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 |
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| Affiliation: | 1. Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, United States;2. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States;3. 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;4. Public Health England, London, United Kingdom;5. Programme National de Lutte Contre les IST/SIDA, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo;6. Expanded Programme on Immunization, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo;7. Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kinshasa, The Democratic Republic of the Congo;1. Children’s Environmental Health Program, Office of Environmental Health Hazard Assessment, California EPA, 1515 Clay Street, 16th Floor, Oakland, CA 94612, USA;2. Western States Pediatric Environmental Health Specialty Unit at UCSF, SFGH, Occupational Environmental Medicine, Box 0843, San Francisco, CA 94143-0843, USA;3. Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1001 I Street, Sacramento, CA 95814, USA;4. Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street, Room D3-145, New York, NY 10029-6574, USA;1. Department of Dermatology and Venereology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria;2. Centre for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University, Spitalgasse 23, A-1090 Vienna, Austria;3. Institute for Clinical Epidemiology, Anichstraße 35, A-6020 Innsbruck, Austria;4. University of California San Francisco, Mt. Zion Cancer Research Center, 2340 Sutter Street N461, San Francisco, CA, USA;5. Brigham and Women''s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur #660, 02115 Boston, MA, USA;6. Department of Pathology and Microbiology, The Rudolfstiftung Hospital, Teaching Hospital of Vienna Medical University, Juchgasse 25, A-1030 Vienna, Austria;7. Austrian National Cancer Registry, Directorate Social Statistics, Statistics Austria, Guglgasse 13, A-1110 Vienna, Austria;1. Hazardous Substances Research Branch; Superfund Research Program, National Institute for Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC;2. Chulabhorn Research Institute, Bangkok, Thailand;3. Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil;4. School of Medicine, Universidad Autonoma de San Luis Potosi, Mexico;6. Institute for Health and the Environment, University at Albany, Rensselaer, NY;5. Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland;1. Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore;2. Public Health Group, Ministry of Health, Singapore;3. Department of Pathology, Singapore General Hospital, Singapore;4. Department of Paediatric Medicine, KK Women''s and Children''s Hospital, Singapore;5. Duke-National University of Singapore Graduate Medical School, Singapore;6. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;7. Saw Swee Hock School of Public Health, National University of Singapore, Singapore |
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| Abstract: | BackgroundRubella-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.MethodsA rubella antibody seroprevalence assessment was conducted using serum collected during 2008–2009 from 1605 pregnant women aged 15–46 years 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.ResultsOverall 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.ConclusionsIn the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15 years. 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 9 months to 14 years of age as well as vaccination of women of child bearing age through routine services. |
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| Keywords: | Rubella Rubella antibody seroprevalence Rubella serosurvey Rubella IgG Rubella incidence Rubella transmission Africa Democratic Republic of the Congo Pregnant women Antenatal Congenital rubella syndrome |
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