Simulations of rubella vaccination strategies in China.

Many infants whose mothers have rubella infections during their first trimester of pregnancy have birth defects called congenital rubella syndrome (CRS). China does not routinely vaccinate against rubella in the public sector, but may need to start as its 'one child per couple' policy changes the population age distribution and the dynamics of rubella epidemiology, so that the incidence of rubella in pregnant women increases. Computer simulations with demographic transitions and rubella transmission dynamics predict that, with no or limited rubella vaccination, CRS incidence in China in the 30 years after 2020 will be more than twice the level in 2005. Comparisons of rubella vaccination strategies using computer simulations show that routine vaccination of over 80% of 1-year-old children would be effective in reducing total CRS cases in 2005-2051 and eliminating rubella in China by 2051. Routine immunizations at higher levels and the addition of early mass vaccinations of 2-14-year-old children and women of childbearing ages would further reduce total CRS cases and speed up the elimination of rubella.