International Journal of Epidemiology, Vol 28, 1176-1184, Copyright © 1999 by International Epidemiological Association
FT Cutts and E Vynnycky
BACKGROUND: As of 1997, less than one-third of developing countries
included rubella vaccine in their national immunization programme. In
countries that have achieved high coverage of measles vaccine, an ideal
opportunity exists to include control of rubella and congenital rubella
syndrome (CRS) in enhanced measles control activities. Data on the burden
of congenital rubella syndrome are important to guide rubella vaccination
policies. METHODS: We reviewed the literature to identify studies of
rubella antibody prevalence in developing countries that were conducted on
populations with no major selection bias, prior to wide-scale rubella
vaccination in the country. We used a simple catalytic model to describe
the age-specific prevalence of susceptibility to rubella virus infection in
given populations. Estimates of the incidence of infection among pregnant
women were calculated using expressions for the average prevalence of
susceptibility to infection and the incidence of infection during
gestation. To estimate the number of cases of CRS, we assumed an overall
risk of 65% after infection in the first 16 weeks of pregnancy and zero
risk thereafter. These estimates were derived for each country for which
data were available, then for each World Health Organization region,
excluding Europe. RESULTS: The estimated mean incidence of CRS per 100,000
live births was lowest in the Eastern Mediterranean region (77.4, range
0-212) and highest in the Americas (175, range 0-598). The mean of the
estimates of the total number of cases of CRS in developing countries in
1996 was approximately 110,000. The range was, however, very wide, from as
few as 14,000 to as many as 308,000 cases. CONCLUSIONS: Congenital rubella
syndrome is an under-recognized public health problem in many developing
countries. There is an urgent need for collection of appropriate data to
estimate the cost-effectiveness of a potential global rubella control
programme.
Modelling the incidence of congenital rubella syndrome in developing countries
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK. f.cutts@lshtm.ac.uk
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