Abstract:
Background: Rubella infections in susceptible women during early pregnancy often results in congenital rubella
syndrome (CRS). World Health Organisation (WHO) recommends that countries without vaccination programmes to
assess the burden of rubella infection and CRS. However; in many African countries there is limited data on epidemiology
of rubella infection and CRS. This review was undertaken to assess the serological markers and genotypes of
rubella virus on the African continent in order to ascertain the gap for future research.
Findings: A systematic search of original literatures from different electronic databases using search terms such
as ‘rubella’ plus individual African countries such as ‘Tanzania’, ‘Kenya’, ‘Nigeria’ etc. and different populations such as
‘children’, ‘pregnant women’ etc. in different combinations was performed. Articles from countries with rubella vaccination
programmes, outbreak data and case reports were excluded. Data were entered in a Microsoft Excel sheet
and analyzed. A total of 44 articles from 17 African countries published between 2002 and 2014 were retrieved; of
which 36 were eligible and included in this review. Of all population tested, the natural immunity of rubella was
found to range from 52.9 to 97.9 %. In these countries, the prevalence of susceptible pregnant women ranged from
2.1 to 47.1 %. Rubella natural immunity was significantly higher among pregnant women than in general population
(P < 0.001). Acute rubella infection was observed to be as low as 0.3 % among pregnant women to 45.1 % among
children. All studies did not ascertain the age-specific prevalence, thus it was difficult to calculate the rate of infection
with increase in age. Only two articles were found to report on rubella genotypes. Of 15 strains genotyped; three
rubella virus genotypes were found to circulate in four African countries.
Conclusion: Despite variations in serological assays, the seroprevalence of IgG rubella antibodies in Africa is high
with a substantial number of women of childbearing age being susceptible to rubella infection. Standardized seroepidemiological
data in various age groups as well as CRS data are important to implement cost-effective vaccination
campaigns and control strategies.
