Rubella metapopulation dynamics and importance of spatial coupling to the risk of congenital rubella syndrome in Peru

C. J.E. Metcalf, C. V. Munayco, G. Chowell, B. T. Grenfell, O. N. Bjørnstad

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Consequently, understanding the age-structured dynamics of this infection has considerable public health value. Vaccination short of the threshold for local elimination of transmission will increase the average age of infection. Accordingly, the classic concern for this infection is the potential for vaccination to increase incidence in individuals of childbearing age. A neglected aspect of rubella dynamics is how age incidence patterns may be moulded by the spatial dynamics inherent to epidemic metapopulations. Here, we use a uniquely detailed dataset from Peru to explore the implications of this for the burden of CRS. Our results show that the risk of CRS may be particularly severe in small remote regions, a prediction at odds with expectations in the endemic situation, and with implications for the outcome of vaccination. This outcome results directly from the metapopulation context: specifically, extinction-re-colonization dynamics are crucial because they allow for significant leakage of susceptible individuals into the older age classes during inter-epidemic periods with the potential to increase CRS risk by as much as fivefold.

Original languageEnglish (US)
Pages (from-to)369-376
Number of pages8
JournalJournal of the Royal Society Interface
Issue number56
StatePublished - Mar 6 2011

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Biophysics
  • Biochemistry
  • Biotechnology
  • Biomedical Engineering
  • Biomaterials


  • Congenital rubella syndrome
  • Epidemiology
  • Metapopulation
  • Rubella


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