title: Inferring rubella outbreak risk from seroprevalence data in Belgium.
abstract: Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks.
authors.affiliation: Interuniversity Institute for Biostatistics and Statistical Bioinformatics, UHasselt (Hasselt University), Diepenbeek, Belgium. Electronic address: steven.abrams@uhasselt.be.
authors.forename: Steven
authors.initials: S
authors.lastname: Abrams
authors.affiliation: Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Kourkouni
authors.affiliation: Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute for Public Health, Brussels, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Sabbe
authors.affiliation: Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Interuniversity Institute for Biostatistics and Statistical Bioinformatics, UHasselt (Hasselt University), Diepenbeek, Belgium; Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium; Department of Epidemiology and Social Medicine, University of Antwerp, Wilrijk, Belgium.
authors.forename: Niel
authors.initials: N
authors.lastname: Hens
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D001530:Belgium / Q000453:epidemiology; D002648:Child; D004196:Disease Outbreaks; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018570:Risk Assessment; D012409:Rubella / Q000453:epidemiology*; D016036:Seroepidemiologic Studies; D000073887:Vaccination Coverage
chemical_list: D000914:Antibodies, Viral
keywords: Disease outbreaks; Effective reproduction number; Next-generation operator; Serology; Social contact hypothesis; Vaccines