Early Clinical Manifestations of Congenital Rubella Syndrome in Oman, 1980-2015

Aim: Congenital rubella syndrome (CRS) is a major cause of severe birth defects worldwide. A national CRS surveillance system was established in Oman to assess the scope of the CRS problem and to detect early manifestations of CRS for planning and early intervention. Methods: Oman implemented a CRS surveillance system in 2004 that was integrated with measles and rubella case-based surveillance. National surveillance occurs through active and passive reporting from all health institutions. Surveillance guidelines were adopted, including case definitions, an algorithm, standard laboratory methods, system operations, and feedback. A systematic retrospective search was conducted to find and describe CRS cases prior to 2004. Results: The CRS surveillance system operates in all health facilities and has been integrated with the communicable diseases surveillance system. A total of 104 suspected CRS cases were reported from 1980-2015. Of those, 101 (97%) were detected through retrospective search (1980-2003) and 3 (3%) through prospective passive surveillance (2004-2015). Of the suspected cases, 61 (59%) were clinically confirmed, 23 (22%) were laboratory confirmed and 1 (1%) was classified as congenital rubella infection. Of 85 confirmed cases, 46 (54%) were located and consented to direct clinical evaluation. In 2015, the median age of this group was 17.9 years (range 8-33 years). Of these patients, 29 (63%) had ocular, 27 (59%) had auditory, 25 (54%) had neurologic, and 18 (39%) had cardiovascular manifestations of CRS; 11 (24%) had low birth weight (≤ 2.5Kg) and 3 (6%) had hepatosplenomegaly. Conclusions: Establishment of a CRS surveillance system that conducts both active and passive surveillance was important to detect and describe CRS. Early clinical manifestations of CRS in Oman included ocular, auditory, neurologic, and cardiovascular abnormalities.