Congenital rubella syndrome burden in Morocco: a rapid retrospective assessment

WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding.

We undertook case finding in the two cities with Morocco's main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001.

We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1-12.7 cases per 100000 livebirths.

We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.