Trends of congenital rubella syndrome among infants (0-11 months old) in India: a multicentre hospital-based sentinel surveillance (2016-2025).
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Shanmugasundaram Devika, Verma Sanjay, Tripathi Shalini, Dwibedi Bhagirathi, Singh Kuldeep, Mahantesh Sangappa, Malik Shikha, Singh Himabindu, Santhanam Sridhar, Mondal Nivedita, Sinha Malay Kumar, Jain Manish, Chowdhary Bhabesh Kant, Vishwanathan Rajlakshmi, Pawar Shailesh D, Sapkal Gajanan, Som Tapas Kumar, Kumar Amber, Pati Sananda, Datta Supratim, Ramasamy Sabarinathan, Rajendran Padma Priya, Singh Mini P, Ratho Radha Kanta, Shukla Suruchi, Mishra Baijayantimala, Gadepalli Ravishekhar, Nag Vijay Lakshmi, Munivenkatappa Ashok, Biswas Debasis, Devara Sudha Madhuri, Vannavada Sudha Rani, Abraham Asha Mary, Dhodapkar Rahul, Ray Raja, Pati Binod Kumar, Sreenivasan Priya, Geetha Saradakutty, Bavdekar Ashish, Prakash Jayant, Ray Jaydeb, Gupta Madhu, Rohit Manoj K, Sankhyan Naveen, Gupta Parul Chawla, Kumar Praveen, Munjal Sanjay Kumar, Naganur Sanjeev Hanumantacharya, Sharma Akhil, Agarwal Siddharth, Verma Veerendra, Sahoo Abhilash, Gupta Neeraj, Priyanka Priyanka, Augustine Ann Mary, John Deepa, Kumar Manish, Bethou Adhisivam, Alexander Arun, Anantharaj Avinash, Kasturi Nirupama, Gupta Dipankar, Chowdhoury Satyabrata Roy, Mukherjee Suchandra, Basu Suprit, Prasad Arun, Raj Amit, Bhavana Kranti, Nalavade Uma, Rane Sneha V, Murhekar Manoj
Аннотация
METHODS: CRS surveillance included eligible infants between 0 and 11 months of age with suspected CRS, defined as the presence of congenital heart defects, hearing impairment, ocular abnormalities or maternal history of rash during pregnancy. All enrolled infants underwent comprehensive clinical evaluation, including cardiac, ophthalmologic, and hearing assessments. Serum samples were tested for rubella-specific IgM and IgG antibodies. The final analysis summarised clinical characteristics and trend of laboratory-confirmed CRS infants.
FINDINGS: Between November 2016 and May 2025, 8953 infants with suspected CRS were enrolled across 16 sentinel sites, among them 583 (6.5%) patients were classified as having laboratory-confirmed CRS. The proportion of laboratory-confirmed patients declined from 24.9% in 2017 to 2.5% in 2025. Among laboratory-confirmed CRS patients, 81.3% had structural heart defects, 26.8% had hearing impairment, and 24.2% had any of the group A ocular sign (cataract, glaucoma or pigmentary retinopathy). Of the 583 infants with laboratory-confirmed CRS, 541 were tested for rubella virus by RT-PCR, of whom 56 (10.4%) were positive, with no positive detections after 2021. Follow-up information was available for 452 laboratory-confirmed CRS patients, of whom 126 died, with a cumulative probability of death by one year of 32.2% (95% CI 26.7-38.4).
INTERPRETATION: The observed decline in the proportion of laboratory-confirmed CRS among suspected CRS infants in this facility-based surveillance is consistent with declining rubella virus transmission in India, although changes in surveillance sensitivity over time could not be excluded. Sustained high-quality surveillance is essential to monitor progress towards CRS elimination in the country.
FUNDING: CRS surveillance was funded by the Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance (Grant number: 00101970).