Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review

Emilia Vynnycky, Elisabeth J Adams, Felicity T Cutts, Susan E Reef, Ann Marie Navar, Emily Simons, Lay-Myint Yoshida, David W J Brown, Charlotte Jackson, Peter M Strebel, Alya J Dabbagh, Emilia Vynnycky, Elisabeth J Adams, Felicity T Cutts, Susan E Reef, Ann Marie Navar, Emily Simons, Lay-Myint Yoshida, David W J Brown, Charlotte Jackson, Peter M Strebel, Alya J Dabbagh

Abstract

Background: The burden of Congenital Rubella Syndrome (CRS) is typically underestimated in routine surveillance. Updated estimates are needed following the recent WHO position paper on rubella and recent GAVI initiatives, funding rubella vaccination in eligible countries. Previous estimates considered the year 1996 and only 78 (developing) countries.

Methods: We reviewed the literature to identify rubella seroprevalence studies conducted before countries introduced rubella-containing vaccination (RCV). These data and the estimated vaccination coverage in the routine schedule and mass campaigns were incorporated in mathematical models to estimate the CRS incidence in 1996 and 2000-2010 for each country, region and globally.

Results: The estimated CRS decreased in the three regions (Americas, Europe and Eastern Mediterranean) which had introduced widespread RCV by 2010, reaching <2 per 100,000 live births (the Americas and Europe) and 25 (95% CI 4-61) per 100,000 live births (the Eastern Mediterranean). The estimated incidence in 2010 ranged from 90 (95% CI: 46-195) in the Western Pacific, excluding China, to 116 (95% CI: 56-235) and 121 (95% CI: 31-238) per 100,000 live births in Africa and SE Asia respectively. Highest numbers of cases were predicted in Africa (39,000, 95% CI: 18,000-80,000) and SE Asia (49,000, 95% CI: 11,000-97,000). In 2010, 105,000 (95% CI: 54,000-158,000) CRS cases were estimated globally, compared to 119,000 (95% CI: 72,000-169,000) in 1996.

Conclusions: Whilst falling dramatically in the Americas, Europe and the Eastern Mediterranean after vaccination, the estimated CRS incidence remains high elsewhere. Well-conducted seroprevalence studies can help to improve the reliability of these estimates and monitor the impact of rubella vaccination.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Results of the literature search…
Fig 1. Results of the literature search for age-specific serological data collected before the introduction of rubella vaccination.
Fig 2. Examples of the fit of…
Fig 2. Examples of the fit of catalytic models to the data sets.
Comparison between model predictions of the percentage susceptible and the percentage seronegative to rubella obtained using the four types of catalytic model (denoted by the lines labelled A, B, C and D), and that observed in various settings. The crosses show the observed percentage seronegative together with 95% (exact) confidence intervals.
Fig 3. Estimates of the number of…
Fig 3. Estimates of the number of CRS cases per 100,000 live births among women aged 15–44 years obtained using datasets from countries in which RCV had not been introduced at the time of collection.
The red bars reflect countries which had not introduced RCV by 2010; the white bars indicate countries which had introduced RCV by 2010. The estimates have been weighted by the number of live births in the corresponding country in 2010. Labels on the x-axis denote the year of data collection; uncertain dates of collection are indicated using a question mark. The countries are grouped by WHO regions (AFRO = African, EMRO = Eastern Mediterranean, SEARO = South East Asian, WPRO = Western Pacific).
Fig 4. Estimates of the median incidence…
Fig 4. Estimates of the median incidence of CRS per 100,000 live births by country in 2010.
Fig 5. Estimates of the median numbers…
Fig 5. Estimates of the median numbers of CRS cases born by country in 2010.

References

    1. Cutts FT, Vynnycky E. Modelling the incidence of congenital rubella syndrome in developing countries. Int J Epidemiol. 1999;28(6):1176–84.
    1. Robertson SE, Cutts FT, Samuel R, Diaz-Ortega JL. Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella. Bull World Health Organ. 1997;75(1):69–80.
    1. Reef SE, Strebel P, Dabbagh A, Gacic-Dobo M, Cochi S. Progress toward control of rubella and prevention of congenital rubella syndrome—worldwide, 2009. J Infect Dis. 2011;204 Suppl 1:S24–7. 10.1093/infdis/jir155
    1. World Health Organization; Global measles and rubella strategic plan: 2012–2020. Geneva: World Health Organization; 2012.
    1. Toda K, Reef S, Tsuruoka M, Iijima M, Huyen DT, Hong DT, et al. Congenital Rubella Syndrome (CRS) in Vietnam 2011–2012. CRS epidemic after rubella epidemic in 2010–2011 Vaccine. 2015;33(31):5.
    1. Miyakawa M, Yoshino H, Yoshida LM, Vynnycky E, Motomura H, Tho le H, et al. Seroprevalence of rubella in the cord blood of pregnant women and congenital rubella incidence in Nha Trang, Vietnam. Vaccine. 2014;32(10):1192–8. 10.1016/j.vaccine.2013.08.076
    1. WHO-UNICEF estimates of MCV coverage [cited 2012 2nd August 2012]. Available from: .
    1. WHO Publication. Rubella vaccines: WHO position paper—recommendations. Vaccine. 2011;29(48):8767–8. 10.1016/j.vaccine.2011.08.061
    1. GAVI. Rubella vaccine support 2012 [cited 2012 30-11-12]. Available from: .
    1. Brown DWJ, Cutts FT, Joseph A. An evaluation of complementary epidemiological methods in a defined population in Southern India for estimating the burden of Congenital Rubella Syndrome. 2004.
    1. Cumberland P, Shulman CE, Maple PA, Bulmer JN, Dorman EK, Kawuondo K, et al. Maternal HIV infection and placental malaria reduce transplacental antibody transfer and tetanus antibody levels in newborns in Kenya. J Infect Dis. 2007;196(4):550–7.
    1. UN Statistics Division, United Nations Population Division,. World Population Prospects. 2008.
    1. Burton A, Monasch R, Lautenbach B, Gacic-Dobo M, Neill M, Karimov R, et al. WHO and UNICEF estimates of national infant immunization coverage: methods and processes. Bull World Health Organ. 2009;87(7):535–41.
    1. World Health Organization. WHO/IVB database.
    1. World Health Organization. WHO SIA database.
    1. Muench H. Catalytic models in epidemiology Cambridge MA: Harvard University Press; 1959.
    1. Press WH. Numerical recipes in C: the art of scientific computing. 2nd ed. ed: Cambridge University Press; 1992.
    1. Shkedy Z, Aerts M, Molenberghs G, Beutels P, Van Damme P. Modelling age-dependent force of infection from prevalence data using fractional polynomials. Stat Med. 2006;25(9):1577–91.
    1. Burnham KP, Anderson DR. Model Selection and Multimodel Inference A Practical Information-Theoretic Approach. 2nd ed: Springer Verlag; 2002.
    1. Ghidini A, Lynch L. Prenatal diagnosis and significance of fetal infections. West J Med. 1993;159(3):366–73.
    1. De Santis M, Cavaliere AF, Straface G, Caruso A. Rubella infection in pregnancy. Reprod Toxicol. 2006;21(4):390–8.
    1. Harvard university, Institute for Health Metrics and evaluation at the university of Washington, Johns Hopkins university, University of Queensland, World Health Organization,. GBD study operations manual. Harvard university, 2009 January 20, 2009. Report No.
    1. Vynnycky E, Gay NJ, Cutts FT. The predicted impact of private sector MMR vaccination on the burden of Congenital Rubella Syndrome. Vaccine. 2003;21(21–22):2708–19.
    1. Mossong J, Hens N, Jit M, Beutels P, Auranen K, Mikolajczyk R, et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med. 2008;5(3):e74 10.1371/journal.pmed.0050074
    1. Develoux M, Pecarrere JL, Ahounou R, Tinni A. [Anti-rubella antibodies in pregnant women in Niamey (Niger)]. Bulletin de la Societe de pathologie exotique (1990). 1991;84(5 Pt 5):509–12.
    1. Ouattara SA, Brettes JP, Aron Y, Akran V, Meite M, Sanogo I, et al. [Rubella in pregnant women in Abidjan (Ivory Coast)]. Bulletin de la Societe de pathologie exotique et de ses filiales. 1987;80(2):149–54.
    1. Wannian S. Rubella in the People's Republic of China. Reviews of Infectious Diseases. 1985;7(Supp 1):S72.
    1. Metcalf CJ, Lessler J, Klepac P, Cutts F, Grenfell BT. Impact of birth rate, seasonality and transmission rate on minimum levels of coverage needed for rubella vaccination. Epidemiol Infect. 2012;140(12):2290–301. 10.1017/S0950268812000131
    1. Cutts FT, Metcalf CJ, Lessler J, Grenfell BT. Rubella vaccination: must not be business as usual. Lancet. 2012;380(9838):217–8. 10.1016/S0140-6736(12)61215-X
    1. World Health Organization. Protecting children against measles and rubella in Nepal 2012 [30/11/12]. Available from: .
    1. Castillo-Solorzano C, Marsigli C, Bravo-Alcantara P, Flannery B, Ruiz Matus C, Tambini G, et al. Elimination of rubella and congenital rubella syndrome in the Americas. J Infect Dis. 2011;204 Suppl 2:S571–8. 10.1093/infdis/jir472
    1. Muscat M, Zimmerman L, Bacci S, Bang H, Glismann S, Molbak K, et al. Toward rubella elimination in Europe: an epidemiological assessment. Vaccine. 2012;30(11):1999–2007. 10.1016/j.vaccine.2011.12.016
    1. Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increase in congenital rubella occurrence after immunisation in Greece: retrospective survey and systematic review. BMJ. 1999;319(7223):1462–7.
    1. Metcalf CJ, Munayco CV, Chowell G, Grenfell BT, Bjornstad ON. Rubella metapopulation dynamics and importance of spatial coupling to the risk of congenital rubella syndrome in Peru. J R Soc Interface. 2011;8(56):369–76. 10.1098/rsif.2010.0320
    1. Cheffins T, Chan A, Keane RJ, Haan EA, Hall R. The impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. Br J Obstet Gynaecol. 1998;105(9):998–1004.
    1. Malakmadze N, Zimmerman LA, Uzicanin A, Shteinke L, Caceres VM, Kasymbekova K, et al. Development of a rubella vaccination strategy: contribution of a rubella susceptibility study of women of childbearing age in Kyrgyzstan, 2001. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2004;38(12):1780–3.
    1. Mou J, Griffiths SM, Fong HF, Hu Q, Xie X, He Y, et al. Seroprevalence of rubella in female migrant factory workers in Shenzhen, China. Vaccine. 2010;28(50):7844–51. 10.1016/j.vaccine.2010.09.082
    1. Robertson SE, Featherstone DA, Gacic-Dobo M, Hersh BS. Rubella and congenital rubella syndrome: global update. Rev Panam Salud Publica. 2003;14(5):306–15.
    1. Zimmerman LA, Muscat M, Jankovic D, Goel A, Bang H, Khetsuriani N, et al. Status of rubella and congenital rubella syndrome surveillance, 2005–2009, the World Health Organization European Region. J Infect Dis. 2011;204 Suppl 1:S381–8. 10.1093/infdis/jir104
    1. Nessa A, Islam MN, Tabassum S, Munshi SU, Ahmed M, Karim R. Seroprevalence of rubella among urban and rural Bangladeshi women emphasises the need for rubella vaccination of pre-pubertal girls. Indian journal of medical microbiology. 2008;26(1):94–5.
    1. Cutts FT, Abebe A, Messele T, Dejene A, Enquselassie F, Nigatu W, et al. Sero-epidemiology of rubella in the urban population of Addis Ababa, Ethiopia. Epidemiol Infect. 2000;124(3):467–79.
    1. Bukbuk DN, el Nafaty AU, Obed JY. Prevalence of rubella-specific IgG antibody in non-immunized pregnant women in Maiduguri, north eastern Nigeria. Central European journal of public health. 2002;10(1–2):21–3.
    1. Strauss J, Dobahi SS, Danes L, Kopecky K, Svandova E. Serological survey of rubella in Yemen in 1985. Journal of hygiene, epidemiology, microbiology, and immunology. 1989;33(2):163–7.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit