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We systematically reviewed the literature on birth outcomes associated with CRS to estimate the duration, severity, and frequency of combinations of morbidities. We searched PubMed, the Science Citation Index, and references from relevant articles for studies in English with primary data on the frequency of CRS manifestations for \u226520 cases and identified 65 studies representing 66 study populations that met our inclusion criteria. We abstracted available data on CRS cases with one or more hearing, heart, and\/or eye defect following maternal rubella infection during the period of 0\u201320 weeks since the last menstrual period. We assessed the quality and weight of the available evidence using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Most of the evidence originates from studies in developed countries of cohorts of infants identified with CRS in the 1960s and 1970s, prior to the development of standardized definitions for CRS and widespread use of vaccine. We developed estimates of undiscounted disability\u2010adjusted life years (DALYs) lost per CRS case for countries of different income levels. The estimates ranged from approximately 19 to 39 for high\u2010income countries assuming optimal treatment and from approximately 29 to 39 DALYs lost per CRS case in low\u2010 and lower\u2010 middle\u2010income countries assuming minimal treatment, with the lower bound based on 2010 general global burden of disease disability weights and the upper bound based on 1990 age\u2010specific and treatment\u2010specific global burden of disease disability weights. Policymakers and analysts should appreciate the significant burden of disability caused by CRS as they evaluate opportunities to manage rubella.<\/jats:p>","DOI":"10.1111\/risa.12263","type":"journal-article","created":{"date-parts":[[2014,8,12]],"date-time":"2014-08-12T22:01:16Z","timestamp":1407880876000},"page":"1332-1356","source":"Crossref","is-referenced-by-count":26,"title":["Systematic Review of the Manifestations of Congenital Rubella Syndrome in Infants and Characterization of Disability\u2010Adjusted Life Years (DALYs)"],"prefix":"10.1111","volume":"36","author":[{"given":"Emily A.","family":"Simons","sequence":"first","affiliation":[{"name":"Kid Risk, Inc  Orlando FL USA"},{"name":"Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Reef","sequence":"additional","affiliation":[{"name":"Global Immunization Division Centers for Disease Control and Prevention  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis Z.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Professor Emeritus of Pediatrics Columbia University  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Global Immunization Division Centers for Disease Control and Prevention  Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly M.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Kid Risk, Inc  Orlando FL USA"},{"name":"University of Central Florida College of Medicine  Orlando FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,8,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.11.091"},{"key":"e_1_2_7_3_1","article-title":"Characterization of the risks of adverse outcomes following rubella infection in pregnancy","author":"Thompson KM","journal-title":"Risk Analysis"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_7_5_1","unstructured":"World Development Indicators 2013 2013 World Bank Washington DC"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61680-8"},{"key":"e_1_2_7_7_1","volume-title":"The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020","author":"Murray CJL","year":"1996"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(82)92677-0"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5408.536"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3181\/00379727-111-27750"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3181\/00379727-111-27749"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268812000131"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7454.1490"},{"key":"e_1_2_7_14_1","volume-title":"World Population Prospects: The 2012 Revision, CD\u2010ROM edition","year":"2013"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61899-6"},{"key":"e_1_2_7_16_1","first-page":"1","article-title":"Rubella and other virus infections during pregnancy","volume":"101","author":"Manson MML","year":"1960","journal-title":"Ministry of Health Reports on Public Health and Medical Subjects"},{"key":"e_1_2_7_17_1","first-page":"1","article-title":"Rubella during pregnancy. 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