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Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding...

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Autores principales: Wesolowski, Amy, Mensah, Keitly, Brook, Cara E., Andrianjafimasy, Miora, Winter, Amy, Buckee, Caroline O., Razafindratsimandresy, Richter, Tatem, Andrew J., Heraud, Jean-Michel, Metcalf, C. Jessica E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Royal Society 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874430/
https://www.ncbi.nlm.nih.gov/pubmed/27122178
http://dx.doi.org/10.1098/rsif.2015.1101
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author Wesolowski, Amy
Mensah, Keitly
Brook, Cara E.
Andrianjafimasy, Miora
Winter, Amy
Buckee, Caroline O.
Razafindratsimandresy, Richter
Tatem, Andrew J.
Heraud, Jean-Michel
Metcalf, C. Jessica E.
author_facet Wesolowski, Amy
Mensah, Keitly
Brook, Cara E.
Andrianjafimasy, Miora
Winter, Amy
Buckee, Caroline O.
Razafindratsimandresy, Richter
Tatem, Andrew J.
Heraud, Jean-Michel
Metcalf, C. Jessica E.
author_sort Wesolowski, Amy
collection PubMed
description Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.
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spelling pubmed-48744302016-05-25 Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination Wesolowski, Amy Mensah, Keitly Brook, Cara E. Andrianjafimasy, Miora Winter, Amy Buckee, Caroline O. Razafindratsimandresy, Richter Tatem, Andrew J. Heraud, Jean-Michel Metcalf, C. Jessica E. J R Soc Interface Life Sciences–Mathematics interface Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require. The Royal Society 2016-04 /pmc/articles/PMC4874430/ /pubmed/27122178 http://dx.doi.org/10.1098/rsif.2015.1101 Text en © 2016 The Authors. http://creativecommons.org/licenses/by/4.0/ Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.
spellingShingle Life Sciences–Mathematics interface
Wesolowski, Amy
Mensah, Keitly
Brook, Cara E.
Andrianjafimasy, Miora
Winter, Amy
Buckee, Caroline O.
Razafindratsimandresy, Richter
Tatem, Andrew J.
Heraud, Jean-Michel
Metcalf, C. Jessica E.
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title_full Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title_fullStr Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title_full_unstemmed Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title_short Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
title_sort introduction of rubella-containing-vaccine to madagascar: implications for roll-out and local elimination
topic Life Sciences–Mathematics interface
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874430/
https://www.ncbi.nlm.nih.gov/pubmed/27122178
http://dx.doi.org/10.1098/rsif.2015.1101
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