Evolution of rubella vaccine policy for the UK.

The principles of rubella vaccine strategy are reviewed against the background of the current UK programme of vaccinating female adolescents, and the contrasting North American programme of vaccinating young children of both sexes. The effects of using both systems simultaneously are then considered: in particular the question of supplementing the established UK system with child vaccination. Previous computer-simulation and mathematical models predicted the consequences of this policy change with insufficient precision, so an elaborated model is proposed, developed and described. Its special advantages over the simpler model from which it was developed are that it represents the detailed pattern of subsequent temporal change, and allows for the effects of earlier epidemic patterns, of seasonal variations in transmission rates, of earlier vaccine policies and changing levels of implementation. Predictions for the current UK programme, unchanged in principle but converging upon target uptake rates, are compared with the effects of introducing a supplementary policy of vaccinating children. Benefits accrue from supplementary child-uptakes greater than about 50%, but the cost effectiveness is poor. In the absence of a commitment to rubella eradication, and provisions for making vaccination compulsory, it should probably not be undertaken.