Reviewer ’s report  
 
Title:  Rubella natural immunity among adolescent girls in Tanzania: The need to vaccinate child 
bearing aged women  
 
Version: 1 Date: 25 Sep 2017 
 
Reviewer:  Vicky  Sheppeard  
 
Reviewer’s report:  
 
Some further tightening of the text around analysis and review of analytic methods is required:  
 
Table 1: Quoted OR appear incorrect for region and education level  
 
p7, line 16 - should be "the asso ciation was NOT significant on random effect logistic regression 
analysis"  
 
Discussion:  
 
p 8, line 4 - do you mean assessing susceptibility or immunity is essential, rather than burden of 
disease, as this paper is not about burden of disease? Nevertheless, Banatvala's paper emphasises 
surveillance for rubella outbreaks when vaccination programs are introduced, not assessing the 
burden of disease.  
 
p8, line 8 - do you mean the majority of girls aged 12 - 18? (not 15)  
 
p8, lines 19 -21: The current advice from WH O is that screening and selective vaccination of 
women of child -bearing age is not cost effective. The recommended strategy is to vaccinate all 
women of childbearing age. The additional sentence is not supported by the AJPH reference, nor 
the current WHO g uidance.  
 
p9, line 4: it is unlikely that higher rubella titres are due to high SES - more likely that high SES 
is associated with other factors that lead to higher exposure to infection, such as higher 
population density.  
 
Conclusion:  
 
line 21 - what is the  rationale for more cross -sectional studies? Why would there be significant 
variation in immunity levels in different regions? and if there were, what are the implications for 
policy, in light of international recommendations for vaccination?  
 
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 unless extensively edited  
 
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