Abstract
Despite long-standing two-dose measles-mumps-rubella (MMR) vaccination, measles outbreaks still occur in highly vaccinated European populations. For instance, large measles outbreaks occurred in France (2008–13), the United Kingdom (2012–13) and the Netherlands (2012). Based on a multicohort model approach, using spatial serological survey data, MMR vaccination coverage data and data on social contacts, we found effective reproduction numbers significantly higher than 1 for measles in Belgium. This indicates that at one of the expected re-introductions, a measles outbreak is likely to spread, especially when it occurs during school term. The predicted average effective reproduction number increased over a 30-year time span from 1.3 to 2.2 and from 1.9 to 3.2 for basic reproduction numbers of 12 and 18, respectively. The expected relative measles incidence was highest in infants under one year of age, in adolescents and young adults. In conclusion, gradually increasing proportions of susceptible adolescents and young adults provide through their highly active social life an avenue for measles to resurge in large outbreaks upon re-introduction in Belgium, especially during school terms. Infants form an important vulnerable group during future measles outbreaks.
Highlights
A large-scale measles outbreak in France started in 2008, with more than 20,000 reported measles cases by 2013
No large measles outbreaks have been reported in Belgium since the start of the two-dose vaccination programme in 1995, some small outbreaks occurred in specific subpopulations
The generalised linear model consisting of an additive decomposition of age and spatial coordinates was the preferred model based on Akaike information criterion (AIC) (1,085.66)
Summary
A large-scale measles outbreak in France started in 2008, with more than 20,000 reported measles cases by 2013 (see e.g. [1]). A large-scale measles outbreak in France started in 2008, with more than 20,000 reported measles cases by 2013 No large measles outbreaks have been reported in Belgium since the start of the two-dose vaccination programme in 1995, some small outbreaks occurred in specific subpopulations. It is of interest to determine whether a potential for a resurgence of measles in Belgium still exists. Serological data are used to determine the age-specific susceptibility profile of the population of interest. Proper quantification of the risk of a possible resurgence based solely on such serological data is only possible if these data are recently collected and if the probability of transmission can be assumed to be independent of age
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