Congenital and Other Related Infectious Diseases of the Newborn (Perspectives in Medical Virology)
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These chapters are then followed by an overview of the principles of diagnosis, epidemiology, and how virus infections can be controlled. The first section concludes with a discussion on emergence and attempts to predict the next major public health challenges.
These form a guide for delving into the specific diseases of interest to the reader as described in Part II. This lucid and concise, yet comprehensive, text is admirably suited to the needs of not only advanced students of science and medicine, but also postgraduate students, teachers, and research workers in all areas of virology. Detaljer ISBN Product format. Product language. Dine kundeopplysninger oppbevares sikkert hos oss. Les om personvern her. In Sudan, national surveillance for measles and rubella was established in We documented the occurrence of CRS in Sudan for the first time in [ 9 ] and reports about rubella seroprevalence among pregnant women are available from some Sudanese states including Khartoum State [ 10 ] and West Sudan [ 11 ].
The present study aimed to identify CRS cases among Sudanese infants presented at different hospitals in Khartoum to obtain more information about the CRS situation in Sudan. These data may help public health authorities to design appropriate CRS prevention strategies.
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This cross-sectional study was conducted between February and September to identify CRS cases among infants presented to five hospitals in Khartoum, Sudan. Khartoum with an estimated 5 million residents in [ 12 ] is considered to be a major centre for medical facilities, also attracting patients from across the country. The hospitals selected for the present study two ophthalmology hospitals, two paediatrics hospitals and a paediatrics echocardiography unit are major specialised hospitals that provide paediatric services for a large number of Sudanese children.
The clinical examination of these cases was done by qualified physicians according to the specialty of the hospital. As hearing loss was not evaluated in this study, we included infants who presented either with congenital eye defects, heart defects or both. At the ophthalmology hospitals and the echocardiography unit all infants matching the inclusion criteria and presenting during the 7-months study period were included.
For the paediatrics hospitals the research team was called upon by hospital staff when patients matching the inclusion criteria were presented. Parents of infants that met the CRS clinical case definition were informed about the study and consented prior to study enrolment.
A questionnaire including age, gender and place of residence of the infant, clinical signs, age of the mother and maternal history of rash and rubella vaccination was completed for each participating infant. While the clinical data were recorded by the physicians, other data were gathered by the research team from the mother. Access to the completed questionnaires was restricted to members of the research team only.
According to the manufacturers these tests have a specificity and sensitivity of at least The data recorded on the questionnaires were analyzed using SPSS software version Most of the infants were from Khartoum The majority of the enrolled infants At presentation, Congenital cataract was the most frequent clinical presentation For one of the clinically-confirmed cases the mother reported that she had febrile rash illness during pregnancy case 3. In many developing countries, the burden of CRS is under-estimated [ 2 ]. Also Sudan lacks robust information about the burden of CRS, although this information is important for the decision to introduce rubella-containing vaccine in the national immunization program.
Our results showed that of 98 infants with symptoms compatible with CRS, two had specific rubella IgM antibodies, one of which was classified as a laboratory-confirmed case and the other as a congenital rubella infection case.
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In addition, none of the mothers was vaccinated and all infants had clinical signs compatible with CRS. However, it is possible that maternal antibodies acquired after rubella infection still persist in 6—12 months old infants [ 21 ].
The remaining 91 subjects, including 21 clinically confirmed cases, were negative for both rubella IgM and IgG antibodies. A potential explanation is that the observed defects were caused by other pathogens involved in congenital disorders such as Toxoplasma gondii , cytomegalovirus or herpes simplex virus [ 22 ]. This hypothesis is supported by rubella surveillance data from Sudan for and , which showed that only about rubella cases were identified per year cases in and in [ 23 ].
Thus, it would be interesting to investigate samples from suspected CRS cases that cannot be confirmed in the laboratory for other possible etiologies to clarify their role in congenital disorders detected in Sudan. The current report again documented the presence of CRS in Sudan. Another recent study identified seven cases of congenital rubella infection among 92 newborns in Khartoum based on ELISA testing of cord blood [ 24 ].
As a high rubella seronegativity rate of In contrast, a much lower rubella seronegativity rate of 4. Both samples have been described as alternatives to serum for rubella surveillance, as they exhibit equivalent sensitivity and specificity [ 24 ]. Here, we observed a high concordance of Initially the OF samples of two other patients tested positive while the corresponding DBS were negative, but upon repetition of the OF testing the positive result was not confirmed.
The discrepancies between OF and DBS testing in this study, as well as the low number of laboratory-confirmed CRS cases could be related to inappropriate collection of these samples [ 25 ]. Given the advantages of these alternative sampling techniques and the high concordance between the two specimen types, alternative samples should nevertheless be considered for future CRS research in Sudan. With the current study, we further emphasized CRS as a public health burden in Sudan. However, this study was subject to some limitations including the short participant recruitment period, the limited number of participating hospitals and the lack of clinical examination of hearing deficits, another common symptom of CRS.
Despite these limitations, our results together with the findings of other recent studies from Sudan highlight the need of introducing rubella vaccination in Sudan. Rubella vaccination has been shown to be cost-effective [ 7 ], while the treatment of CRS even in poor countries is very costly. The WHO recommends that all countries that have not yet introduced rubella vaccine should consider its inclusion in their national immunization programme [ 3 ]. This study again documented the presence of CRS in Sudan. It also highlighted the importance of rubella vaccination for the interruption of rubella virus transmission to prevent future CRS cases in Sudan.
Clin Microbiol Rev.
Identification of congenital rubella syndrome in Sudan
Wkly Epidemiol Rec. Best JM: Rubella. Semin Fetal Neonatal Med. J Infect Dis.
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WHO: Controlling rubella and preventing congenital rubella syndrome - global progress, Clin Microbiol Infect. East Mediterr Health J. Virol J. Sudan Central Bureau of Statistics.