Scheme: University Research Fellowship
Organisation: University of Oxford
Dates: Oct 2010-Jan 2014
Summary: In Africa and other parts of the world, thousands of children may be born with Congenital Rubella Syndrome (CRS) every year. The associated disabilities, including blindness, deafness and learning disabilities, are the result of the mother contracting rubella during the early weeks of pregnancy. Although there is a cheap and effective vaccine that induces life long immunity to rubella, and its introduction could theoretically allow regional eradication of this disease, thus preventing occurrence of rubella in women during pregnancy, introduction of the vaccine has been cautious. This is because vaccination short of the eradication threshold may increase the average age of infection sufficiently to increase the burden of CRS. In the context of ongoing efforts towards measles elimination, and given the ease with which the rubella and measles vaccination can be combined, revisiting this caution is timely. One of the challenges to exploring this question is that the global burden of rubella is poorly known. I use rubella time-series from around the globe to develop a mechanistic understanding of what shapes rubella dynamics, and how this translates into CRS burden. My work has shown that the burden of CRS may be highest in remote locations in Peru; that transmission varies considerably across Mexico; and how declining birth rates have shaped the burden of CRS in Costa Rica. Building on these empirical investigations, I have developed a generic strategic framework to predict when vaccination against rubella can be most effectively introduced, taking into account current measles efforts, as well as variation in human demography, and spatial structure. In the specific case of South Africa, modelling indicates that despite spatial variability in vaccine cover and variable dynamics, predictions relative to the outcome of rubella vaccination are very positive. I am expanding this work to consider other countries that have yet to introduce the vaccine.