title: Estimating the burden of rubella virus infection and congenital rubella syndrome through a rubella immunity assessment among pregnant women in the Democratic Republic of the Congo: Potential impact on vaccination policy.
abstract: Rubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo's (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC's historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country's strategy for RCV introduction.
  
  
  
  A rubella antibody seroprevalence assessment was conducted using serum collected during 2008-2009 from 1605 pregnant women aged 15-46years attending 7 antenatal care sites in 3 of DRC's provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC.
  
  
  
  Overall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p=0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p⩽0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p=0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS.
  
  
  
  In the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15years. However, approximately 10-20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9months to 14years of age as well as vaccination of women of child bearing age through routine services.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States. Electronic address: mea4@cdc.gov.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Alleman
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Hao
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Perelygina
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Icenogle
authors.affiliation: TB Modelling Group, Centre for Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Public Health England, London, United Kingdom.
authors.forename: Emilia
authors.initials: E
authors.lastname: Vynnycky
authors.affiliation: Programme National de Lutte Contre les IST/SIDA, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo.
authors.forename: Franck
authors.initials: F
authors.lastname: Fwamba
authors.affiliation: Programme National de Lutte Contre les IST/SIDA, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo.
authors.forename: Samuel
authors.initials: S
authors.lastname: Edidi
authors.affiliation: Expanded Programme on Immunization, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo.
authors.forename: Audry
authors.initials: A
authors.lastname: Mulumba
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kinshasa, The Democratic Republic of the Congo.
authors.forename: Kassim
authors.initials: K
authors.lastname: Sidibe
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Reef
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs; D008875:Middle Aged; D011247:Pregnancy; D037841:Pregnant People; D012409:Rubella / Q000453:epidemiology*; D012412:Rubella virus / Q000276:immunology*; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
keywords: Africa; Antenatal; Congenital rubella syndrome; Democratic Republic of the Congo; Pregnant women; Rubella; Rubella IgG; Rubella antibody seroprevalence; Rubella incidence; Rubella serosurvey; Rubella transmission