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

OBJECTIVE: The study determined the ocular manifestations as well as the clinico-demographic, maternal profile, and management of infants with Congenital Rubella Syndrome (CRS) seen at the Philippine Children‘s Medical Center from 2015 to 2021. MATERIALS AND METHODS: A retrospective chart review was conducted among children less than 1 year of age, born between January 1, 2015, to December 31, 2021, who met the clinical case definition of CRS. RESULTS: Among the 398 reviewed charts, 312 were suspected cases of CRS, 79 were probable, and 7 were laboratory-confirmed. Ocular conditions were found in 54 suspect cases, 14 probable cases, and 2 confirmed cases. Congenital cataract was the most common ocular manifestation in infants with CRS, and associated clinical manifestations were mainly congenital heart disease followed by microcephaly and hearing loss. CONCLUSION This study highlighted the challenge of CRS diagnosis in the country, with most cases diagnosed based on clinical manifestations and a limited number of laboratory-confirmed cases due to the expense and availability of confirmatory tests. These findings emphasize the importance of recognizing ocular manifestations as an early indicator of CRS and the need for improved surveillance and awareness of the disease to facilitate early recognition and management.
Rubella Syndrome, Congenital

OBJECTIVE: To analyze the epidemiological characteristics of measles, mumps, and rubella (MMR) between 2014 and 2021 and identify potential strategies and measures for the prevention and control of MMR in China. METHODS: Data on MMR was obtained from China's National Notifiable Disease Reporting System for the period from 2014 to 2021. Spatiotemporal distributions were analyzed using SaTScan; temporal trends were analyzed using JoinPoint; and clusters were visualized using ArcGIS. RESULTS: A total of 1,808,067 cases of MMR were reported from 2014 to 2021 in China's mainland, most of which were children and students under the age of 20. The incidence of measles declined during 2014-2021, whereas that of mumps and rubella peaked in 2019. MMR-reported cases generally peaked from March to July; however, high numbers of mumps cases were reported from September to November in 2020-2021. Measles and rubella clusters predominantly occurred in Western China, whereas clusters of mumps were generally found in the southern region. CONCLUSION The relatively heterogeneous epidemiological characteristics of MMR have highlighted the weaknesses and gaps in surveillance and timely control of MMR transmission in China's mainland. Real-time and intelligent monitoring data should be collected for evidence-based early interventions.
China/epidemiology* ; Humans ; Measles/epidemiology* ; Child ; Mumps/epidemiology* ; Adolescent ; Child, Preschool ; Rubella/epidemiology* ; Young Adult ; Infant ; Male ; Female ; Adult ; Incidence ; Middle Aged ; Measles-Mumps-Rubella Vaccine ; Infant, Newborn

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

A study was conducted on rural women of childbearing age aged 20-49 who underwent the National Free Preconception Health Examination Project (NFPHEP)in Yunnan Province from 2013 to 2019. Descriptive analysis was conducted to determine the negative rate of IgG antibodies against the rubella virus and its differences among various socio-demographic characteristics. Among the 1 511 203 study subjects, the negative rate of IgG antibodies against the rubella virus was 24.36%. Only 2.64% of the population had received rubella virus vaccine. The negative rate of IgG antibodies among rural childbearing-age women in the preconception period in Yunnan Province decreased with age and educational level (P_trend<0.001). The negative rate of IgG antibodies in ethnic minority women of childbearing age in the preconception period (25.19%) was higher than that of Han women (23.88%). Among the 22 ethnic groups with over 1 000 participants, the negative rates of IgG antibodies in women of childbearing age from the Blang (32.85%), Bouyei (31.03%), Zhuang (31.01%), and Miao (30.70%) ethnic groups were higher than those of women from other ethnic groups. Among the 16 states (cities) in Yunnan Province, the negative rate of IgG antibodies in pregnant women of childbearing age in Wenshan Zhuang and Miao Autonomous Prefecture (38.06%) and Lincang City (32.63%) was higher than that in other states (cities). The negative rate of serum IgG antibodies in women who reported having received rubella virus vaccine (18.60%) was lower than that in other non-vaccinated populations (24.52%). The proportion of rural women of childbearing age in Yunnan Province who were susceptible to the rubella virus before pregnancy was still high. It is necessary to promote rubella vaccination among people susceptible to rubella, especially pregnant women, to prevent rubella virus infection and reduce the incidence rate and disease burden of rubella people.
Pregnancy ; Female ; Humans ; Rubella virus ; Immunoglobulin G ; Ethnicity ; Minority Groups ; China ; Rubella/prevention & control* ; Antigens, Viral ; Vaccines

Objective: To understand the genotype distribution and transmission pattern of rubella virus (RuV) circulating in Yunnan Province. Methods: Throat swab samples were collected from rubella outbreaks and sporadic cases in nine prefectures/cities of Yunnan Province from 2011 to 2021. Virus isolation, amplification of target genes and sequence determination were performed on the RuV-positive samples. The genotypes and lineages of Yunnan strains were determined by comparing them with the reference strains, and further phylogenetic analysis was performed with Yunnan strains and strains circulating in other provinces of China during the same period. Results: RuV circulating in Yunnan province during 2011-2021 showed significant genetic diversity, and three lineages, 1E-L1, 2B-L1 and 1E-L2, were detected. Two lineage-switches were also identified, including the conversion of 1E-L1 to 2B-L1 between 2012 and 2013, and the replacement of 2B-L1 to 1E-L2 after 2018. The time of the switches was basically consistent with the outbreak in Yunnan province in 2012 and the time of the rubella reemergence and epidemic between 2018 and 2019. The amino acid sequence of RuV virus strains in Yunnan province was highly conserved, and no important functional regions were changed. Conclusions: The transmission pattern of RuV in Yunnan province is generally consistent with the epidemic trend of RuV in other provinces of China.
Humans ; Rubella virus/genetics* ; Phylogeny ; China/epidemiology* ; Rubella/epidemiology* ; Genotype

A study was conducted on rural women of childbearing age aged 20-49 who underwent the National Free Preconception Health Examination Project (NFPHEP)in Yunnan Province from 2013 to 2019. Descriptive analysis was conducted to determine the negative rate of IgG antibodies against the rubella virus and its differences among various socio-demographic characteristics. Among the 1 511 203 study subjects, the negative rate of IgG antibodies against the rubella virus was 24.36%. Only 2.64% of the population had received rubella virus vaccine. The negative rate of IgG antibodies among rural childbearing-age women in the preconception period in Yunnan Province decreased with age and educational level (P_trend<0.001). The negative rate of IgG antibodies in ethnic minority women of childbearing age in the preconception period (25.19%) was higher than that of Han women (23.88%). Among the 22 ethnic groups with over 1 000 participants, the negative rates of IgG antibodies in women of childbearing age from the Blang (32.85%), Bouyei (31.03%), Zhuang (31.01%), and Miao (30.70%) ethnic groups were higher than those of women from other ethnic groups. Among the 16 states (cities) in Yunnan Province, the negative rate of IgG antibodies in pregnant women of childbearing age in Wenshan Zhuang and Miao Autonomous Prefecture (38.06%) and Lincang City (32.63%) was higher than that in other states (cities). The negative rate of serum IgG antibodies in women who reported having received rubella virus vaccine (18.60%) was lower than that in other non-vaccinated populations (24.52%). The proportion of rural women of childbearing age in Yunnan Province who were susceptible to the rubella virus before pregnancy was still high. It is necessary to promote rubella vaccination among people susceptible to rubella, especially pregnant women, to prevent rubella virus infection and reduce the incidence rate and disease burden of rubella people.
Pregnancy ; Female ; Humans ; Rubella virus ; Immunoglobulin G ; Ethnicity ; Minority Groups ; China ; Rubella/prevention & control* ; Antigens, Viral ; Vaccines

Objective: To understand the genotype distribution and transmission pattern of rubella virus (RuV) circulating in Yunnan Province. Methods: Throat swab samples were collected from rubella outbreaks and sporadic cases in nine prefectures/cities of Yunnan Province from 2011 to 2021. Virus isolation, amplification of target genes and sequence determination were performed on the RuV-positive samples. The genotypes and lineages of Yunnan strains were determined by comparing them with the reference strains, and further phylogenetic analysis was performed with Yunnan strains and strains circulating in other provinces of China during the same period. Results: RuV circulating in Yunnan province during 2011-2021 showed significant genetic diversity, and three lineages, 1E-L1, 2B-L1 and 1E-L2, were detected. Two lineage-switches were also identified, including the conversion of 1E-L1 to 2B-L1 between 2012 and 2013, and the replacement of 2B-L1 to 1E-L2 after 2018. The time of the switches was basically consistent with the outbreak in Yunnan province in 2012 and the time of the rubella reemergence and epidemic between 2018 and 2019. The amino acid sequence of RuV virus strains in Yunnan province was highly conserved, and no important functional regions were changed. Conclusions: The transmission pattern of RuV in Yunnan province is generally consistent with the epidemic trend of RuV in other provinces of China.
Humans ; Rubella virus/genetics* ; Phylogeny ; China/epidemiology* ; Rubella/epidemiology* ; Genotype

Objective: To determine IgG antibody levels of measles, rubella, mumps in healthy population in Shanghai from 2010 to 2020 and analyze the trend of antibody changes in different age groups. Methods: 10 828 healthy people without measles, rubella and mumps in Shanghai were included in the study from 2010 to 2020. Serum samples were collected from 12 age groups, and the serum IgG antibody of measles, rubella and mumps were detected by ELISA. The difference of antibody positive rates and antibody levels were analyzed. Results: The median age M (Q₁, Q₃) of 10 828 objects were 8 years old (9 months old, 20 years old). Males accounted for 48.34% (5 234/10 828) and females accounted for 50.92% (5 514/10 828). Unknown gender information accounted for 0.74% (80/10 828), and 27.03% (2 927/10 828) of participants had unknown MMR immunization history. The total positive rates of measles, rubella and mumps IgG antibody were 76.78%, 64.46% and 64.29% and their GMCs were 541.45 mIU/ml, 31.76 IU/ml and 133.73 U/ml respectively. There were significant differences in serum IgG antibody GMC of measles, rubella and mumps in each year (F_measles=180.74, P<0.001; F_rubella=189.95, P<0.001; F_mumps=122.40, P<0.001). The positive rate of measles antibody was higher than that of rubella and mumps, and the difference was statistically significant (χ²=518.09, P<0.001). Conclusion: The level of measles IgG antibody in healthy people in Shanghai is higher, while the level of rubella and mumps IgG antibody is slightly lower.
Adult ; Antibodies, Viral ; Child ; China/epidemiology* ; Female ; Humans ; Immunoglobulin G ; Infant ; Male ; Measles/prevention & control* ; Measles-Mumps-Rubella Vaccine ; Mumps/prevention & control* ; Mumps virus ; Rubella/prevention & control* ; Young Adult

HPV vaccination is the most effective way for preventing the cervical cancer. To respond the WHO calling for cervical cancer elimination, some Chinese provincial governments are launching the Free HPV Vaccination Programs for teenagers. Basing on the current stage of domestic utilization and the global immunization strategies of HPV vaccination, this paper provides a comprehensive review of the key aspects in the process of HPV vaccination, including subjects and priority vaccination population, vaccination dose and time interval, the principal of vaccination replacement, and the vaccination suggestion on special populations, etc. The article above contents and gives the advice on the immunization strategy of HPV vaccination in China.
AIDS Vaccines ; Adolescent ; BCG Vaccine ; China ; Diphtheria-Tetanus-Pertussis Vaccine ; Female ; Humans ; Immunization Programs ; Influenza Vaccines ; Measles-Mumps-Rubella Vaccine ; Papillomavirus Infections/prevention & control* ; Papillomavirus Vaccines ; Respiratory Syncytial Virus Vaccines ; SAIDS Vaccines ; Uterine Cervical Neoplasms ; Vaccination