title: Models of strategies for control of rubella and congenital rubella syndrome-a 40 year experience from Australia.
abstract: We investigated the impact of vaccination on rubella epidemiology in Australia, using a mathematical model fitted to Australian serosurvey data and incorporating pre-vaccination European estimates of rubella transmissibility. Mass infant measles-mumps-rubella (MMR) vaccination produced a 99% reduction in both rubella and congenital rubella syndrome (CRS) incidence by 2010 compared to the pre-vaccination era (1960-70). The model is consistent with reductions in CRS based on surveillance of congenital hearing impairment. Model simulations suggest that selective schoolgirl vaccination (1971-88) was associated with a 90% reduction in CRS incidence, but only a 1-4% reduction in rubella incidence. Our model predicted that these reductions in rubella were much less vulnerable to reductions in MMR vaccine coverage than for measles. In the future, a less than 15% decrease in MMR vaccine coverage is estimated to have minimal impact before 2060, but a 20% reduction may result in a 7-fold increase in rubella incidence, with the effective reproductive number R rising from 0.28 to 0.78 by 2060. The 99% reduction in both rubella and CRS incidence and low effective reproductive number (R≤0.28) we documented after 2010 are consistent with Australia having achieved rubella elimination.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. z.gao@unsw.edu.au
authors.forename: Zhanhai
authors.initials: Z
authors.lastname: Gao
authors.forename: James G
authors.initials: JG
authors.lastname: Wood
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Burgess
authors.forename: Robert I
authors.initials: RI
authors.lastname: Menzies
authors.forename: Peter B
authors.initials: PB
authors.lastname: McIntyre
authors.forename: C Raina
authors.initials: CR
authors.lastname: MacIntyre
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage* / Q000276:immunology; D008954:Models, Biological; D012409:Rubella / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012410:Rubella Syndrome, Congenital / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012412:Rubella virus / Q000276:immunology*
chemical_list: D022542:Measles-Mumps-Rubella Vaccine