Rubella in South Africa : an impending Greek tragedy?
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Date
Authors
Schoub, Barry D.
Harris, Bernice Nerine
McAnerney, Johanna M.
Blumberg, Lucille Hellen
Journal Title
Journal ISSN
Volume Title
Publisher
Health and Medical Publishing Group
Abstract
BACKGROUND: The incidence of congenital rubella syndrome (CRS) is unknown in South Africa. There is evidence that it may be significant and largely undetected, particularly in the upper socio-economic group. This may be due to incomplete routine administration of MMR vaccine in infancy and a build-up of susceptible females reaching the childbearing age group who could be exposed to the extensive reservoir of virus in the unimmunised public sector of the population. OBJECTIVE: To assess the extent of the immunity gap to rubella by testing for protective IgG antibodies and the incidence of rubella infection by testing for IgM antibodies in sera. The data obtained would also be used to model the extent of CRS. DESIGN: Residual laboratory serum specimens from public and private laboratories were serologically tested for rubella IgG antibodies to investigate the immunity gap in the population and IgM antibodies in sera collected from the measles rashlike illness surveillance programme. Modelling exercises calculated the force of infection and the predicted incidence of CRS in South Africa. RESULTS: The serological immunity gap was significantly greater in the private sector specimens compared with the public sector - 10.7% versus 5.4%, respectively. In most years rubella caused much more rash-like illness than measles, with a significant number (5.1 - 9.6%) of rubella-positive IgM specimens occurring in women of childbearing age. CONCLUSION: Modelling of the data suggests that the extent of CRS may be grossly underestimated in South Africa. Approximately 654 cases are calculated to occur every year. It is suggested that selective immunisation of girls before puberty should be instituted together with a routine rubella immunisation programme of infants to forestall a possible future outbreak of CRS, as occurred in Greece in 1993.
Description
Keywords
Congenital rubella syndrome, Serological immunity gap
Sustainable Development Goals
Citation
Schoub, BD, Harris, BN, McAnerney, J & Blumberg, L 2009, 'Rubella in South Africa : an impending Greek tragedy?', South African Medical Journal, vol. 99, no. 7, pp. 515-519. [www.samj.org.za]