Polio eradication in Africa: overcoming the final hurdles

Introduction: rubella infection in the first trimester of pregnancy can cause fetal organ damage and manifest as congenital rubella syndrome (CRS) in live-born babies. Global estimates indicate that 25,000 cases of CRS occur annually in the WHO African Region, most of whom occur in countries that do not provide rubella vaccination in their immunization programs. Ethiopia has documented widespread rubella infection through the measles-rubella case-based surveillance system, and has not yet introduced rubella vaccine. Methods: a retrospective records review was conducted in four selected tertiary referral hospitals in Ethiopia covering medical records from January 2015 to December 2024, in various clinics likely to identify and characterize CRS cases. Results: the hospital-based retrospective record review identified 1213 suspected cases of congenital rubella syndrome, of which 378 were confirmed by clinical compatibility and 3 by serological laboratory testing. Most of these confirmed cases were identified from clinical records in the years 2021-2024. Congenital heart disease (96%), Hepatomegaly (53%), hepatosplenomegaly (20%) as well as ocular manifestations (16%) were the most common signs among the confirmed CRS cases. Conclusion: this retrospective review has documented the occurrence of CRS in Ethiopia. As Ethiopia prepares to introduce rubella containing vaccine in the next few years, it will be important to strengthen measles-rubella surveillance, utilize the national measles-rubella laboratory for serological confirmation of suspected CRS cases and for genotyping of rubella viruses, and possibly establish sentinel surveillance sites that can help monitor the CRS trends. These measures will be critical to measure the impact of vaccine introduction in the long term.