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![Visualization of estimated population density in the Democratic Republic of the Congo. Data from 2020 WorldPop estimates of UN adjusted, unconstrained population counts [45].](publication/356178470/figure/fig1/AS:1098366356340737@1638882354494/Visualization-of-estimated-population-density-in-the-Democratic-Republic-of-the-Congo.png)
Visualization of estimated population density in the Democratic Republic of the Congo. Data from 2020 WorldPop estimates of UN adjusted, unconstrained population counts [45].
Source publication
Background
Rubella vaccine has yet to be introduced into the national immunization schedule of the Democratic Republic of the Congo (DRC); the current burden of congenital rubella syndrome (CRS) is unknown and likely to be high. An important consideration prior to introducing rubella containing vaccine (RCV) is the potential inverse relationship be...
Context in source publication
Context 1
... immunization activities (SIAs). Taking advantage of these efforts to introduce RCV as a combined MR vaccine may provide an opportunity for progressing towards rubella and CRS elimination [26]. Health infrastructure in the DRC has struggled with limited roads and access to electricity and water; estimated population density is depicted in Fig. 1 and illustrates the challenging environment for nationwide coordinated vaccination. Maintaining and improving rates of routine immunization for measles has been difficult [27]. As rubella and measles immunization can be easily combined, there may be opportunity to leverage ongoing measles elimination activities to support rubella ...
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Citations
... Dynamics of rubella transmission were explored using EMOD, a software tool for building stochastic, agent-based infection models [14]. Details of the rubella model have been described previously [15]. The model has been generalized by applying population and fertility estimates for sub-Saharan Africa from the United Nations World Population Prospects (WPP) [16]. ...
... This study groups those outcomes together. The likelihood of burden associated with a rubella infection was approximated as 80% if infection occurs during the first trimester of pregnancy, and 50% if infection occurs in the four weeks prior to conception or in the first four weeks of the second trimester of pregnancy [15]. ...
... Rubella infectivity is uncertain for most settings, and sub-national variation is expected for large, heterogeneous countries such as Nigeria [18] or the Democratic Republic of the Congo [15]. Neglecting demographic and connectivity effects, demonstration outcomes suggest a vaccination rate of 60% would decrease the equilibrium rate of burden for R0 = 3.0 (from 4 to 2), increase the equilibrium rate of burden for R0 = 7.0 (from 1 to 2), and not change the equilibrium rate for R0 = 5.0. ...
Rubella infection is typically mild or asymptomatic except when infection occurs during pregnancy. Infection in early pregnancy can cause miscarriage, stillbirth, or congenital rubella syndrome. Only individuals that are still susceptible to rubella infection during child-bearing age are vulnerable to this burden. Rubella containing vaccine (RCV) is safe and effective, providing life-long immunity. However, average age-at-infection increases with increasing vaccination coverage, which could potentially lead to increased disease burden as well, if the absolute risk of infection during child-bearing age increases. Dynamics of rubella transmission were explored using EMOD, a software tool for building stochastic, agent-based infection models. Simulations of pre-vaccine, endemic transmission of rubella virus introduced RCV at varying levels of coverage to determine the expected future trajectories of disease burden. Introducing RCV reduces both rubella virus transmission and disease burden for a period of around 15 years. Increased disease burden is only possible more than a decade post-introduction, and only for contexts with low current burden and high transmission intensity. Low or declining rubella virus transmission intensity is concurrently associated with both greater disease burden and greater vaccine effectiveness. The risk of increasing burden through vaccination only exists for locations with persistently high infectivity, high connectivity, and high fertility. A trade-off between the risk of a small, future burden increase and a large, immediate burden decrease strongly favors RCV introduction.
... Moreover, other studies were developed to evaluate immunization scenarios by estimating the burden of congenital rubella syndrome (CRS) incidence in specific countries, e.g., Madagascar, Vietnam, South Africa, and Dem. Republic of Congo [20][21][22][23]. Nonetheless, additional efforts are required to evaluate the potential impact of RCV introduction in Tier 1 countries, with prior efforts providing a validated modeling framework. ...
We assessed the potential impact of introducing rubella-containing vaccine (RCV) on congenital rubella syndrome (CRS) incidence in Afghanistan (AFG), Democratic Republic of Congo (COD), Ethiopia (ETH), Nigeria (NGA), and Pakistan (PAK). We simulated several RCV introduction scenarios over 30 years using a validated mathematical model. Our findings indicate that RCV introduction could avert between 86,000 and 535,000 CRS births, preventing 2.5 to 15.8 million disability-adjusted life years. AFG and PAK could reduce about 90% of CRS births by introducing RCV with current measles routine coverage and executing supplemental immunization activities (SIAs). However, COD, NGA, and ETH must increase their current routine vaccination coverage to reduce CRS incidence significantly. This study showcases the potential benefits of RCV introduction and reinforces the need for global action to strengthen immunization programs.
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