The Lancet Regional Health - Southeast Asia (Sep 2023)
Profile of cardiac lesions among laboratory confirmed congenital rubella syndrome (CRS) infants: a nationwide sentinel surveillance, India, 2016–22Research in context
- Pradeep Kumar Gunasekaran,
- Devika Shanmugasundaram,
- Sridhar Santhanam,
- Sanjay Verma,
- Kuldeep Singh,
- Bhagirathi Dwibedi,
- Shally Awasthi,
- Himabindu Singh,
- Mahantesh Sangappa,
- Nivedita Mondal,
- Priya Sreenivasan,
- Geetha Saradakutty,
- Shikha Malik,
- Manish Jain,
- Rajlakshmi Viswanathan,
- Gajanan Sapkal,
- Shalini Tripathi,
- Bhupeshwari Patel,
- Mahendra Kumar Jain,
- Sanjeev Hanumantacharya Naganur,
- Arun Baranwal,
- Manoj K Rohit,
- Surender Deora,
- Akhil Sharma,
- Avinash Anantharaj,
- Lakshmi Sadasivan Pillai,
- Amber Kumar,
- Sabarinathan Ramasamy,
- Padma Priya Rajendran,
- Mini P. Singh,
- Radha Kanta Ratho,
- Vijaylakshmi Nag,
- Ravishekhar Gadepalli,
- Baijayantimala Mishra,
- Tapas Kumar Som,
- Amita Jain,
- Sudha Madhuri Devara,
- Sudha Rani Vannavada,
- Ashok Munivenkatappa,
- Asha Mary Abraham,
- Rahul Dhodapkar,
- Syed Ali,
- Debasis Biswas,
- Deepashri Pratkeye,
- Ashish Bavdekar,
- Jayant Prakash,
- Jaydeb Ray,
- Manoj Murhekar,
- Praveen Kumar,
- Parul Chawla Gupta,
- Sanjay Munjal,
- Naveen Sankhyan,
- Nabaneeta Dash,
- Madhu Gupta,
- Ria Sai,
- Vishaly Sharma,
- Neeraj Gupta,
- Varuna Vyas,
- Nidhi Kaushal,
- Suhanimanasa,
- Niranjan Hunasanahalli Shivanna,
- Prem Kumar P,
- Deepa John,
- Arun Alexander,
- Nirupama Kasturi,
- Adhisivam Bethou,
- Varsha Singh,
- Nidhi Prasad,
- Aniruddha Ghosh,
- Agniva Majumdar,
- Shanta Dutta
Affiliations
- Pradeep Kumar Gunasekaran
- All India Institute of Medical Sciences, Jodhpur, India
- Devika Shanmugasundaram
- ICMR – National Institute of Epidemiology, Chennai, India
- Sridhar Santhanam
- Christian Medical College, Vellore, India
- Sanjay Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Kuldeep Singh
- All India Institute of Medical Sciences, Jodhpur, India
- Bhagirathi Dwibedi
- All India Institute of Medical Sciences, Bhubaneswar, India
- Shally Awasthi
- King George's Medical University, Lucknow, India
- Himabindu Singh
- Niloufer Hospital, Hyderabad, India
- Mahantesh Sangappa
- Indira Gandhi Institute of Child Health, Bengaluru, India
- Nivedita Mondal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
- Priya Sreenivasan
- Government Medical College, Trivandrum, India
- Geetha Saradakutty
- Government Medical College, Trivandrum, India
- Shikha Malik
- All India Institute of Medical Sciences, Bhopal, India
- Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
- Rajlakshmi Viswanathan
- ICMR-National Institute of Virology, Pune, India
- Gajanan Sapkal
- ICMR-National Institute of Virology, Pune, India
- Shalini Tripathi
- King George's Medical University, Lucknow, India
- Bhupeshwari Patel
- All India Institute of Medical Sciences, Bhopal, India
- Mahendra Kumar Jain
- All India Institute of Medical Sciences, Bhopal, India
- Sanjeev Hanumantacharya Naganur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Arun Baranwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Manoj K Rohit
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Surender Deora
- All India Institute of Medical Sciences, Jodhpur, India
- Akhil Sharma
- King George's Medical University, Lucknow, India
- Avinash Anantharaj
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
- Lakshmi Sadasivan Pillai
- Government Medical College, Trivandrum, India
- Amber Kumar
- All India Institute of Medical Sciences, Bhopal, India
- Sabarinathan Ramasamy
- ICMR – National Institute of Epidemiology, Chennai, India
- Padma Priya Rajendran
- ICMR – National Institute of Epidemiology, Chennai, India
- Mini P. Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Radha Kanta Ratho
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Vijaylakshmi Nag
- All India Institute of Medical Sciences, Jodhpur, India
- Ravishekhar Gadepalli
- All India Institute of Medical Sciences, Jodhpur, India
- Baijayantimala Mishra
- All India Institute of Medical Sciences, Bhubaneswar, India
- Tapas Kumar Som
- All India Institute of Medical Sciences, Bhubaneswar, India
- Amita Jain
- King George's Medical University, Lucknow, India
- Sudha Madhuri Devara
- Niloufer Hospital, Hyderabad, India
- Sudha Rani Vannavada
- Niloufer Hospital, Hyderabad, India
- Ashok Munivenkatappa
- ICMR-National Institute of Virology, Pune, India
- Asha Mary Abraham
- Christian Medical College, Vellore, India
- Rahul Dhodapkar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
- Syed Ali
- Government Medical College, Trivandrum, India
- Debasis Biswas
- All India Institute of Medical Sciences, Bhopal, India
- Deepashri Pratkeye
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
- Ashish Bavdekar
- KEM Hospital, Pune, India
- Jayant Prakash
- Indira Gandhi Institute of Medical Sciences, Patna, India
- Jaydeb Ray
- Institute of Child Health, Kolkata, India
- Manoj Murhekar
- ICMR – National Institute of Epidemiology, Chennai, India; Corresponding author. R127, TNHB, Ayapakkam, Chennai, 600077, India.
- Praveen Kumar
- Parul Chawla Gupta
- Sanjay Munjal
- Naveen Sankhyan
- Nabaneeta Dash
- Madhu Gupta
- Ria Sai
- Vishaly Sharma
- Neeraj Gupta
- Varuna Vyas
- Nidhi Kaushal
- Suhanimanasa
- Niranjan Hunasanahalli Shivanna
- Prem Kumar P
- Deepa John
- Arun Alexander
- Nirupama Kasturi
- Adhisivam Bethou
- Varsha Singh
- Nidhi Prasad
- Aniruddha Ghosh
- Agniva Majumdar
- Shanta Dutta
- Journal volume & issue
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Vol. 16
p. 100268
Abstract
Summary: Background: The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016–22. Methods: Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as ‘Simple’ or ‘Complex’ as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings: Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15–2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42–2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26–3.30). Interpretation: Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding: Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.
