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Evolution of rubella vaccine policy for the UK
1Department of Social Medicine, University of Birmingham, Edgbaston, UK.
Insights
This study models rubella vaccine strategies. Supplementing the UK
Area of Science:
- Epidemiology
- Public Health
- Vaccinology
Background:
- Review of current UK rubella vaccination strategy targeting female adolescents.
- Comparison with the North American strategy of vaccinating young children of both sexes.
- Consideration of simultaneous implementation of both strategies, focusing on supplementing the UK system with child vaccination.
Purpose of the Study:
- To develop an elaborated computer-simulation model for predicting the consequences of supplementary child vaccination in the UK.
- To overcome limitations of previous models in precision and detail.
- To compare the UK's current program with the effects of introducing supplementary child vaccination.
Main Methods:
- Development and description of an elaborated computer-simulation and mathematical model.
- The model accounts for detailed temporal changes, epidemic patterns, seasonal transmission variations, prior vaccine policies, and implementation levels.
- Comparison of predictions for the existing UK program with those incorporating supplementary child vaccination.
Main Results:
- Benefits observed with supplementary child vaccination rates exceeding 50%.
- Cost-effectiveness of supplementary child vaccination is poor.
- The model provides more precise predictions than simpler predecessors.
Conclusions:
- Supplementary child vaccination in the UK may offer benefits above 50% uptake.
- The cost-effectiveness of this supplementary strategy is questionable.
- Without a commitment to rubella eradication and compulsory vaccination, supplementary child vaccination is likely not advisable.
Abstract:
The principles of rubella vaccine strategy are reviewed against the background of the current UK programme of vaccinating female adolescents, and the contrasting North American programme of vaccinating young children of both sexes. The effects of using both systems simultaneously are then considered: in particular the question of supplementing the established UK system with child vaccination. Previous computer-simulation and mathematical models predicted the consequences of this policy change with insufficient precision, so an elaborated model is proposed, developed and described. Its special advantages over the simpler model from which it was developed are that it represents the detailed pattern of subsequent temporal change, and allows for the effects of earlier epidemic patterns, of seasonal variations in transmission rates, of earlier vaccine policies and changing levels of implementation. Predictions for the current UK programme, unchanged in principle but converging upon target uptake rates, are compared with the effects of introducing a supplementary policy of vaccinating children. Benefits accrue from supplementary child-uptakes greater than about 50%, but the cost effectiveness is poor. In the absence of a commitment to rubella eradication, and provisions for making vaccination compulsory, it should probably not be undertaken.