Epidemiology, Burden, and Public Health Impact of Rubella Infection and Congenital Rubella Syndrome: A Systematic Review

Abstract

Rubella is a vaccine-preventable viral infection that remains a significant public health concern because of its association with congenital rubella syndrome (CRS), a leading cause of preventable congenital disability worldwide. This systematic review aimed to synthesize the available evidence on the epidemiology, disease burden, clinical manifestations, and public health impact of rubella infection and CRS. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A total of 293 records were identified through database searching. Following duplicate removal, screening, and eligibility assessment, 15 studies published between 2014 and 2021 met the inclusion criteria and were included in the review. Data were extracted on study characteristics, study populations, diagnostic approaches, epidemiological findings, clinical manifestations of CRS, and public health outcomes. The included studies comprised seroprevalence investigations, outbreak studies, surveillance reports, cohort studies, case series, and case reports. The evidence demonstrated ongoing rubella transmission in both endemic and outbreak settings, with susceptibility persisting among pregnant women and other vulnerable populations. School-based outbreak investigations highlighted the contribution of inadequate vaccination coverage to sustained transmission, while serological studies revealed variations in population immunity. Congenital rubella syndrome was associated with congenital heart disease, cataracts, retinopathy, hearing impairment, developmental delay, and neurodevelopmental disorders. Most of the available evidence was derived from descriptive observational studies, highlighting the need for additional large-scale epidemiological investigations. Rubella infection and CRS continue to impose substantial health and social burdens despite advances in vaccination programmes. Strengthening immunization coverage, enhancing surveillance systems, expanding laboratory diagnostic capacity, and supporting robust epidemiological research are essential for reducing disease burden and advancing rubella elimination efforts.