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Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa

Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa
Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa
Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Since vaccination at levels short of those necessary to achieve eradication may increase the average age of infection, and thus potentially the CRS burden, introduction of the vaccine has been limited to contexts where coverage is high. Recent work suggests that spatial heterogeneity in coverage should also be a focus of concern. Here, we use a detailed dataset from South Africa to explore the implications of heterogeneous vaccination for the burden of CRS, introducing realistic vaccination scenarios based on reported levels of measles vaccine coverage. Our results highlight the potential impact of country-wide reductions of incidence of rubella on the local CRS burdens in districts with small population sizes. However, simulations indicate that if rubella vaccination is introduced with coverage reflecting current estimates for measles coverage in South Africa, the burden of CRS is likely to be reduced overall over a 30 year time horizon by a factor of 3, despite the fact that this coverage is lower than the traditional 80 per cent rule of thumb for vaccine introduction, probably owing to a combination of relatively low birth and transmission rates. We conclude by discussing the likely impact of private-sector vaccination.
rubella, vaccination, spatial variation
20120756-[10pp]
Metcalf, C.J.E.
6b7f06bd-e6b4-4c9c-a3e2-027d710aff1d
Cohen, C.
820ff915-6d69-46b0-a352-4949ccdd73d7
Lessler, J.
02600458-d8b9-4f9a-96bc-f1295fc0a624
McAnerney, J.M.
43b2d4f4-fc7f-4b4a-9cdc-3484b1419e91
Ntshoe, G.M.
09089a76-cf48-4a80-a8ec-b7fd5041875e
Puren, A.
f4e68f91-a3a8-435c-b502-c24355ff8bcb
Klepac, P.
03525084-e4a1-4638-bdd2-c78e7e303d2a
Tatem, A.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Grenfell, B.T.
eba8efe9-8276-41b0-9cd2-387c19742080
Bjørnstad, O.N.
54b33371-e895-4c57-bf14-8d35803456f4
Metcalf, C.J.E.
6b7f06bd-e6b4-4c9c-a3e2-027d710aff1d
Cohen, C.
820ff915-6d69-46b0-a352-4949ccdd73d7
Lessler, J.
02600458-d8b9-4f9a-96bc-f1295fc0a624
McAnerney, J.M.
43b2d4f4-fc7f-4b4a-9cdc-3484b1419e91
Ntshoe, G.M.
09089a76-cf48-4a80-a8ec-b7fd5041875e
Puren, A.
f4e68f91-a3a8-435c-b502-c24355ff8bcb
Klepac, P.
03525084-e4a1-4638-bdd2-c78e7e303d2a
Tatem, A.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Grenfell, B.T.
eba8efe9-8276-41b0-9cd2-387c19742080
Bjørnstad, O.N.
54b33371-e895-4c57-bf14-8d35803456f4

Metcalf, C.J.E., Cohen, C., Lessler, J., McAnerney, J.M., Ntshoe, G.M., Puren, A., Klepac, P., Tatem, A., Grenfell, B.T. and Bjørnstad, O.N. (2013) Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa. Journal of the Royal Society Interface, 10 (78), 20120756-[10pp]. (doi:10.1098/?rsif.2012.0756). (PMID:23152104)

Record type: Article

Abstract

Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Since vaccination at levels short of those necessary to achieve eradication may increase the average age of infection, and thus potentially the CRS burden, introduction of the vaccine has been limited to contexts where coverage is high. Recent work suggests that spatial heterogeneity in coverage should also be a focus of concern. Here, we use a detailed dataset from South Africa to explore the implications of heterogeneous vaccination for the burden of CRS, introducing realistic vaccination scenarios based on reported levels of measles vaccine coverage. Our results highlight the potential impact of country-wide reductions of incidence of rubella on the local CRS burdens in districts with small population sizes. However, simulations indicate that if rubella vaccination is introduced with coverage reflecting current estimates for measles coverage in South Africa, the burden of CRS is likely to be reduced overall over a 30 year time horizon by a factor of 3, despite the fact that this coverage is lower than the traditional 80 per cent rule of thumb for vaccine introduction, probably owing to a combination of relatively low birth and transmission rates. We conclude by discussing the likely impact of private-sector vaccination.

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More information

e-pub ahead of print date: 14 November 2012
Published date: 6 January 2013
Keywords: rubella, vaccination, spatial variation
Organisations: Global Env Change & Earth Observation, WorldPop, PHEW – P (Population Health), Population, Health & Wellbeing (PHeW)

Identifiers

Local EPrints ID: 347373
URI: https://eprints.soton.ac.uk/id/eprint/347373
PURE UUID: 05d56821-7c98-4177-8e07-cbd91d8b5a1a
ORCID for A. Tatem: ORCID iD orcid.org/0000-0002-7270-941X

Catalogue record

Date deposited: 21 Jan 2013 12:49
Last modified: 26 Nov 2019 01:37

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Contributors

Author: C.J.E. Metcalf
Author: C. Cohen
Author: J. Lessler
Author: J.M. McAnerney
Author: G.M. Ntshoe
Author: A. Puren
Author: P. Klepac
Author: A. Tatem ORCID iD
Author: B.T. Grenfell
Author: O.N. Bjørnstad

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