Vaccine 32 (2014) 6746–6751 Contents lists available at ScienceDirect Vaccine j o ur na l ho me page: www.elsevier.com/locate/vaccine Surveillance for congenital rubella in Australia since 1993: Cases reported between 2004 and 2013 Gulam Khandaker a,b,c,d , Yvonne Zurynski c,e , Cheryl Jones a,c,d,f,∗ a Centre for Perinatal Infection Research, The Children’s Hospital at Westmead, NSW, Australia b National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, NSW, Australia c Sydney Medical School, The University of Sydney, NSW, Australia d Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, NSW, Australia e Australian Paediatric Surveillance Unit, Sydney, NSW, Australia f The Children’s Hospital at Westmead, NSW, Australia a r t i c l e i n f o Article history: Received 4 July 2014 Received in revised form 9 October 2014 Accepted 12 October 2014 Available online 23 October 2014 Keywords: Congenital rubella syndrome Rubella Vaccination a b s t r a c t Objective: To describe the epidemiology of congenital rubella infections notified to the Australian Paedi- atric Surveillance Unit (APSU) from 2004 to 2013 and compare that with previously published APSU data for 1993–2003. Methods: Active national surveillance for congenital rubella infection has been conducted through the APSU since 1993. Monthly reporting by child health clinicians according to pre-defined case criteria trigg- ers requests for clinicians to provide de-identified clinical, epidemiological, and laboratory information. Data were extracted for cases reported between January 2004 and December 2013 and compared with previous years. Results: Five cases of confirmed congenital rubella infection were identified during the reporting period. All five infants had defects consistent with congenital rubella syndrome (CRS). Four of the infants were born in Australia during the study period, and all were born to mothers born overseas. Three of the five mothers had not had rubella vaccination, and in two vaccination status was unknown, although both were from countries without routine rubella immunization programmes. Since 1993, there have been 57 notifications of congenital rubella infection to the APSU; 40 of these infants were born between January 1993 and December 2013, of whom 34 had confirmed CRS. Conclusions: Congenital rubella infection in Australia is predominantly among children born to unim- munized immigrant mothers. Migrant women born in rubella endemic countries without routine immunization remain an important group to target for vaccination. Rubella-susceptible women, espe- cially those in the early stages of pregnancy, should also carefully consider the risks of travelling to rubella endemic countries. Crown Copyright © 2014 Published by Elsevier Ltd. All rights reserved. 1. Introduction Rubella is an acute, usually self-limiting, mild viral infection which has teratogenic potential [1]. Rubella infection during preg- nancy, especially during the first trimester, can cause congenital rubella infection that may manifest as foetal death and/or a spec- trum of birth defects known as congenital rubella syndrome (CRS). CRS manifestations include deafness, blindness, cardiac anomalies, ∗ Corresponding author at: Sydney Children’s Hospital Network (The Children’s at Westmead), Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145, Australia. Tel.: +61 2 9845 3382; fax: +61 2 9845 3389. E-mail address: cheryl.jones@health.nsw.gov.au (C. Jones). growth retardation, and neurological abnormalities (e.g. progres- sive rubella panencephalitis) [2]. Global estimates suggest that the number of infants born with CRS exceeded 110,000 in 2008 which makes rubella the leading cause of preventable congenital defects [3]. Rubella vaccination has resulted in drastic reductions in CRS in most developed countries including Australia [4,5]. The primary goal of rubella vaccination is to prevent CRS [1]. There are two common methods of using rubella-containing vaccines; immunization of adolescent girls and/or women of child- bearing age to reduce CRS burden or use of rubella-containing vaccine in the childhood immunization schedule in addition to tar- geted vaccination of susceptible individuals (males and female) in older age groups to interrupt rubella transmission, and ultimately eliminate both CRS and endemic rubella infection [1]. In Australia, http://dx.doi.org/10.1016/j.vaccine.2014.10.021 0264-410X/Crown Copyright © 2014 Published by Elsevier Ltd. All rights reserved.