UCLA

Rubella is an acute, usually mild infectious disease characterized by a distinctive red rash. One of the major concerns with rubella is when a susceptible pregnant woman contracts the disease, and the rubella virus infects the placenta and fetus, leading to a range of birth defects known as congenital rubella syndrome (CRS). Despite the availability of a safe and effective vaccine, rubella continues to be a leading cause of vaccine-preventable birth defects. In the Democratic Republic of Congo (DRC), rubella vaccines are not yet available, and as documentation on rubella and CRS has been limited, the burden of infection among adults is unknown. The primary concern with introducing rubella vaccination is the potential for an increase in CRS incidence as a result of low vaccine coverage, due to the increase in the average age of infection. This dissertation aims to provide a backbone for introducing rubella vaccination in the DRC by assessing the prevalence and predictors of rubella antibody seropositivity, evaluating the impact of vaccination on rubella and CRS burden, and comparing the cost-effectiveness of different vaccination scenarios. In the first study, we assess rubella antibody seroprevalence in adults using serology collected through dried blood spots. We found that rubella seroprevalence is high among adults in the DRC, and a significant proportion of individuals remain susceptible to infection at the beginning of adulthood, including women entering reproductive age. The second study investigates the level of disease burden that could be reduced by the introduction of rubella vaccination. Rubella transmission dynamics were simulated using a stochastic agent-based model, and our results indicate that introduction of rubella immunization in the DRC may decrease the burden of rubella and CRS. The third study objective was to assess the health and economic impacts of implementing rubella immunization under different vaccination scenarios compared to the current no-vaccination scenario in the DRC. Cost-effectiveness analyses were conducted on vaccination scenarios by comparing incremental net costs per disability-adjusted life-year averted and we found that the introduction of rubella vaccination would be highly cost-effective. In conclusion, our results support investment in the introduction of rubella vaccination in the DRC.