Abstract
Using a mathematical model with realistic demography, we analyze a large outbreak of measles in Muyinga sector in rural Burundi in 1988–1989. We generate simulated epidemic curves and age × time epidemic surfaces, which we qualitatively and quantitatively compare with the data. Our findings suggest that supplementary immunization activities (SIAs) should be used in places where routine vaccination cannot keep up with the increasing numbers of susceptible individuals resulting from population growth or from logistical problems such as cold chain maintenance. We use the model to characterize the relationship between SIA frequency and SIA age range necessary to suppress measles outbreaks. If SIAs are less frequent, they must expand their target age range.
Highlights
Measles is a viral disease of worldwide public health importance despite enormous reduction in incidence and mortality since the 1980s (Otten et al, 2003; Otten et al, 2005; Brenzel et al, 2006; Perry et al, 2014)
Foremost among the problems of measles control is the post-honeymoon epidemic, occurring when susceptibles accumulate in a population despite relatively good vaccine coverage (Cutts & Markowitz, 1994)
Mathematical models can play a role in understanding epidemics, when natural equilibria are perturbed by vaccination
Summary
Measles is a viral disease of worldwide public health importance despite enormous reduction in incidence and mortality since the 1980s (Otten et al, 2003; Otten et al, 2005; Brenzel et al, 2006; Perry et al, 2014). Foremost among the problems of measles control is the post-honeymoon epidemic, occurring when susceptibles accumulate in a population despite relatively good vaccine coverage (Cutts & Markowitz, 1994). These outbreaks are not limited to developing countries; Pyle (1973) documents a post-honeymoon outbreak in the USA, seven years after the introduction of vaccination. Such epidemics were especially a problem in the late 1980s and early 1990s (Gindler et al, 1992; Mulholland, 1995), but continue to this day, in the presence of ‘‘antivax’’ sentiment (Majumder et al, 2015), and health system interruptions (Takahashi et al, 2015). One goal is to make outbreak-avoiding recommendations for measles vaccine policy in high growth rate populations
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