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Target immunity levels for achieving and maintaining measles elimination

Sebastian Funk, Jennifer K. Knapp, Emmaculate Lebo, Susan E. Reef, Alya J. Dabbagh, Katrina Kretsinger, Mark Jit, W. John Edmunds, Peter M. Strebel
doi: https://doi.org/10.1101/201574
Sebastian Funk
aCentre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
bDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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  • For correspondence: sebastian.funk@lshtm.ac.uk
Jennifer K. Knapp
cCentres for Disease Control and Prevention, Atlanta, United States
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Emmaculate Lebo
cCentres for Disease Control and Prevention, Atlanta, United States
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Susan E. Reef
cCentres for Disease Control and Prevention, Atlanta, United States
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Alya J. Dabbagh
dWorld Health Organization, Geneva, Switzerland
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Katrina Kretsinger
dWorld Health Organization, Geneva, Switzerland
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Mark Jit
aCentre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
bDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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W. John Edmunds
aCentre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
bDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Peter M. Strebel
eGAVI Alliance, Geneva, Switzerland
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Abstract

Vaccination has reduced the global incidence of measles to the lowest rates in history. Local interruption of measles transmission, however, requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure, however, does not easily translate into required immunity levels across all age groups that would be sufficient to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study is to determine age-specific immunity levels that would ensure elimination of measles using observed contact patterns from a broad range of settings. We combined recent observations on age-specific mixing patterns with scenarios for the distribution of immunity to estimate transmission potential. We validated these models by deriving predictions based on serological studies and comparing them to observed case data. We found that 95% immunity needs to be achieved at the time of school entry to guarantee elimination. The level of immunity found in the 5-to-9 year old age group in serological studies was the strongest predictor of future case load. Higher levels of immunity in 5-to-9 year olds are required than the previously derived target of 90% to interrupt transmission. While such high levels can be difficult to achieve, school entry provides a clear opportunity to ensure sufficient levels of immunity.

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The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
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Posted October 13, 2017.
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Target immunity levels for achieving and maintaining measles elimination
Sebastian Funk, Jennifer K. Knapp, Emmaculate Lebo, Susan E. Reef, Alya J. Dabbagh, Katrina Kretsinger, Mark Jit, W. John Edmunds, Peter M. Strebel
bioRxiv 201574; doi: https://doi.org/10.1101/201574
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Target immunity levels for achieving and maintaining measles elimination
Sebastian Funk, Jennifer K. Knapp, Emmaculate Lebo, Susan E. Reef, Alya J. Dabbagh, Katrina Kretsinger, Mark Jit, W. John Edmunds, Peter M. Strebel
bioRxiv 201574; doi: https://doi.org/10.1101/201574

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