Rubella Epidemiology in Africa in the Prevaccine Era, 2002-2009

Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 07/2011; 204 Suppl 1(suppl 1):S215-25. DOI: 10.1093/infdis/jir108
Source: PubMed
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Available from: James L Goodson, Sep 13, 2014
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    • "We estimated R 0 based on the age distribution of infection using laboratory-confirmed rubella case data collected as part of WHO measles surveillance in 40 different countries in Africa from 2002– 2009 (from Table 1 in Goodson et at al. 2011 [10]). Rubella is thought to be endemic throughout Africa. "
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    ABSTRACT: Despite 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. We 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. The 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. Under 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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    ABSTRACT: Rubella viruses are single-stranded ribonucleic acid viruses, which are surrounded by a lipid-containing membrane. From the taxonomic point of view, these serologically uniform viruses belong to the family of Togaviridae, and to the genus Rubivirus. After birth, infection with rubella virus occurs through inhalation of contaminated droplets. In children infected after birth, rubella viruses usually cause uncomplicated diseases that are associated with an unspecific rash (postnatal rubella). Rubella virus infections in adults might be more severe and can be accompanied by complications such as joint pain and inflammation in the joints. Rubella virus infection during pregnancy can lead to the infection of the fetus. In the first and second trimester of pregnancy, fetal rubella infection often lead to severe abnormalities of the newborn, which are summarized as rubella embryopathy or congenital rubella syndrome. One of these disorders, the Gregg syndrome, is associated with serious damage to heart, ears and eyes of the newborn. Therefore, in suspected cases of rubella virus infection during pregnancy, or after contact of a pregnant woman with an infected person, a serological diagnosis must be performed. The diagnosis of an acute rubella virus infection usually consists of the detection of rubella-specific IgM. Critical to avoiding a rubella virus infection is the immune prophylaxis, for which a live attenuated vaccine, usually given as trivalent vaccine against measles, mumps and rubella (MMR vaccine), is available. Since the introduction of the rubella vaccination in the 1970s, in many areas of the world the number of rubella diseases has declined dramatically. Nevertheless, rubella is still widespread in some countries, and still occurs in Germany. Postnatal rubella virus infections can be treated symptomatically. A specific (antiviral) therapy is not available.
    No preview · Article · Jan 2012 · Medizinische Monatsschrift für Pharmazeuten
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    ABSTRACT: In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination.
    Full-text · Article · Apr 2012 · Vaccine
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