Profile of cardiac lesions among laboratory confirmed congenital rubella syndrome (CRS) infants: a nationwide sentinel surveillance, India, 2016-22.
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Gunasekaran Pradeep Kumar, Shanmugasundaram Devika, Santhanam Sridhar, Verma Sanjay, Singh Kuldeep, Dwibedi Bhagirathi, Awasthi Shally, Singh Himabindu, Sangappa Mahantesh, Mondal Nivedita, Sreenivasan Priya, Saradakutty Geetha, Malik Shikha, Jain Manish, Viswanathan Rajlakshmi, Sapkal Gajanan, Tripathi Shalini, Patel Bhupeshwari, Jain Mahendra Kumar, Naganur Sanjeev Hanumantacharya, Baranwal Arun, Rohit Manoj K, Deora Surender, Sharma Akhil, Anantharaj Avinash, Pillai Lakshmi Sadasivan, Kumar Amber, Ramasamy Sabarinathan, Rajendran Padma Priya, Singh Mini P, Ratho Radha Kanta, Nag Vijaylakshmi, Gadepalli Ravishekhar, Mishra Baijayantimala, Som Tapas Kumar, Jain Amita, Devara Sudha Madhuri, Vannavada Sudha Rani, Munivenkatappa Ashok, Abraham Asha Mary, Dhodapkar Rahul, Ali Syed, Biswas Debasis, Pratkeye Deepashri, Bavdekar Ashish, Prakash Jayant, Ray Jaydeb, Murhekar Manoj, for CRS Surveillance Group
Аннотация
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.