PLoS Neglected Tropical Diseases (Jul 2021)

Burden of congenital rubella syndrome (CRS) in India based on data from cross-sectional serosurveys, 2017 and 2019-20.

  • Devika Shanmugasundaram,
  • Shally Awasthi,
  • Bhagirathi Dwibedi,
  • S Geetha,
  • Manish Jain,
  • Shikha Malik,
  • Bhupeshwari Patel,
  • Himabindu Singh,
  • Shalini Tripathi,
  • Rajlakshmi Viswanathan,
  • Anjoo Agarwal,
  • Rajeswari Bonu,
  • Shuchi Jain,
  • Saubhagya Kumar Jena,
  • J Priyasree,
  • K Pushpalatha,
  • Syed Ali,
  • Debasis Biswas,
  • Amita Jain,
  • Rahul Narang,
  • Sudha Madhuri,
  • Suji George,
  • Ojas Kaduskar,
  • G Kiruthika,
  • R Sabarinathan,
  • Gajanan Sapakal,
  • Nivedita Gupta,
  • Manoj V Murhekar

DOI
https://doi.org/10.1371/journal.pntd.0009608
Journal volume & issue
Vol. 15, no. 7
p. e0009608

Abstract

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BackgroundIndia has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to MethodsWe conducted serosurveys in 2019-20 among pregnant women attending antenatal clinics of 6 hospitals, which were also sentinel sites for CRS surveillance, to estimate the prevalence of IgG antibodies against rubella. We systematically sampled 1800 women attending antenatal clinics and tested their sera for IgG antibodies against rubella. We used rubella seroprevalence data from the current survey and the survey conducted in 2017 among antenatal women from another 6 CRS surveillance sites to construct a catalytic models to estimate the incidence and burden of CRS.ResultThe seroprevalence of rubella antibodies was 82.3% (95% CI: 80.4-84.0). Rubella seropositivity did not differ by age group and educational status. Based on the constant and age-dependent force of infection models, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births (95% CI: 217.49-232.41) and 65.47 per 100,000 live births (95% CI: 41.60-104.16) respectively. This translated to an estimated 14,520 (95% CI: 9,225-23,100) and 50,028 (95% CI: 48,234-51,543) infants with CRS every year based on age-dependent and constant force of infection models respectively.ConclusionsOur findings indicated that about one fifth of women in the reproductive age group in India were susceptible for rubella. The estimates of CRS incidence will serve as a baseline to monitor the impact of MRCV SIAs, as well progress towards the elimination goal of rubella/CRS.