Descriptive Epidemiology of Rubella in Saudi Arabia: Progress Toward the 2020 Elimination Target Open Access

Al-Alawi, Mohrah Mansi (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/7m01bm12v?locale=en
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Abstract

ABSTRACT

OBJECTIVE: Rubella is a mild disease with nonspecific symptoms; its significance owes to its adverse effects on pregnancy outcomes that can cause congenital rubella syndrome (CRS). Rubella is targeted for elimination in Saudi Arabia by 2020. The objective of this study is to determine the incidence and the distribution of rubella and CRS in Saudi Arabia over a 3-year period, 2013 - 2015.

METHODS: We conducted a secondary data analysis of a dataset obtained from the Expanded Program of the Immunization Department, which is housed within the Directorate of Infectious Diseases Control of the Saudi Ministry of Health.

RESULTS: From 2013 to 2015, a total of 3,193 cases of febrile rash illness were reported. Of those, there were 94 (2.9%) confirmed rubella cases. No confirmed CRS cases were reported. In 2013, the incidence rate for confirmed rubella cases was 0.22 per 100,000 population, which dropped to 0.07 in 2014 and 0.02 in 2015. The age distribution of confirmed cases was as follows: 5 (5.32%) were under 1 year, 40 (42.55%) were 1-4 years old, 19 (20.21%) were 5-19 years old, 22 (23.40%) were 20-34 years old and 8 (8.51 %) were 35-49 years old. The overall ratio of male to female was equal to one, and the majority of cases (73.40%) occurred among Saudi nationals. Approximately half of the cases (N=48) were not vaccinated, 29.79% had an unknown vaccination status (N=28), 8.51% had had their first MMR dose (N= 8), 1.06% had had two doses of the vaccine (N= 1), and 5.32% were below the vaccination age according to vaccination guidelines in Saudi Arabia (N=5). Interestingly, out of 94 cases of rubella, 15 were found to be positive for the measles immunoglobulin M (IgM) antibody.

CONCLUSION: The annual incidence of rubella in the Kingdom of Saudi Arabia in the last three years was very low (less than 1/100,000 population), and no cases of CRS have been reported since the implementation of CRS surveillance in 2013. Further studies to assess national immunization coverage and ongoing monitoring of seropositivity are necessary to evaluate progress toward rubella elimination in 2020.

Table of Contents

Table of Contents:

CHAPTER 1: INTRODUCTION .............................................................................................................. 1

Overview on Rubella ................................................................................................................................ 1

Problem Statement ................................................................................................................................... 3

Study Purpose and Research Questions .................................................................................................. 4

Research Significance .............................................................................................................................. 5

CHAPTER 2: LITERATURE REVIEW .................................................................................................. 6

Background on Rubella ........................................................................................................................... 6

Epidemiologic Profile of Rubella ............................................................................................................ 9

Strategies for Rubella Prevention and Elimination .............................................................................. 10

The Status of Rubella in KSA ................................................................................................................ 14

CHAPTER 3: MANUSCRIPT ................................................................................................................. 17

Abstract ................................................................................................................................................... 17

Introduction ............................................................................................................................................ 18

Methods .................................................................................................................................................. 20

Study Setting ...................................................................................................................................... 20

Data Source ........................................................................................................................................ 21

Case Definition .................................................................................................................................. 21

Study Variables ................................................................................................................................. 23

Data Management ............................................................................................................................. 23

Statistical Analysis ............................................................................................................................ 24

Ethical Considerations ...................................................................................................................... 24

Results .................................................................................................................................................... 25

Incidence Rates and the Proportion of Confirmed Rubella Cases ............................................... 25

Descriptive Epidemiology for Confirmed Rubella Cases .............................................................. 26

Descriptive Epidemiology for Febrile Rash Illness Cases ............................................................. 28

Discussion .............................................................................................................................................. 30

CHAPTER 4 - CONCLUSION AND RECOMMENDATIONS .......................................................... 36

Tables and Figures .................................................................................................................................... 39

References .................................................................................................................................................. 48

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