Strengthening surveillance for congenital rubella syndrome: a retrospective health system audit and case review in Fiji and Solomon Islands — The Association Specialists
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  3. Strengthening surveillance for congenital rubella syndrome: a retrospective health system audit and case review in Fiji and Solomon Islands

Strengthening surveillance for congenital rubella syndrome: a retrospective health system audit and case review in Fiji and Solomon Islands (23906)

Ryan Noronha 1 2 , Ilisapeci Vereti 3 , Marcia Soihaka 4 , Tonia Marquardt 1 , Paddy Cashman 1 , Kerry-Ann F O’Grady 1 , Sarah Sheridan 1 , Laila Sauduadua 3 , Carol Tituliu 4 , Meru Sheel 2 5 , Guddu Kaur 2 , Kristine Macartney 1
  1. National Centre for Immunisation Research and Surveillance (NCIRS), Sydney Children's Hospitals Network, Westmead, NSW, Australia
  2. National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
  3. Ministry of Health and Medical Services, Suva, Fiji
  4. Ministry of Health and Medical Services, Honiara, Solomon Islands
  5. Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

Background

In September 2025, all 21 Pacific Island Countries and Areas (PICs) were collectively verified by the World Health Organization as having eliminated measles and rubella, culminating two decades of coordinated regional effort. Sustaining elimination requires functional congenital rubella syndrome (CRS) surveillance, which remains limited across PICs. We assessed health system capacity and retrospectively audited suspected CRS cases at tertiary referral hospitals in Fiji and Solomon Islands, to support regional verification and inform sentinel surveillance design.

Methods

A health system assessment and retrospective medical record audit (2020–2024) was conducted at the two national tertiary referral hospitals. Six clinical registers were systematically screened to identify infants who met the WHO Western Pacific Region suspect CRS case definition. Eligible charts were audited by paediatricians and classified as laboratory-confirmed, clinical, or not a case using the WHO 2022 classification flowchart. Detection rates, phenotypic distribution, and surveillance system components and gaps were summarised descriptively.

Results

Of 214 potential cases, 127 met the WHO suspect definition. No laboratory-confirmed cases were detected. Nine cases (Fiji: 5; Solomon Islands: 4) met the clinical case definition. Suspect detection exceeded the WHO benchmark of ≥1 per 10,000 live births at both sites (Fiji: 12.6; Solomon Islands: 1.6). Congenital heart disease dominated the clinical phenotype (95%); no cases were identified through auditory pathways, reflecting a structural surveillance gap. Only five of 127 suspect cases underwent rubella IgM testing.

Conclusion

Findings were consistent with sustained rubella elimination and contributed to the regional verification dossier. Sentinel CRS surveillance anchored at tertiary referral centres is feasible using existing health system infrastructure. With in-country rubella testing now established in both countries, strengthening laboratory-linked investigation, integrating disability registers, and embedding ministry-led periodic audits into routine systems will support maintenance of elimination across the Pacific.