Rubella and Congenital Rubella Syndrome in India: A State-Level Time Series Model of Relative CRS Burden

Abstract

Measles and rubella are both acute, immunizing childhood diseases, presenting with a short-lived fever and rash. While measles cases can become serious, cases of rubella are typically mild. However, rubella infection during the first 16 weeks of pregnancy can cause fetal death or a host of severe fetal defects known as congenital rubella syndrome (CRS). The goal of rubella vaccination should therefore be to minimize the number of susceptible women of childbearing age (WCBA). However, weak vaccination efforts can actually increase these susceptibles (by reducing childhood circulation) and hence increase CRS burden. Thus, though routine rubella immunization is common globally, many countries in the developing world have yet to establish a strong enough vaccination system to support rubella immunization and avoid increasing CRS burden. This paper examines the global burden of measles and rubella, and focuses on one major contributor—India. Using Indian state-level data to parameterize a 30-year time series model, this thesis projects how the current vaccination levels will affect future CRS burden in each India state. The model found that certain states face the risk of increasing CRS burden through insufficient vaccination, while many states appear to avoid this possibility. These findings should be considered by health policy-makers, as an increased CRS burden would add a heavy cost to the Indian health system.