Surveillance of congenital rubella: the Campania “Perinatal Infections” Registry experience
Wilma Buffolano1, Elvira Lorenzo2, Sergio Lodato3, Antonio Parlato4, Renato Pizzuti2, Onlus Rete Punti Nascita Regione Campania, Servizi Epidemiologia e Prevenzione ASL Regione Campania (SEP)
1Dipartimento Pediatria, Università Federico II, Napoli
2Osservatorio Epidemiologico Regionale
3Agenzia Regionale Sanità
4ASL Napoli 2
In 1997, the Epidemiological Observatory of the Campania Region implemented a Registry of Perinatal Infections within the Department of Pediatrics of Federico II University, in order to monitor the burden of disease (incidence and outcome) and the effectiveness of prevention and treatment practices recommended by the Ministry of Health (1, 2). A network of maternity wards (onlus RePuNaRC) that account for 89% of births in Campania, participates in the registry. Live newborns with known exposure to maternal infections that are transmissible to the fetus, are prospectively enrolled in internationally accredited diagnostic and treatment protocols (3). When a congenital infection is diagnosed only after birth, and exposure to maternal infection is not known, information on maternal risk factors, including infection during pregnancy, is retrospectively collected by reviewing clinical records and interviewing the clinicians in charge.
In this article we illustrate data regarding cases of congenital rubella (CR) identified between 1997 and 2002. According to international standards, a case with compatible clinical manifestations and a positive laboratory diagnosis was defined as confirmed (1999 CDC criteria) (4). To supplement the data obtained from the registry and to obtain further information on the burden of CR in the Campania Region, we also identified all children born between 1997- 2001 who had received a hospital discharge diagnosis of CR (ICD-9 code: 771.0 ). The clinical documentation of these cases was verified, and cases were classified according to 1999 CDC criteria. All cases that did not meet the confirmed case definition were excluded (4). We also compared the temporal pattern of identified CR cases with that of statutory notifications of rubella in Campania, in the years between 1996 and 2002.
A total of 18 infants with CR were identified; for 5, diagnosis was based exclusively on revision of the discharge ICD-9 codes. Two CR incidence peaks were identified: one in 1997 (5 cases) and another in 2001-2002 (4 and 3 cases respectively). During these same years, infectious disease notification data showed an increased incidence of rubella.(figure).
Approximately 70,000 children are born each year in the Campania region; the annual incidence rate of CR between 1996 and 2002 has consistently exceeded 1/100,000 newborns, with a peak in 2001 of 6/100,000. These data show that surveillance and prevention programs targeted at CR have so far been inadequate.
Considering that measles, mumps and rubella vaccine coverage varies greatly between regions in Italy and in some regions remains below 50%, it is highly probable that CR is an important problem not only in the Campania region but in the rest of Italy as well.
The Campania experience demonstrates that collaborative efforts between maternity wards, local health units and regional authorities have led to efficient strategies for identifying cases of congenital rubella and highlighting the severe burden of the disease.
It also underscores the need for public health efforts to eliminate the risk of rubella infection in pregnant women. Efforts should be directed towards ensuring high levels of rubella vaccination and eventually carrying out special vaccination campaigns aimed at susceptible women of child bearing age.
1 Decreto Ministero della Sanità n. 78, 6 marzo 1995. Aggiornamento del D.M. 14 aprile 1984: “Protocolli di accesso agli esami di laboratorio e di diagnostica strumentale per le donne in stato di gravidanza ed a tutela della maternità responsabile”
2. Decreto Ministero della Sanità n. 245, 20 ottobre 1998. Aggiornamento del D.M. 6 marzo 1995.
3. Center for Diseases Control, National Immunization Program. Manual for the Surveillance of Vaccine-Preventable Diseases, 3rd Edition, 2002.
4.CDC. Rubella Congenital Syndrome, 1999 case definition.
5. Gruppo di lavoro ICONA. ICONA: indagine nazionale sulla copertura vaccinale infantile. Istituto Superiore di Sanità: Rapporti ISTISAN 98/33. 1998