Benefits and Challenges in Using Seroprevalence Data to Inform Models for Measles and Rubella Elimination.

Amy K Winter,Jacco Wallinga,C Jess E Metcalf,Micaela E Martinez,William J Moss,Justin Lessler,Amalie Mckee,Felicity T Cutts,Kyla Hayford,Matt J Ferrari

doi:10.1093/infdis/jiy137

Abstract

Control efforts for measles and rubella are intensifying globally. It becomes increasingly important to identify and reach remaining susceptible populations as elimination is approached. Serological surveys for measles and rubella can potentially measure susceptibility directly, but their use remains rare. In this study, using simulations, we outline key subtleties in interpretation associated with the dynamic context of age-specific immunity, highlighting how the patterns of immunity predicted from disease surveillance and vaccination coverage data may be misleading. High-quality representative serosurveys could provide a more accurate assessment of immunity if challenges of conducting, analyzing, and interpreting them are overcome. We frame the core disease control and elimination questions that could be addressed by improved serological tools, discussing challenges and suggesting approaches to increase the feasibility and sustainability of the tool. Accounting for the dynamical context, serosurveys could play a key role in efforts to achieve and sustain elimination.

Highlights

MethodsSerological surveys for measles and rubella can potentially measure susceptibility directly, but their use remains rare
Control efforts for measles and rubella are intensifying globally
Accounting for the dynamical context, serosurveys could play a key role in efforts to achieve and sustain elimination

Summary

Methods

Serological surveys for measles and rubella can potentially measure susceptibility directly, but their use remains rare. Age-Specific Serological Profiles: Expectations Across a Transmission Spectrum From Endemic to Elimination Seropositivity in young infants results from the transplacental transfer of maternal IgG antibodies to the fetus. The proportion of seropositive children increases at a rate determined by the rate of immunization through vaccination or infection. Age-specific seroprevalence profiles vary over time because vaccine coverage and infection transmission vary, as described below and illustrated in Figures 1 and 2 (model assumptions are described in Tables 1 and 2, methods are decribed in Supplementary Materials S1). R0, the basic reproductive number representing the number of new infections per infectious individual in a completely susceptible population, is a commonly used measure of transmission potential that informs expected age-specific patterns of seropositivity [1]. The profile of cases accumulated across age strata may be used to reflect the cumulative proportion of immune individuals by age, biases may emerge due to age-specific sensitivity of reporting

Results

Discussion

Conclusion