Abstract
Rubella is a completely immunizing and mild infection in children. Understanding its behaviour is of considerable public health importance because of congenital rubella syndrome, which results from infection with rubella during early pregnancy and may entail a variety of birth defects. The recurrent dynamics of rubella are relatively poorly resolved, and appear to show considerable diversity globally. Here, we investigate the behaviour of a stochastic seasonally forced susceptible–infected–recovered model to characterize the determinants of these dynamics and illustrate patterns by comparison with measles. We perform a systematic analysis of spectra of stochastic fluctuations around stable attractors of the corresponding deterministic model and compare them with spectra from full stochastic simulations in large populations. This approach allows us to quantify the effects of demographic stochasticity and to give a coherent picture of measles and rubella dynamics, explaining essential differences in the recurrent patterns exhibited by these diseases. We discuss the implications of our findings in the context of vaccination and changing birth rates as well as the persistence of these two childhood infections.
Highlights
Rubella is a completely immunizing, directly transmitted viral infection, generally presenting as a mild and potentially even asymptomatic childhood disease [1]
Because infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects [2], understanding the dynamics of rubella is of considerable public health importance
Its location depends on the population size, the length of time series and the number of runs used in simulations
Summary
Rubella is a completely immunizing, directly transmitted viral infection, generally presenting as a mild and potentially even asymptomatic childhood disease [1]. Rubella tends to be underreported, and its recurrent dynamics are fairly poorly characterized. Because infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects [2], understanding the dynamics of rubella is of considerable public health importance. Dynamical features of rubella may alter the CRS burden via their effects on the average age of infection. Episodic dynamics may increase the average age of infection, as the intervals between larger outbreaks provide the opportunity for individuals to age into later age classes [3,4]. Local extinction dynamics can allow individuals to remain susceptible as they age into their childbearing years [5,6], resulting in the potential for a considerable CRS burden once rubella is reintroduced
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