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

Objectives. Although rubella sero-susceptibility among women of reproductiv e age in West Africa ranges From 10% to 30%, congenital rubella syndrome ha s not been reported. In Ghana, rubella immunization and serologic testing a re unavailable. Our objectives were to identify congenital rubella syndrome cases, ascertain rubella antibody seroprevalence during pregnancy, and rec ommend strategies for congenital rubella syndrome surveillance. Methods. Congenital rubella syndrome cases were identified through prospect ive surveillance and retrospective surveys of hospital records. A rubella s erosurvey of pregnant urban and rural women was performed. Results. Eighteen infants born within a 5-month period met the congenital r ubella syndrome case definitions, coinciding with a 9-fold increase in pres entation of infantile congenital cataract. The congenital rubella syndrome rate For this otherwise unrecorded rubella epidemic was conservatively esti mated to be 0.8 per 1000 live births. A postepidemic rubella immunity rate of 92.6% was documented among 405 pregnant women; susceptibility was signif icantly associated with younger age (P = .000) and ethnicity (northern trib es, P = .024). Conclusions. Congenital rubella syndrome occurs in Ghana but is not reporte d. Information about congenital rubella syndrome and rubella in sub-Saharan Africa is needed to evaluate inclusion of rubella vaccine in proposed meas les control campaigns.