Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling

Yue Wu, James Wood, Gulam Khandaker, Claire Waddington, Thomas Snelling

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000 live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.

    Original languageEnglish
    Pages (from-to)5636-5642
    Number of pages7
    JournalVaccine
    Volume34
    Issue number46
    DOIs
    Publication statusPublished - 4 Nov 2016

    Fingerprint

    Congenital Rubella Syndrome
    Indonesia
    Rubella
    Rubella Vaccine
    Vaccination
    vaccination
    vaccines
    Vaccines
    infants
    Disease Eradication
    Measles Vaccine
    Combined Vaccines
    Southeastern Asia
    Incidence
    Measles
    Live Birth
    dosage
    incidence
    burden of disease
    Parturition

    Cite this

    Wu, Yue ; Wood, James ; Khandaker, Gulam ; Waddington, Claire ; Snelling, Thomas. / Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling. In: Vaccine. 2016 ; Vol. 34, No. 46. pp. 5636-5642.
    @article{5073b6fac5bf47bb9a9e30189be01a9d,
    title = "Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling",
    abstract = "An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000 live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9{\%} annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8{\%} of 9-month-old infants and 80{\%} of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.",
    keywords = "Congenital rubella syndrome, Developing countries, Immunisation, Modelling, Rubella vaccine, South-East Asia",
    author = "Yue Wu and James Wood and Gulam Khandaker and Claire Waddington and Thomas Snelling",
    year = "2016",
    month = "11",
    day = "4",
    doi = "10.1016/j.vaccine.2016.09.010",
    language = "English",
    volume = "34",
    pages = "5636--5642",
    journal = "Vaccine",
    issn = "0264-410X",
    publisher = "Elsevier",
    number = "46",

    }

    Wu, Y, Wood, J, Khandaker, G, Waddington, C & Snelling, T 2016, 'Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling', Vaccine, vol. 34, no. 46, pp. 5636-5642. https://doi.org/10.1016/j.vaccine.2016.09.010

    Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling. / Wu, Yue; Wood, James; Khandaker, Gulam; Waddington, Claire; Snelling, Thomas.

    In: Vaccine, Vol. 34, No. 46, 04.11.2016, p. 5636-5642.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling

    AU - Wu, Yue

    AU - Wood, James

    AU - Khandaker, Gulam

    AU - Waddington, Claire

    AU - Snelling, Thomas

    PY - 2016/11/4

    Y1 - 2016/11/4

    N2 - An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000 live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.

    AB - An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000 live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.

    KW - Congenital rubella syndrome

    KW - Developing countries

    KW - Immunisation

    KW - Modelling

    KW - Rubella vaccine

    KW - South-East Asia

    UR - http://www.scopus.com/inward/record.url?scp=84992315744&partnerID=8YFLogxK

    U2 - 10.1016/j.vaccine.2016.09.010

    DO - 10.1016/j.vaccine.2016.09.010

    M3 - Article

    VL - 34

    SP - 5636

    EP - 5642

    JO - Vaccine

    JF - Vaccine

    SN - 0264-410X

    IS - 46

    ER -