Estimates of the global burden of Congenital Rubella Syndrome, 1996-2019

Background Many countries introduced rubella-containing vaccination (RCV) after 2011, following changes in recommended World Health Organization (WHO) vaccination strategies and external support. The full impact of these introductions is unknown as previous estimates of the global burden of Congenital Rubella Syndrome (CRS) considered the period 1996-2010. Methods We updated a previously-published literature review to identify rubella seroprevalence studies among unvaccinated populations. These were used in an age-structured transmission model, including routine and campaign vaccination coverage to estimate the CRS incidence during 1996-2019 in each country, each region and globally. Findings For 2019, the highest CRS incidence was estimated for the WHO African (AFR) and Eastern Mediterranean (EMR) regions (64 (95% CI: 24-123) and 27 (95% CI: 4-67) per 100,000 live births respectively), where nearly half of births occur in countries that have introduced RCV.. In regions elsewhere, where over 95% of births occurred in countries which had introduced RCV, the estimated CRS incidence was low (<1 (95% CI: <1-8) and <1 (95% CI: <1-12) per 100,000 live births in the South East Asian (SEAR) and Western Pacific (WPR) regions respectively, and similarly in Europe and the Americas). The estimated number of CRS births globally declined by approximately two thirds from 100,000 (95% CI: 54,000-166,000) in 2010 to 32,000 (95% CI: 13,000-60,000) by 2019, with the biggest falls in SEAR and WPR. Interpretation The introduction of RCV in SEAR and WPR led to dramatic regional and global reductions in the CRS incidence since 2010. Introducing RCV in the remaining countries and maintaining high RCV coverage can result in further reductions. Funding Gavi the Vaccine Alliance via the Vaccine Impact Modelling Consortium (VIMC). VIMC is jointly funded by Gavi the Vaccine Alliance and the Bill and Melinda Gates Foundation (BMGF grant number: OPP1157270).