Feasibility of measles and rubella vaccination programmes for disease elimination: a modelling study

Winter, Amy; Lambert, Brian; Klein, Daniel J.; Klepac, Petra; Papadopoulos, Timos; Truelove, Shaun; Burgess, Colleen; Santos, Heather; Knapp, Jennifer K.; Reef, Susan E.; Kayembe, Lidia; Shendale, Stephanie; Kretsinger, Katrina; Lessler, Justin; Vynnycky, Emilia; McCarthy, Kevin; Ferrari, Matthew J.; Jit, Mark

doi:10.1016/s2214-109x(22)00335-7

Cited by 23 publications

(22 citation statements)

References 26 publications

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“…In addition to being the most cost-effective, the Intensified Investment scenario is also the most likely to produce reductions in cases and deaths in countries that would achieve the threshold for elimination of measles and rubella, based on the results of the modelling 11. For measles, our previous modelling analysis found that the threshold of less than 5 cases per 1 000 000 is more likely to be reached in countries that are projected to reach high levels of coverage.…”

Section: Discussionmentioning

confidence: 99%

“…To estimate cost-effectiveness of MR vaccination, the impact of four different vaccination scenarios on measles and rubella incidence and mortality for 93 low-income and middle-income countries was calculated for the years 2018–2047, using mathematical models of measles and rubella transmission 11. It was assumed that the countries would remain in their 2018 World Bank income group12 during the period.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Levin¹,

Burgess²,

Shendale³

et al. 2023

BMJ Glob Health

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BackgroundSince 2000, the incidence of measles and rubella has declined as measles–rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country.MethodsWe used projections of impact of routine and SIAs during 2018–2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries.ResultsThe CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment.ConclusionsThe Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Levin¹,

Burgess²,

Shendale³

et al. 2023

BMJ Glob Health

Self Cite

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“…Measles and rubella have been verified as eliminated in 81 and 93 countries, respectively, as of 2020. 2,3 Given this fluid global context, Amy Winter and colleagues, in The Lancet Global Health, 4 modelled the probability of achieving measles and rubella elimination between 2018 and 2100 in 93 countries that currently bear the greatest measles and rubella burden. Five independent modelling groups collaborated on this tour-de-force effort to project the annual probability of measles and rubella elimination, conservatively defined in this report as 5 infections per million population, in each country under two different scenarios.…”

Section: Investing In Global Measles and Rubella Elimination Is Neede...mentioning

confidence: 99%

Investing in global measles and rubella elimination is needed to avert deaths and advance health equity

Raghunathan

Orenstein

2022

The Lancet Global Health

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“…This can leave countries trapped in a state of prolonged non-introduction. Furthermore, much of the analysis on RCV introduction has been at a national level, where minimum safe levels of coverage are defined for a country at large without consideration of sub-national variation in the risks of introduction [15,22]. This focus on national-level analyses can also contribute to overly conservative decision-making, whereby risks estimated at the national level preclude the potential benefit of local RCV introduction.…”

Section: Introductionmentioning

confidence: 99%

The impact of sub-national heterogeneities in demography and epidemiology on the introduction of rubella vaccination programs in Nigeria

Nakase,

Brownwright,

Okunromade

et al. 2024

Preprint

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Rubella infection during pregnancy can result in miscarriage or infants with a constellation of birth defects known as congenital rubella syndrome (CRS). When coverage is inadequate, rubella vaccination can increase CRS cases by increasing the average age of infection. Thus, the World Health Organisation recommends that countries introducing rubella vaccine be able to vaccinate at least 80% of each birth cohort. Previous studies have focused on national-level analyses and have overlooked sub-national variation in introduction risk. We characterised the sub-national heterogeneity in rubella transmission within Nigeria and modelled local rubella vaccine introduction under different scenarios to refine the set of conditions and strategies required for safe rubella vaccine use. Across Nigeria, the basic reproduction number ranged from 2.6 to 6.2. Consequently, the conditions for safe vaccination varied across states with low-risk areas requiring coverage levels well below 80%. In high-risk settings, inadequate routine coverage needed to be supplemented by campaigns that allowed for gradual improvements in vaccination coverage over time. Understanding local heterogeneities in both short-term and long-term epidemic dynamics can permit earlier nationwide introduction of rubella vaccination and identify sub-national areas suitable for program monitoring, program improvement and campaign support.

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Feasibility of measles and rubella vaccination programmes for disease elimination: a modelling study

Cited by 23 publications

References 26 publications

Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Cost-effectiveness of measles and rubella elimination in low-income and middle-income countries

Investing in global measles and rubella elimination is needed to avert deaths and advance health equity

The impact of sub-national heterogeneities in demography and epidemiology on the introduction of rubella vaccination programs in Nigeria

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