CDC STACKS serves as an archival repository of CDC-published products including scientific findings, journal articles, guidelines, recommendations, or other public health information authored or co-authored by CDC or funded partners.
As a repository, CDC STACKS retains documents in their original published format to ensure public access to scientific information.
i
Assessing the burden of Congenital Rubella Syndrome in China and evaluating mitigation strategies: a meta-population modeling study
-
7 2021
-
-
Source: Lancet Infect Dis. 21(7):1004-1013
[PDF-1.40 MB]
Details:
-
Alternative Title:Lancet Infect Dis
-
Personal Author:
-
Description:Background:
A rubella vaccine was licensed in China in 1993 and added to the Expanded Program on Immunization in 2008, but a national cross-sectional serological survey during 2014 indicates that many adolescents remain susceptible. Maternal infections during the first trimester often cause miscarriages, stillbirths and, among livebirths, congenital rubella syndrome (CRS). We aimed to evaluate possible supplemental immunization activities (SIAs) to accelerate rubella and CRS elimination.
Methods:
We analyzed the serosurvey, rubella surveillance from 2005–16, and relevant publications. Using an age-structured population model with provincial strata, we calculated the reproduction numbers and evaluated the gradient of the effective number with respect to supplemental immunization rates. We corroborated these analytical results and estimated times-to-elimination by simulating SIAs among adolescents and young adults (ages 10–19 and 20–29 years, respectively) using a model with regional strata. And we estimated the incidence of rubella and burden of CRS by simulating transmission in a relatively small population lacking only spatial structure.
Findings:
By 2014, childhood immunization had reduced rubella’s reproduction number from 7·6 to 1·2 and SIAs among adolescents were the optimal elimination strategy. We estimate that a) less than 10% of rubella infections were reported; b) while some women with symptomatic first trimester infections may have elected to terminate their pregnancies, 700 children could have been born with CRS during 2014; and c) timely SIAs would avert outbreaks that, as susceptible adolescents reach reproductive age, could greatly increase the burden of CRS.
Interpretation:
The finding that SIAs among adolescents would most effectively reduce CRS as well as eliminate rubella is due to fewer infections than immunized people would otherwise have caused, which meta-population models with realistic mixing are uniquely capable of assessing.
Funding:
This work was supported by the World Health Organization (Cooperative Projects 090171 and 090187 to China CDC) and National Science Foundation (DMS-1022758 and DMS-1814545 to Zhilan Feng).
-
Subjects:
-
Source:
-
Pubmed ID:33515508
-
Pubmed Central ID:PMC9102636
-
Document Type:
-
Funding:
-
Place as Subject:
-
Volume:21
-
Issue:7
-
Collection(s):
-
Main Document Checksum:
-
Download URL:
-
File Type:
