Results of the rubella elimination program in Catalonia (Spain), 2002–2011

Abstract

Rubella is usually a mild disease with nonspecific symptoms, but can cause congenital rubella syndrome (CRS) when infection occurs during pregnancy. The objective of this study was to evaluate the sensitivity and positive predictive value of different data sources used for surveillance purposes in the Rubella Elimination Program of Catalonia between 2002 and 2011. The Urgent Notification to the Statutory Disease Reporting System, the Individualized Disease Reporting System, screening for other viruses included in the Measles Elimination Program, the Microbiological Reporting System and the Minimum Hospital Discharge Data were evaluated. 100 suspected cases of postnatal rubella and 6 suspected cases of CRS were detected. For postnatal rubella, Urgent Notification had the highest sensitivity (32.5%; 95%CI 18.6–49.1), followed by the Virus screening in Measles Elimination Program (25%; 95%CI 12.7-41.2). Virus screening in the Measles Elimination Program had the highest PPV (76.9%; 95%CI 46.1–94.9), followed by the Individualized Disease Reporting System (57.1%; 95%CI 28.9–82.3). For CRS cases, the Individualized Disease Reporting System had the highest sensitivity (100%, 95%CI 29.2–100) and the highest PPV (60%; 95%CI 14.7–100). Most confirmed postnatal cases (25 cases, 48.1%) were in the 25–44 y age group followed by the 15–24 y age group (11 cases, 21.2%). The highest values of sensitivity and PPV for the detection of confirmed cases corresponded to activities that were specifically introduced in the measles and rubella elimination programs.

Keywords: :

• rubella elimination
• measles elimination
• surveillance
• sensitivity
• positive predictive value
• MMR vaccination

Submitted

10/19/12

Accepted

10/29/12

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Acknowledgments

We thank Dr Fernando de Ory, Centro Nacional de Microbiología (Instituto de Salud Carlos III) for support in CRS confirmation, the physicians and microbiologists that have reported cases, the staff of the regional units of epidemiological surveillance of Public Health Agency of Catalonia and the Public Health Agency of Barcelona for their support in the epidemiological investigation of cases, and the staff of the Catalan Health Service for providing the information of the Minimum Hospital Discharge Data.

The other members of the Rubella Surveillance Working Group of Catalonia are: Miquel Alsedà, Josep Álvarez, César Arias, Antoni Artigues, Pilar Jorgina Balañà, Neus Camps, Mónica Carol, Maria Company, Nuria Follia, Pere Godoy, Conchita Izquierdo, Sofia Minguell, Ignasi Parrón, Elsa Plasencia, Ana Rodés, Ariadna Rovira, Laura Ruiz, M Rosa Sala, Roser Torra, Luis Urbiztondo (Agency of Public Health of Catalonia), Joan Caylà, Sara Lafuente, Cristina Rius, Cecilia Tortajada (Agency of Public Health of Barcelona) and Teresa Salas (Catalan Service of Health).

Funding

This study was partially supported by the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2009/ SGR 42) and CIBERESP (expedient number CB06/02/0076, Instituto de Salud Carlos III).