Rubella vaccination in India: identifying broad consequences of vaccine introduction and key knowledge gaps

A. K. WINTER, S. PRAMANIK, Justin T Lessler, M. FERRARI, B. T. GRENFELL, C. J.E. METCALF

Research output: Contribution to journalArticle

Abstract

Rubella virus infection typically presents as a mild illness in children; however, infection during pregnancy may cause the birth of an infant with congenital rubella syndrome (CRS). As of February 2017, India began introducing rubella-containing vaccine (RCV) into the public-sector childhood vaccination programme. Low-level RCV coverage among children over several years can result in an increase in CRS incidence by increasing the average age of infection without sufficiently reducing rubella incidence. We evaluated the impact of RCV introduction on CRS incidence across India's heterogeneous demographic and epidemiological contexts. We used a deterministic age-structured model that reflects Indian states’ rural and urban area-specific demography and vaccination coverage levels to simulate rubella dynamics and estimate CRS incidence with and without RCV introduction to the public sector. Our analysis suggests that current low-level private-sector vaccination has already slightly increased the burden of CRS in India. We additionally found that the effect of public-sector RCV introduction depends on the basic reproductive number, R 0, of rubella. If R 0 is five, a value empirically estimated from an array of settings, CRS incidence post-RCV introduction will likely decrease. However, if R 0 is seven or nine, some states may experience short-term or annual increases in CRS, even if a long-term total reduction in cases (30 years) is expected. Investment in population-based serological surveys and India's fever/rash surveillance system will be key to monitoring the success of the vaccination programme.

Original languageEnglish (US)
Pages (from-to)1-13
Number of pages13
JournalEpidemiology and Infection
DOIs
StateAccepted/In press - Dec 4 2017

Fingerprint

Congenital Rubella Syndrome
Rubella Vaccine
Rubella
India
Vaccination
Vaccines
Public Sector
Incidence
Demography
Rubella virus
Private Sector
Virus Diseases
Infection
Exanthema
Fever
Parturition
Pregnancy

Keywords

  • Congenital rubella syndrome
  • CRS
  • India
  • rubella
  • vaccine

ASJC Scopus subject areas

  • Epidemiology
  • Infectious Diseases

Cite this

Rubella vaccination in India : identifying broad consequences of vaccine introduction and key knowledge gaps. / WINTER, A. K.; PRAMANIK, S.; Lessler, Justin T; FERRARI, M.; GRENFELL, B. T.; METCALF, C. J.E.

In: Epidemiology and Infection, 04.12.2017, p. 1-13.

Research output: Contribution to journalArticle

WINTER, A. K. ; PRAMANIK, S. ; Lessler, Justin T ; FERRARI, M. ; GRENFELL, B. T. ; METCALF, C. J.E. / Rubella vaccination in India : identifying broad consequences of vaccine introduction and key knowledge gaps. In: Epidemiology and Infection. 2017 ; pp. 1-13.
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