Background: Infants with congenital rubella syndrome (CRS) often require multiple diagnostic procedures and interventions that include cataract surgery and procedures for congenital heart abnormalities. CRS is a vaccine preventable disease. Objective: This study aimed to determine the costs incurred by the parents, Philippine Health Insurance Corporation (PHIC), hospital's medical social service (MSS), and non-governmental organization (NGO) in the management of CRS. Methods: This is a costing study of five children diagnosed with probable CRS who were managed in a tertiary government hospital in Northern Luzon, Philippines. The parents or guardians of the patients were interviewed on the cost incurred particularly on non-medical related expenses during their outpatient department consultations and admissions. Hospital bills from our institutions and those from the previous institutions, if available, were retrieved. Expenses incurred from procedures or medical supplies relating to known complications of CRS were included in the computation. Results: All five patients diagnosed with CRS had cardiac, ear, and eye manifestations. Two patients had postnatal complications. The average cost spent by the five patients' early years of life (mean age of patients was 16 ± 14 months) was ₱409,740.84. A quarter of the cost was out-of-pocket expenses while a third was covered by the hospital's MSS where the patients were seen. Another third was shouldered by an NGO. Most expenses were from the treatment of cardiac complications at 42% of the cost and had the highest average cost at ₱116,586.59. Case 1 had the highest financial cost at ₱833,514.24 mainly from the cardiac complications of CRS. Conclusion The cost of CRS in the early years of life is high. This is a significant financial burden to parents, PHIC, hospital's MSS, and NGO.
Congenital rubella syndrome ; cataract

Background and Objective: The Philippines does not have a national congenital rubella syndrome (CRS) surveillance or registry. Regular monitoring of CRS cases in hospitals, including in a Philippine tertiary hospital, helped in the past to provide clinico-epidemiologic data on CRS. This study aimed to continue providing clinico-epidemiologic data on CRS cases seen in the Philippine tertiary hospital from 2009-2012 and 2019-2022 and compare the cases seen from said timelines. Methods: A cross-sectional study was used, employing chart review of patients newly diagnosed with CRS from 2009-2012 and 2019-2022 in the Department of Ophthalmology and Visual Sciences at the Philippine tertiary hospital. Results: Forty-two patients newly diagnosed with CRS from 2009-2012 and 2019-2022 were included. Only 14 (33%) were serologically-confirmed cases (albeit qualitatively). Median age (first and third interquartile ranges) at consult was 1 year (0.4, 2.5). Twenty-four (57%) patients had maternal history of rashes and/or fever. Trimester of pregnancy when mother became symptomatic was not significantly correlated with chief complaint (p=0.20) and numbers of ophthalmic (p=0.68) and systemic manifestations (p=0.32). Cataract was the most common ophthalmic manifestation present in 40 (95%) patients. Twenty-six (62%) patients had other associated systemic findings of which hearing loss was the most common. Only 29 of 40 patients with cataract underwent lensectomy, with 23 patients having poor visual prognosis prior to surgery (5 with nystagmus alone, 10 with nystagmus and strabismus, and 8 with strabismus alone). Discussion: Using ophthalmic manifestations as primary indicator, this study provided an update on the CRS cases in the country. Laboratory confirmation remains a challenge in diagnosing CRS as the tests are costly and not widely available. There was increase from 2009-2012 compared to 2019-2022 in number of patients who underwent surgical treatment for cataract but visual outcomes were suboptimal due to delay in consultation. Although there was a decrease in number of CRS cases seen in the Philippine tertiary hospital, this cannot be attributed to increased rubella-containing vaccine (RCV) coverage alone. Conclusion Provision of data from individual hospital-based studies similar to this highlights the need for a national CRS surveillance system or registry. This can better gauge the burden of CRS and identify the gap in RCV coverage.
Rubella Syndrome, Congenital ; Retinitis Pigmentosa

BACKGROUND: In Korea, there was resurgence of rubella among adolescents in 1995-6. The risk of rubella infection is higher in hospital employees than that in others because of higher chances to exposure to rubella viruses. As rubella infection during pregnancy can cause congenital rubella syndrome, special preventive measures should be taken for female employees under reproductive age in the hospital. METHODS: The subjects were 440 employees(male 100, female 340) aged from 18 to 45 years in Soonchunhyang university hospital. Rubella IgG antibody was assayed by microparticle enzyme immunoassay (MEIA). RESULTS: Among 440 subjects, the positive rate for rubella IgG antibody was 91.4% (402/440) that was 95% (95/100) in male and 90% (307/340) in female. The overall titer of the antibody was 105+/- 113IU/mL (mean+/-SD). The titer of rubella antibody was 144+/-135 IU/mL in male and 94+/-103 IU/mL in female with statistical significance (P<0.05). The titer was 152+/-142 IU/mL in doctor and 90+/- 99 IU/mL in female employee with statistical significance (P<0.05). CONCLUSION: Because 8.6% of hospital employees was susceptible to rubella, we recommended that the hospital employee should be checked for rubella antibody and be vaccinated when they are seronegative.
Adolescent ; Female ; Humans ; Immunoenzyme Techniques ; Immunoglobulin G ; Korea ; Male ; Pregnancy ; Rubella Syndrome, Congenital ; Rubella virus* ; Rubella*

Congenital rubella syndrome (CRS) cases being seen in a tertiary hospital in Baguio rose in 2020 during the COVID-19 pandemic. Its communicability presented logistical challenges to the hospital as additional contact and droplet precautions, including COVID-19 RT-PCR testing, were needed to be observed to prevent rubella transmission. The operations of the institute have also been disrupted and compromised since its space and resources were diverted to the pandemic response. A probable rubella transmission occurred when a patient with CRS was admitted for cataract surgery but was delayed due to the COVID-19 RT-PCR test requirement. Another patient admitted from the Outpatient Department on the same day developed maculopapular rashes for three days during admission but with no febrile episodes and lymphadenopathy. These cases showed how managing CRS cataracts got complicated by the current COVID-19 pandemic which resulted in the review and proposal to revise current hospital policies to minimize the exposure of vulnerable individuals and prevent future transmission.
Rubella Syndrome, Congenital ; Cataract ; COVID-19

This is a case of a four-month-old female infant who presented with clinical manifestations of congenital rubella syndrome (CRS) — bilateral cataracts, poorly-dilating pupils, microcorneas, salt and pepper retinopathies seen after cataract extractions, bilateral sensorineural hearing loss, patent ductus arteriosus, microcephaly, history of blueberry spots and low birth weight, and positive serum IgM and IgG tests for rubella. The patient’s mother also had prenatal rubella infection. However, the patient also presented with additional set of clinical findings not seen in recent patients with CRS and not commonly reported in literature: visual acuities of poor to no dazzle, bilateral choroidal thickening on ocular ultrasound that spontaneously resolved, optic nerve inflammation that became atrophic, vessel tortuosities seen after cataract extractions, bilateral subependymal cysts with lenticulostriate vasculopathy in basal ganglia, basal ganglia hyperintensity suggestive of calcification, and jaundice. These findings plus the overlapping clinical manifestations with CRS and the positive IgM and IgG for cytomegalovirus (CMV) made us consider a congenital CMV co-infection. CRS already causes significant childhood morbidity. Getting co-infected with CMV in utero worsens morbidity and makes management more difficult. This case presented a congenital co-infection of rubella and CMV and discussed the added challenges in their diagnosis and management.
Rubella Syndrome, Congenital ; Cytomegalovirus Infections ; Coinfection

Reversible splenial lesion syndrome can be caused by viral infection. Rubella generally occurs in childhood, and it is rarely accompanied by neurological complications in adulthood. A 35-year-old man visited our hospital due to conjunctival injection, mild fever, and headache 3 days after experiencing skin rash. Brain magnetic resonance imaging (MRI) revealed distinct lesions involving white matter in the splenium of the corpus callosum approximately 3 days following the onset of symptoms. Enzyme immunoassay performed on serum and CSF samples was positive for rubella virus IgM. A follow-up brain MRI was performed 24 days after the onset of symptoms, and reduced lesion size with decreased signals were observed on diffusion weighted image. This case showed that rubella infection can result in reversible splenial lesion accompanied by only mild neurological symptoms.
Rubella

BACKGROUND: The risk of rubella infection is higher among hospital employees than others because of more exposure to rubella viruses. Because rubella infection during pregnancy can cause congenital rubella syndrome, special preventive measures should be taken for female employees in the hospital. METHODS: 309 employees in Soonchunhyang Kumi Hospital, aged from 18 to 45 years old, were included this study. Rubella IgG antibody was detected by the method of MEIA (microparticle enzyme immunoassay). And non-immunized employees were received by Wister RA 27/3 rubella vaccination and rechecked rubella antibody titers at 2 months later after vaccination. RESULTS: Among 309 subjects, 276(89.3%) were positive for rubella IgG antibody. The overall mean titer of rubella antibody was 72 IU/mL (SD: 67 IU/mL). The rubella antibody in titer decreased gradually with aging. The seroconversion rate after vaccination was 100%(28/28). CONCLUSIONS: The authors recommend that the employees susceptible to rubella or all employees in the hospital should be vaccinated for preventing rubella.
Aging ; Cross Infection* ; Female ; Gyeongsangbuk-do ; Humans ; Immunoglobulin G ; Middle Aged ; Pregnancy ; Rubella Syndrome, Congenital ; Rubella Vaccine ; Rubella virus* ; Rubella* ; Vaccination*

Congenital cytomegalovirus (CMV) infection (cCMV) is challenging to differentiate from congenital rubella syndrome (CRS) clinically. Virus detection and serological tests are needed. However, they are often not readily available or are expensive. This is a case of a five-month-old male with bilateral cataracts. He was jaundiced at birth and started having seizure episodes at one month of age. He was also diagnosed with right inguinal hernia and had abnormal bilateral hearing tests. Both eyes were noted to have leukocoria at two months of age. There was dazzle on both eyes and sclerae were anicteric. Examination revealed dense cataracts on both eyes, but their ocular ultrasound results were essentially normal. Due to the bilateral hearing loss and bilateral cataracts, CRS was initially considered despite the absence of heart abnormality since there were reported CRS cases without the complete triad. However, possible coinfection or another disease was considered due to the presence of jaundice, seizures, and hernia, which were never seen in our previous CRS patients nor were reported in the literature. The patient underwent cataract extraction on both eyes without intraocular lens implantation (IOL) as recommended for CRS cataracts to prevent severe inflammation. TORCH (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) test was negative for rubella but positive for CMV. As such, the patient would have benefitted from early IOL implantation. The patient was then referred to a national medical center for possible treatment. However, since the patient already tested negative for CMV polymerase chain reaction (PCR) there, systemic antiviral therapy was no longer initiated. This case presented the challenge of clinically differentiating cCMV and CRS.
Cytomegalovirus Infections ; Rubella Syndrome, Congenital ; Hearing Loss ; Jaundice

BACKGROUND: Congenital rubella syndrome (CRS) can be controlled by vaccination. Because rubella is typically a childhood disease, occurring predominantly in the 5 to 14 year age group, female school teachers may be a high-risk population for CRS. CONCLUSIONS: To determine the prevalence rate of rubella antibodies in school teachers of child bearing age. METHODS: The study population consisted of primary, middle and high school teachers of child bearing age. The subjects were aged 35 years and younger, and consented to immunoglobulin (Ig) level testing using the ELISA method. RESULTS: The positive rate of IgG was 77.9% in the study subjects (n=314). Sixty-three teachers (21.4%) were susceptible to rubella infection. Thirty-seven teachers (11.8%) had a history of rubella vaccination. Among the female teachers with no vaccination history, the proportion of negative IgM and IgG was 21.7%, and the proportion of positive IgM was 2.9%. Seventy-nine percent of the study subjects did not know that they should not become pregnant for three months after receiving the rubella vaccine. CONCLUSION: School teachers of child bearing age should be considered a high risk group for CRS, and should be vaccinated if they are found to be seronegative.
Antibodies* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Jeju-do* ; Prevalence* ; Rubella Syndrome, Congenital ; Rubella Vaccine ; Rubella* ; Vaccination

OBJECTIVE: Rubella viral infection in pregnant women is frequently transmitted to the fetus, resulting in the fetal damage. The incidence of rubella infection has decreased due to a nation-wide rubella vaccination program, but, vulnerability to rubella infection has been detected in 10-20% by serology test. The purpose of this study is to assess the rubella specific immune status of a group of reproductive ages. METHODS: The seroprevalence of rubella was determined in the study group that consists of 430 university girl students (ages 19-23 years). Rubella specific IgG antibody titer of the girl's sera was checked by enzyme immunoassay. And we questioned about the knowledge of rubella infection and wanted age for marriage. RESULTS: According to our study, the seropositivity rate of the women was 73.0% for rubella. And mean IgG antibody titer was 67.09 +/- 57.75 IU/mL. There was no significant difference between immunized groups during highschool students and others. Nine girls had natural immunity from rubella infection and they all had positive IgG antibody titers. And there were no statistical differences of IgG positive rate according to age. CONCLUSION: With such a high susceptible density of reproductive women, vaccination against rubella should be enforced more actively in order to prevent possible outbreaks of the congenital rubella syndrome, especially in reproductive women. And education about rubella infection, immunity and pregnancy outcome after rubella infection should be enforced.
Disease Outbreaks ; Education ; Female ; Fetus ; Humans ; Immunity, Innate ; Immunoenzyme Techniques ; Immunoglobulin G ; Incidence ; Marriage ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Rubella Syndrome, Congenital ; Rubella* ; Seroepidemiologic Studies* ; Vaccination