Estimating the Burden of Congenital Rubella Syndrome in Costa Rica, 1996–2001

Jiménez, Gabriela; Ávila-Agüero, María Luisa; Morice, Ana; Gutiérrez, Hazel; Soriano, Alejandra; Badilla, Xiomara; Reef, Susan E.; Castillo‐Solórzano, Carlos

doi:10.1097/01.inf.0000260000.84792.9e

Cited by 22 publications

(14 citation statements)

References 11 publications

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“…Previous reports of CRS increases in Greece and Costa Rica likely reflect this pattern [1], [2], [25], with single years where a large number of CRS cases occur, despite an overall decline in cumulative CRS burden. Policy makers should consider whether such events can be dealt with by the health system and the degree to which such events may adversely affect attitudes towards vaccination.…”

Section: Discussionmentioning

confidence: 74%

“…However, for rubella, an increase in the average age of infection may lead to an increased risk of rubella among women of child bearing age, and hence an increase in CRS. Caution in the introduction of rubella-containing vaccine is supported by observations of suspected vaccination-associated transient increases in the CRS burden in Greece and Costa Rica [1], [2].…”

Section: Introductionmentioning

confidence: 96%

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Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

Lessler

Metcalf

2013

PLoS ONE

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BackgroundDespite 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.MethodsWe 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.FindingsThe 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.ConclusionsUnder 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.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 96%

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

Lessler

Metcalf

2013

PLoS ONE

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“…For instance, sero-surveys providing cumulative incidence by age, incidence data from surveillance systems, and rates of severe outcomes (e.g., CRS, death) can all be compared with model outputs and used in fitting procedures. Data from Costa Rica indicates that large, irregular outbreaks occurred prior to eradication, with the age structure shifting upwards (Jimenez et al, 2007; Morice et al, 2003) as predicted by epidemic theory (Anderson and May, 1991; Knox, 1980). Changes in the age-profile in serology are reviewed in (Morice et al, 2005), and overall indicate an increase in the age of infection, and proportion of women of child-bearing age at risk, also seen in the incidence reports (Fig.…”

Section: Parameterizing the Modelmentioning

confidence: 87%

“…Vaccination was introduced at first at low coverage levels, and following years of low incidence, large outbreaks in older individuals occurred in 1987 and 1999. This was matched by an increase of susceptibility in older age groups (Jimenez et al, 2007) as well as an increase in CRS incidence. However, interpreting the impact of vaccination on CRS incidence in Costa Rica is complicated by the dramatic concurrent declines in the population birth rate.…”

Section: Introductionmentioning

confidence: 84%

Structured models of infectious disease: Inference with discrete data

Metcalf

Lessler

Klepac

et al. 2012

Theoretical Population Biology

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The usage of structured population models can make substantial contributions to public health, particularly for infections where clinical outcomes vary over age. There are three theoretical challenges in implementing such analyses: i) developing an appropriate framework that models both demographic and epidemiological transitions; ii) parameterizing the framework, where parameters may be based on data ranging from the biological course of infection, basic patterns of human demography, specific characteristics of population growth, and details of vaccination regimes implemented; and iii) evaluating public health strategies in the face of changing human demography. We illustrate the general approach by developing a model of rubella in Costa Rica. The demographic profile of this infection is a crucial aspect of its public health impact, and we use a transient perturbation analysis to explore the impact of changing human demography on immunization strategies implemented.

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“…However, infection early in pregnancy, particularly during the first 16 weeks of gestation can result in miscarriage, stillbirth or an infant born with Congenital Rubella Syndrome (CRS) [1][2][3][4]. The World Health Organization (WHO) estimates that around 238,000 children are born with CRS every year, the majority of whom live in developing countries [4][5][6][7][8][9]. The frequency of CRS varies in different parts of the world, depending on levels of naturally acquired immunity, overcrowding and immunization policies and practices [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Testing of IgG and IgM against Rubella Virus in School Girls and Pregnant Women in Hanoi where an Outbreak had occurred

Bang¹

2014

Virology & Mycology

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Background: Congenital Rubella Syndrome (CRS) is preventable illness but stays frequent in developing countries where rubella vaccination is not incorporated in national program of vaccination like in Vietnam actually. Aims:This study aimed at obtaining baseline information on acquired immunization status of school girls as well as the rate of susceptibility and rubella infection in pregnant women around a rubella outbreak in Hanoi, Vietnam. Population and methods:During and after the rubella outbreak in 2011, sera from 136 school girls (aged from 14 to 17 years) and 140 pregnant women in Hanoi French hospital were tested for rubella-specific IgG and for rubella-specific IgM (only in pregnant women) by the technique of Electro-Chemiluminescence Immunoassay (ECLIA) (Roche Diagnostics) with cut-off value ≥ 10 IU/mL for IgG and ≥ 0.3 IU/mL for IgM.Results: Rubella-specific IgG antibodies was positive in 125/136 (91.9%) school girls and 119/140 (85%) pregnant women, with strong-to-extreme concentration in 86/136 (63.2%) school girls versus 19/140 (13.6%) in pregnant women (p<0.002). Rubella-specific IgG was negative (susceptible to rubella infection) in 21/140 (15%) and rubella-specific IgM antibodies was positive in 27.9% (39/140) pregnant women, of whom 38 (27.1%) a co-existence of rubella-specific IgG and IgM were documented. Conclusions:This preliminary, baseline per/post epidemic information showed a high rate of acquired immunization in female adolescents but also high rate of susceptibility and very high rate of rubella infection in pregnant women, warranting further comprehensive studies to determine robust, nationwide epidemiological data prior to establishing the national program of immunization against rubella and identify appropriate methods for CRS surveillance in Vietnam.

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Estimating the Burden of Congenital Rubella Syndrome in Costa Rica, 1996–2001

Cited by 22 publications

References 11 publications

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

Structured models of infectious disease: Inference with discrete data

Testing of IgG and IgM against Rubella Virus in School Girls and Pregnant Women in Hanoi where an Outbreak had occurred

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