Unseen blindness, unheard deafness, and unrecorded death and disability: Congenital rubella in Kumasi, Ghana

Objectives: Although rubella sero-susceptibility among women of reproductive age in West Africa ravages from 10% to 30%, congenital rubella syndrome has not been reported. In Ghana, rubella immunization and serologic testing are unavailable. Our objectives were to identify congenital rubella Syndrome cases, ascertain rubella antibody sero-prevalence during pregnancy, and recommend strategies for congenital rubella syndrome surveillance. Methods: Congenital rubella syndrome cases were identified through prospective surveillance and retrospective surveys of hospital records. A rubella serosurvey of pregnant urban and rural women was performed. Results: Eighteen infants born within a 5-month period met the congenital rubella syndrome case definitions, coinciding with a 9-fold increase in presentation of infantile congenital cataract. The congenital nibella syndrome rate for this otherwise unrecorded rubella epidemic was conservatively estimated to be 0.8 per 1000 live births. A postepidemic rubella immunity rate of 92.6% was documented among 405 pregnant women; susceptibility was significantly associated with younger age (P=.000) and ethnicity (northern tribes, P=.024). Conclusions: Congenital rubella syrdrome occurs in Ghana but is not reported. Information about congenital rubella syndrome and rubella in sub-Saharan Africa is needed to evaluate inclusion of rubella vaccine in proposed measles control campaigns.