Modelling rubella in Europe

The prevention of congenital rubella syndrome (CRS), as a complication of r ubella infection during pregnancy, is the main aim of rubella vaccination p rogrammes. However, as vaccination of infants leads to an increase in the a verage age at which those who were not immunized become infected, certain r ubella vaccination programmes can lead to an increase in the incidence of C RS. In this paper we use a mathematical model of the transmission dynamics of rubella virus to investigate the likely impact of different Vaccination policies in Europe. The model was able to capture pre-and post-vaccination patterns of infection and prevalence of serological markers under a wide va riety of scenarios, suggesting that the model structure and parameter estim ates were appropriate. Analytical and numerical results suggest that endemi c circulation of rubella is unlikely in Finland, the United Kingdom, The Ne therlands, and perhaps Denmark, provided vaccine coverage is uniform across geographical and social groups. In Italy and Germany vaccine coverage in i nfancy has not been sufficient to interrupt rubella transmission, and conti nued epidemics of CRS seem probable. It seems unlikely that the immunizatio n programmes in these countries are doing more harm than good, but this may be partly as a result of selective immunization of schoolgirls. Indeed, in both these countries, selective Vaccination of schoolgirls with inadequate vaccination histories is likely to be an important mechanism by which CRS incidence is suppressed (unlike the other countries, which have had suffici ently high infant coverage rates to withdraw this option). Reducing inequal ities in the uptake of rubella vaccine may bring greater health benefits th an increasing the mean level of coverage.