Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

Justin T Lessler, C. Jessica E Metcalf

Research output: Contribution to journalArticle

Abstract

Background:Despite a safe and effective vaccine, rubella vaccination programs with inadequate coverage can raise the average age of rubella infection; thereby increasing rubella cases among pregnant women and the resulting congenital rubella syndrome (CRS) in their newborns. The vaccination coverage necessary to reduce CRS depends on the birthrate in a country and the reproductive number, R0, a measure of how efficiently a disease transmits. While the birthrate within a country can be known with some accuracy, R0 varies between settings and can be difficult to measure. Here we aim to provide guidance on the safe introduction of rubella vaccine into countries in the face of substantial uncertainty in R0.Methods:We estimated the distribution of R0 in African countries based on the age distribution of rubella infection using Bayesian hierarchical models. We developed an age specific model of rubella transmission to predict the level of R0 that would result in an increase in CRS burden for specific birth rates and coverage levels. Combining these results, we summarize the safety of introducing rubella vaccine across demographic and coverage contexts.Findings:The median R0 of rubella in the African region is 5.2, with 90% of countries expected to have an R0 between 4.0 and 6.7. Overall, we predict that countries maintaining routine vaccination coverage of 80% or higher are can be confident in seeing a reduction in CRS over a 30 year time horizon.Conclusions:Under realistic assumptions about human contact, our results suggest that even in low birth rate settings high vaccine coverage must be maintained to avoid an increase in CRS. These results lend further support to the WHO recommendation that countries reach 80% coverage for measles vaccine before introducing rubella vaccination, and highlight the importance of maintaining high levels of vaccination coverage once the vaccine is introduced.

Original languageEnglish (US)
Article numbere67639
JournalPLoS One
Volume8
Issue number7
DOIs
StatePublished - Jul 5 2013

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Rubella Vaccine
Congenital Rubella Syndrome
Rubella
Uncertainty
uncertainty
vaccines
Vaccination
vaccination
Vaccines
Measles Vaccine
birth rate
Birth Rate
Age Distribution
pregnant women
Infection
infection
Pregnant Women
neonates
demographic statistics
Demography

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction. / Lessler, Justin T; Metcalf, C. Jessica E.

In: PLoS One, Vol. 8, No. 7, e67639, 05.07.2013.

Research output: Contribution to journalArticle

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