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Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.
1-11
Wesolowski, Amy
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Mensah, Keitly
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Brook, Cara E.
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Andrianjafimasy, Miora
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Winter, Amy
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Buckee, Caroline O.
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Razafindratsimandresy, Richter
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Tatem, Andrew J.
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Heraud, Jean-Michel
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Metcalf, C. Jessica E.
ce1431b5-f784-4552-b66c-52fcb08f095c
Wesolowski, Amy
343b0df8-5a2f-46e2-9f1c-001d4adf7fb1
Mensah, Keitly
425aec55-f4d7-48b3-b73c-7870a2bc55fe
Brook, Cara E.
b1f285da-1b83-4098-826f-6ccec78ad6a2
Andrianjafimasy, Miora
53a717f0-8a45-4420-aac0-ebc2beb0c23f
Winter, Amy
09b1026c-77e0-48aa-9f09-b2e92e3b8c21
Buckee, Caroline O.
f4bc891c-4f42-46a6-822d-03fc1f9cd55b
Razafindratsimandresy, Richter
d5451a72-179c-48cd-af0d-eda6efa2f4b9
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Heraud, Jean-Michel
161adf0c-d0aa-434d-805a-0e8f5ce9a743
Metcalf, C. Jessica E.
ce1431b5-f784-4552-b66c-52fcb08f095c

Wesolowski, Amy, Mensah, Keitly, Brook, Cara E., Andrianjafimasy, Miora, Winter, Amy, Buckee, Caroline O., Razafindratsimandresy, Richter, Tatem, Andrew J., Heraud, Jean-Michel and Metcalf, C. Jessica E. (2016) Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination. Journal of the Royal Society Interface, 13 (20151101), 1-11. (doi:10.1098/rsif.2015.1101). (PMID:27122178)

Record type: Article

Abstract

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

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Accepted/In Press date: 7 April 2016
e-pub ahead of print date: 27 April 2016
Organisations: Global Env Change & Earth Observation, WorldPop, Population, Health & Wellbeing (PHeW)

Identifiers

Local EPrints ID: 393669
URI: https://eprints.soton.ac.uk/id/eprint/393669
PURE UUID: 4b5d35c2-bc81-4cca-b39d-7cc02e422b76
ORCID for Andrew J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X

Catalogue record

Date deposited: 03 May 2016 08:47
Last modified: 15 Aug 2019 00:36

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Contributors

Author: Amy Wesolowski
Author: Keitly Mensah
Author: Cara E. Brook
Author: Miora Andrianjafimasy
Author: Amy Winter
Author: Caroline O. Buckee
Author: Richter Razafindratsimandresy
Author: Andrew J. Tatem ORCID iD
Author: Jean-Michel Heraud
Author: C. Jessica E. Metcalf

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