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Comparison of Congenital Rubella Syndrome Cases at a Philippine Tertiary Hospital from 2009-2012 to 2019-2022
Melissa Anne S Gonzales1, Alvina Pauline D Santiago1, Roland Joseph D Tan1
1Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Insights
Congenital rubella syndrome (CRS) cases in the Philippines show a rise in surgical interventions for cataracts, yet suboptimal visual outcomes persist due to delayed consultations. Enhanced surveillance is crucial for understanding CRS burden and vaccination gaps.
Area of Science:
- Ophthalmology
- Pediatrics
- Public Health
Background:
- The Philippines lacks a national congenital rubella syndrome (CRS) surveillance system.
- Hospital-based monitoring has historically provided crucial clinico-epidemiologic data on CRS.
- This study updates clinico-epidemiologic data on CRS cases in a Philippine tertiary hospital.
Purpose of the Study:
- To provide updated clinico-epidemiologic data on CRS cases from 2009-2012 and 2019-2022.
- To compare CRS cases between these two time periods.
- To highlight challenges in CRS diagnosis and management in the Philippines.
Main Methods:
- A cross-sectional study design was employed.
- Chart review of patients newly diagnosed with CRS between 2009-2012 and 2019-2022.
- Data collected from the Department of Ophthalmology and Visual Sciences at a Philippine tertiary hospital.
Main Results:
- Forty-two CRS patients were included; only 33% were serologically confirmed.
- Cataract (95%) was the most common ophthalmic manifestation, and hearing loss (62%) was a frequent systemic finding.
- An increase in cataract surgeries was observed, but visual outcomes remained poor due to delayed consultations.
Conclusions:
- Ophthalmic manifestations provide key indicators for CRS surveillance in the absence of robust laboratory confirmation.
- Suboptimal visual outcomes underscore the impact of delayed consultations for CRS-related cataracts.
- The findings emphasize the urgent need for a national CRS surveillance system to assess disease burden and vaccination coverage gaps.
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.
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