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Prevalence of eye signs in congenital rubella syndrome in South India: A role for population screening
  1. P Vijayalakshmi1,
  2. T Amala Rajasundari2,
  3. Noela Marie Prasad3,
  4. S Karthik Prakash3,
  5. Kalpana Narendran4,
  6. Meenakshi Ravindran5,
  7. V R Muthukkaruppan6,
  8. Prajna Lalitha7,
  9. David W G Brown8
  1. 1
    Aravind Eye Hospital, 1, Annanagar, Madurai, India
  2. 2
    AMRF, Aravind Eye Care System, Madurai, India
  3. 3
    LAICO, Aravind Eye Care System, Madurai, India
  4. 4
    Aravind Eye Hospital, Coimbatore, India
  5. 5
    Aravind Eye Hospital, Tirunelveli, India
  6. 6
    Research & Immunology, AMRF, Madurai, India
  7. 7
    Aravind Eye Hospital, Madurai, India
  8. 8
    Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK
  1. Dr P Vijayalakshmi, Aravind Eye Hospital, 1, Annanagar, Madurai 625 020, India; p.vijayalakshmi{at}aravind.org

Abstract

Purpose: Congenital rubella syndrome (CRS) resulting from maternal rubella infection, especially in the first trimester, affects an estimated 100 000 infants each year worldwide. Immunisation has reduced its occurrence in the developed world, though it remains a problem in countries with poor immunisation coverage. This population-based study was aimed at screening children below 5 years of age for ocular signs suspicious of CRS.

Methods: Suspected CRS cases were recruited from hospital and outreach services of the Aravind Eye Care System over a 24-month period. Clinical confirmation was based on the fulfilment of the World Health Organization (WHO) definition, and laboratory confirmation was based on a positive test for IgM antibody.

Results: Children under 5 years of age (n = 51 548) with ocular complaints were screened for eye signs suspicious of CRS; CRS compatible signs were detected in 1.92% (1090) children. Of these suspects (299), 27.42% were subsequently confirmed clinically according to WHO definition, and (46) 4.2% were serologically (Laboratory) confirmed. Of all the eye signs evaluated for screening, cataracts were the most sensitive (80.43%).

Conclusions: Cataracts among children have a high sensitivity for detecting CRS in India. It is the only clinical eye finding that has a high enough sensitivity and specificity to be useful as a screening tool for CRS.

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Footnotes

  • Competing interests: None declared.

  • Funding: World Health Organization, Geneva (project V28/181/67).

  • Abbreviations:
    ACES

    Aravind Eye Care System

    CRS

    congenital rubella syndrome

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