title: Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review.
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.
authors.affiliation: Public Health England, 61 Colindale Ave, London NW9 5EQ, United Kingdom.|London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
authors.forename: Emilia
authors.initials: E
authors.lastname: Vynnycky
authors.affiliation: Public Health England, 61 Colindale Ave, London NW9 5EQ, United Kingdom.|Aquarius Population Health, London, United Kingdom.|University of Bristol, University of Bristol, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Adams
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Cutts
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton RD., NE, Atlanta, GA 30333, United States of America.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Reef
authors.affiliation: Duke University Medical Center, Durham, NC, United States of America.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar
authors.affiliation: World Health Organization, 20 Ave Appia, 1211 Geneva 27, Switzerland.
authors.forename: Emily
authors.initials: E
authors.lastname: Simons
authors.affiliation: Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
authors.forename: Lay-Myint
authors.initials: LM
authors.lastname: Yoshida
authors.affiliation: Public Health England, 61 Colindale Ave, London NW9 5EQ, United Kingdom.|Influenza and Measles Laboratory, IOC, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: David W J
authors.initials: DW
authors.lastname: Brown
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.|University College London, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jackson
authors.affiliation: World Health Organization, 20 Ave Appia, 1211 Geneva 27, Switzerland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Strebel
authors.affiliation: World Health Organization, 20 Ave Appia, 1211 Geneva 27, Switzerland.
authors.forename: Alya J
authors.initials: AJ
authors.lastname: Dabbagh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017281:Cost of Illness; D005260:Female; D005843:Geography; D006801:Humans; D007114:Immunization; D015994:Incidence; D038622:Internationality; D050498:Live Birth; D008954:Models, Biological; D012410:Rubella Syndrome, Congenital / Q000453:epidemiology*; D016036:Seroepidemiologic Studies; D055815:Young Adult