Accelerating measles and rubella elimination through research and innovation - Findings from the Measles & Rubella Initiative research prioritization process, 2016.

The Measles & Rubella Initiative (M&RI) identified five key strategies to achieve measles and rubella elimination, including research and innovation to support cost-effective operations and improve vaccination and diagnostic tools. In 2016, the M&RI Research and Innovation Working Group (R&IWG) completed a research prioritization process to identify key research questions and update the global research agenda. The R&IWG reviewed meeting reports and strategic planning documents and solicited programmatic inputs from vaccination experts at the program operational level through a web survey, to identify previous research priorities and new research questions. The R&IWG then convened a meeting of experts to prioritize the identified research questions in four strategic areas: (1) epidemiology and economics, (2) surveillance and laboratory, (3) immunization strategies, and (4) demand creation and communications. The experts identified 19 priority research questions in the four strategic areas to address key areas of work necessary to further progress toward elimination. Future commitments from partners will be needed to develop a platform for improved coordination with adequate and predictable resources for research implementation and innovation to address these identified priorities.

Reconstructing the transmission dynamics of rubella in Japan, 2012-2013.

BACKGROUND: Japan experienced a nationwide rubella epidemic from 2012 to 2013, mostly in urban prefectures with large population sizes. The present study aimed to capture the spatiotemporal patterns of rubella using a parsimonious metapopulation epidemic model and examine the potential usefulness of spatial vaccination. METHODOLOGY/PRINCIPAL FINDINGS: A metapopulation epidemic model in discrete time and space was devised and applied to rubella notification data from 2012 to 2013. Employing a piecewise constant model for the linear growth rate in six different time periods, and using the particle Markov chain Monte Carlo method, the effective reproduction numbers were estimated at 1.37 (95% CrI: 1.12, 1.77) and 1.37 (95% CrI: 1.24, 1.48) in Tokyo and Osaka groups, respectively, during the growing phase of the epidemic in 2013. The rubella epidemic in 2012 involved substantial uncertainties in its parameter estimates and forecasts. We examined multiple scenarios of spatial vaccination with coverages of 1%, 3% and 5% for all of Japan to be distributed in different combinations of prefectures. Scenarios indicated that vaccinating the top six populous urban prefectures (i.e., Tokyo, Kanagawa, Osaka, Aichi, Saitama and Chiba) could potentially be more effective than random allocation. However, greater uncertainty was introduced by stochasticity and initial conditions such as the number of infectious individuals and the fraction of susceptibles. CONCLUSIONS: While the forecast in 2012 was accompanied by broad uncertainties, a narrower uncertainty bound of parameters and reliable forecast were achieved during the greater rubella epidemic in 2013. By better capturing the underlying epidemic dynamics, spatial vaccination could substantially outperform the random vaccination.

Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases.

Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccines formulations and immunization schedules. With endemic measles and rubella transmission interrupted in the region of the Americas, all five other regions of the World Health Organization (WHO) targeting the elimination of measles transmission by 2020, and increasing adoption of rubella vaccine globally, integrated dynamic disease, risk, decision, and economic models can help national, regional, and global health leaders manage measles and rubella population immunity. Despite hundreds of publications describing models for measles or rubella and decades of use of vaccines that contain both antigens (e.g., measles, mumps, and rubella vaccine or MMR), no transmission models for measles and rubella exist to support global policy analyses. We describe the development of a dynamic disease model for measles and rubella transmission, which we apply to 180 WHO member states and three other areas (Puerto Rico, Hong Kong, and Macao) representing >99.5% of the global population in 2013. The model accounts for seasonality, age-heterogeneous mixing, and the potential existence of preferentially mixing undervaccinated subpopulations, which create heterogeneity in immunization coverage that impacts transmission. Using our transmission model with the best available information about routine, supplemental, and outbreak response immunization, we characterize the complex transmission dynamics for measles and rubella historically to compare the results with available incidence and serological data. We show the results from several countries that represent diverse epidemiological situations to demonstrate the performance of the model. The model suggests relatively high measles and rubella control costs of approximately $3 billion annually for vaccination based on 2013 estimates, but still leads to approximately 17 million disability-adjusted life years lost with associated costs for treatment, home care, and productivity loss costs of approximately $4, $3, and $47 billion annually, respectively. Combined with vaccination and other financial cost estimates, our estimates imply that the eradication of measles and rubella could save at least $10 billion per year, even without considering the benefits of preventing lost productivity and potential savings from reductions in vaccination. The model should provide a useful tool for exploring the health and economic outcomes of prospective opportunities to manage measles and rubella. Improving the quality of data available to support decision making and modeling should represent a priority as countries work toward measles and rubella goals.

Insights from epidemiological game theory into gender-specific vaccination against rubella.

Rubella is a highly contagious childhood disease that causes relatively mild symptoms. However, rubella can result in severe congenital defects, known as congenital rubella syndrome (CRS), if transmitted from a mother to a fetus. Consequently, women have higher incentive to vaccinate against rubella than men do. Within the population vaccination reduces transmission but also increases the average age of infection and possibly the risk of CRS among unvaccinated females. To evaluate how the balance among these factors results in optimal coverage of vaccination, we developed a game theoretic age-structured epidemiological model of rubella transmission and vaccination. We found that high levels of vaccination for both genders are most effective in maximizing average utility across the population by decreasing the risk of CRS and reducing transmission of rubella. By contrast, the demands for vaccines driven by self-interest among males and females are 0% and 100% acceptance, respectively, if the cost of vaccination is relatively low. Our results suggest that the rubella vaccination by males that is likely to be achieved on voluntary basis without additional incentives would have been far lower than the population optimum, if rubella vaccine were offered separately instead of combined with measles and mumps vaccination as the MMR vaccine.

Rubéola: risco que as gestantes não precisam correr / Viva Legal

Explica o que é a rubéola, a maneira como é transmitida, seus sintomas e a forma de evitá-la. Fala sobre a vacina contra essa doença e a idade ideal para se vacinar a criança. Mostra o porquê a rubéola é tão perigosa para as gestantes e os cuidados necessários que ela deve ter para não contrair essa doença que pode trazer conseqüências graves na gestação e na formação do feto

[Child and adolescent hepatitis B vaccination--responsibilities of the public health service]. / Die Hepatitis-B-Kinder- und Jugendimpfung-Aufgaben des OGD.

In Oct. 1995, the National Committee for Immunisation at the Robert Koch-Institute recommended general hepatitis B vaccination for all infants as well as adolescents between 13 to 15 years of age. With an incidence of 50,000 cases per year, hepatitis B (HB) is the most common vaccine-preventable disease in Germany. Sexual contacts are the primary means of transmission of HB. Because of this fact, young adolescents are an important target group for a national HB vaccination programme. Having only few contacts to physicians in private clinics, these adolescents may accept this vaccination after intelligent and long-term health-campaigns. In the present situation, we are running out of time. To reach all targeted adolescents, we need activities by public-health offices having regular contacts with school classes only when immunizing all girls against rubella at the age of 11 to 15. This provides an ideal opportunity to immunise against HB as well. Substantial support seems possible if HB is clearly recognized as a serious emerging infectious disease in Germany.

The concept of herd immunity and the design of community-based immunization programmes.

The paper focuses on the concepts of transmission success and herd immunity and their relevance to the design of community-based immunization programmes for the control of infectious diseases. Recent work in a number of areas is reviewed, including the influence of mass vaccination on the average age of infection and the incidence of morbidity due to infection and vaccination, the age window of susceptibility and the problems of vaccine programme design in developing countries, the interaction between vaccine efficacy and vaccine safety and the design of vaccination programmes for the control of sexually transmitted infections. Discussions centre on the interplay between an understanding of the transmission dynamics of an infection and the design of community-based control programmes.