Reviewer ’s report  
 
Title:  Rubella natural immunity among adolescent girls in Tanzania: The need to vaccinate child 
bearing aged women  
 
Version: 0 Date: 10 Aug 2017 
 
Reviewer:  Vicky  Sheppeard  
 
Reviewer’s report:  
 
The paper is improved.  
 
Some statements require references, such as (p. 3 line 3 - 5 "most low and middle income 
countries the introduction of rubella containing vaccine is still not implemented", and others 
need updated references and corrections e.g. (p. 3 lines 18 -20) the refer ence should be WHO 
2011, and the WHO recommendation is that a wide age range campaign should be conducted as 
part of RCV introduction (not before it is introduced), and the 80% coverage is to reduce 
transmission, not to ensure infants do not pose a risk.  
 
In fact, the WHO do not state there is a need to determine the level of natural immunity before 
introducing RCV in order to implement effective control strategies - in fact, serological 
determination of immunity is discouraged.  
 
I suggest that lines 12 - 13 on p.4 are removed, as this is a false premise.  
 
Methods: the definition of SES categories should be provided (it is unusual that 75% of subjects 
are "high" SES)  
 
Discussion - the first statement - that assessing natural rubella immunity is crucial for effe ctive 
vaccination program is supported by a reference from 1985 - subsequent,more authoritative 
references, such as WHO, do not support this proposition.  
 
p. 8, lines 12 - 15 - what is the justification for further ascertainment of population immunity 
level s by age to determine the targeting of mass vaccination programs?  
 
p.8, lines 24 - p.9 line2: the WHO do not recommend screening and selective vaccination. This 
approach is unlikely to be cost -effective compared to mass vaccination of all adolescents or a ll 
women of child -bearing age.  
 
p.9 lines 6 -7 : what is meant by "recurrent infection" in the context of rubella?  
 
Conclusion line20 - 22 - the recommendation to screen and vaccinate susceptible adolescent girls 
cannot be supported without comparison to oth er strategies such as mass adolescent vaccination.  
 
Lines 22 - 24 - what additional studies are you recommending? what is needed to be known to 
improve cost effectiveness of CRS prevention?  
 
Are the methods appropriate and well described?  
If not, please specify  what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specif y what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unle ss extensively edited  
 
Declaration of competing interests  
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