristics of clinical findings in congenital infection [table]. Textbook of Pediatric Infectious Diseases. 3rd ed. Philadelphia: Saunders; 1992: 1804-1805
• 10 Kemp DT. Otoacoustic emissions, their origin in cochlear function, and use. Br Med Bull 2002; 63 (01) 223-241
• 11 World Health Organization. WHO-recommended standards for surveillance of selected vaccine-preventable diseases. 2012 . Available at: http://www.measlesrubellainitiative.org/wp-content/uploads/2013/06/WHO-surveillance-standard.pdf . Accessed August 28, 2013
• 12 Stanley FJ, Burgar PJ, Fong NW, Milroy HM. Congenital rubella syndrome in Western Australia. Aust Paediatr J 1985; 21 (02) 111-114
• 13 Ueda K, Hisanaga S, Nishida Y, Shepard TH. Low-birth-weight and congenital rubella syndrome: effect of gestational age at time of maternal rubella infection. Clin Pediatr (Phila) 1981; 20 (11) 730-733
• 14 Ueda K, Nishida Y, Oshima K, Shepard TH. Congenital rubella syndrome: correlation of gestational age at time of maternal rubella with type of defect. J Pediatr 1979; 94 (05) 763-765
• 15 Naeye RL, Blanc W. Pathogenesis of congenital rubella. JAMA 1965; 194 (12) 1277-1283
• 16 Toda K, Reef S, Tsuruoka M. , et al. Congenital rubella syndrome (CRS) in Vietnam 2011-2012--CRS epidemic after rubella epidemic in 2010-2011. Vaccine 2015; 33 (31) 3673-3677
• 17 George IO, Frank-Briggs AI, Oruamabo RS. Congenital rubella syndrome: pattern and presentation in a southern Nigerian tertiary hospital. World J Pediatr 2009; 5 (04) 287-291
• 18 Peckham CS, Martin JA, Marshall WC, Dudgeon JA. Congenital rubella deafness: a preventable disease. Lancet 1979; 1 (8110): 258-261
• 19 Thant KZ, Oo WM, Myint TT. , et al. Active surveillance for congenital rubella syndrome in Yangon, Myanmar. Bull World Health Organ 2006; 84 (01) 12-20
• 20 Olusanya BO, Luxon LM, Wirz SL. Benefits and challenges of newborn hearing screening for developing countries. Int J Pediatr Otorhinolaryngol 2004; 68 (03) 287-305
• 21 Olusanya BO. Making targeted screening for infant hearing loss an effective option in less developed countries. Int J Pediatr Otorhinolaryngol 2011; 75 (03) 316-321
• 22 World Health Organization. Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region. 2003
• 23 IDAI. Jadwal Imunisasi Anak Usia 0–18 Tahun Rekomendasi Ikatan Dokter Anak Indonesia (IDAI), Tahun 2011. Available at: http://www.idai.or.id/wp-content/uploads/2013/02/Jadwal_Imunisasi_IDAI2011.pdf . Accessed August 28, 2013