First cases of rubella infection during pregnancy detected by new reporting system in Italy

On 1 January 2005, rubella infection during pregnancy and congenital rubella syndrome/infection (CRS/CRI) were made statutorily notifiable in Italy, as recommended by the national plan for the elimination of measles and congenital rubella [1]. This plan set a goal in 2003, to eliminate measles and reduce the incidence of congenital rubella cases to under 1 /100 000 live births by the year 2007. In Italy, rubella has been a statutorily notifiable disease since 1970, but reporting of congenital rubella (CR) was mandatory only between 1987 and 1991 and no specific surveillance of rubella in pregnancy has ever previously been conducted. All suspected cases of rubella during pregnancy and congenital rubella must now be reported by physicians to the local health authorities. A suspected case of rubella during pregnancy can be in any woman in whom a physician suspects rubella, even if the signs and symptoms do not meet the clinical case definition (that is, acute onset of generalised maculopapular rash and arthralgia/arthritis, lymphadenopathy or conjunctivitis) [2] Between January and December 2005, nine cases of suspected rubella infection during pregnancy were reported. Follow up has so far been completed for seven of these cases, and they are described in this report. The other two cases are still being evaluated. These cases reveal that rubella during pregnancy and congenital rubella infection do occur in Italy. Only one case of congenital rubella was identified, indicating an incidence of CR well below the elimination threshold of less than 1 case per 100 000 live births, which in Italy would be equivalent to 5 CR cases. These data, however, probably represent marked underreporting. All cases were notified by the same hospital centre in Rome, and so we assume that many more unreported cases occur across Italy. This indicates a need for improved training of physicians regarding the necessity of reporting cases of suspected rubella in pregnancy and of congenital rubella.