KARACHI: Fourteen infants have been diagnosed with congenital rubella syndrome in a study being conducted at the National Institute of Child Health (NICH) in collaboration with the National Institute of Health, Islamabad and WHO, it emerged on Friday.

Experts associated with the project told Dawn that it’s the first-ever study, initiated in 2019, on this subject in Pakistan.

Rubella, or German measles, is a mild contagious viral infection that occurs most often in children and young adults. In pregnant women, the infection may cause congenital defects known as congenital rubella syndrome.

“Rubella is the leading vaccine-preventable cause of birth defects. It also results in high rate of prematurity, stillbirths, miscarriage and foetal death. This explains why it’s so important to include it in the ongoing country-wide vaccination drive along with measles,” explained Dr Jamal Raza, principal researcher of the study.

‘Make sure that women are protected from rubella before they get pregnant’

Dr Raza, who is also the executive director of government-run Sindh Institute of Child Health, said under the study blood samples from more than 500 infants (aged less than one year) suspected of having the illness had been sent to NIH from NICH — the largest public sector health facility for children in Sindh — for analysis in more than two years.

Six cases this year

“There were five positive cases of congenital rubella syndrome in 2019, three in 2020 and six this year so far. It’s still a very high number given the fact that it represents children at only one public sector healthcare facility,” he said.

About the birth defects in affected children, Dr Raza said the team was focusing only on congenital glaucoma/cataract, heart disease and deafness, though rubella congenital syndrome could cause one or multiple birth defects including small head size or microcephaly, intellectual disabilities, mental retardation, learning and development delays. According to Dr Raza, there is no cure for congenital rubella syndrome. The long-term outlook for a child born with the illness depends on the severity of birth defects and specific symptoms of the disease can be treated accordingly.

The NICH would have complete data on the illness once the study is completed in the next two years.

It is important to mention here that congenital rubella syndrome has been reported to affect an estimated 100,000 infants each year in the world, mainly in developing countries. No consolidated data exist on the prevalence of rubella infection in Pakistan.

Some local studies, however, indicate that rubella infection in females of child bearing age in Pakistan is a serious concern. For instance, a 2018 study conducted in Rawalpindi showed a high prevalence of rubella in females aged between 18 and 45.

“This is alarming as it can result in high risk of congenital rubella syndrome in newborns and foetal death. Therefore, women planning to become pregnant, who do not have natural immunity to rubella should be vaccinated at least 4 weeks prior to conception,” the study said.

In a 2019 study conducted in Lakki Marwat in Kyber Pakhtunkhwa a lot of women, particularly in the rural area, were found to have recent rubella infection, suggestive of placing many unborn babies to a high risk for acquiring congenital rubella syndrome.

These studies were published in the Journal of Islamabad Medical and Dental College and the Journal of the Pakistan Medical Association.

Life with disability

When asked how big the problem of rubella infection is among pregnant women in Pakistan, senior gynaecologist Dr Shershah Syed said: “It’s a major issue because rubella is very dangerous for a pregnant woman and her developing baby. Also, it’s important to understand that disability will have serious and long-term consequences not just on the individual himself but also on his family and society. Hence, it’s a vital family responsibility to make sure that women are protected from rubella before they get pregnant.”

Sharing observations of her clinical practice in Karachi, Dr Nusrat Shah, senior gynaecologist and Pro Vice Chancellor of Dow University of Health Sciences, said rubella infection among pregnant women was rare.

“This is because women have had it in childhood and develop natural immunity which is life-long. We routinely carry out the rubella IgG test for every pregnant woman to see her immune status and the test is positive, most of the time. This means the woman is immune either because she had childhood rubella or she has been vaccinated,” she added.

According to the experts, the initial finding of the NICH study suggests that a significant number of girls fail to get immunised against rubella that later affects them during pregnancy and the foetus.

“The government has now included vaccination against rubella in the Expanded Programme for Immunisation, raising hopes that the illness will be eliminated in the next few years in the country,” said Dr Raza.

Published in Dawn, November 27th, 2021