Persistence Of Measles Research Articles

Understanding the persistence of measles: reconciling theory, simulation and observation.

Ever since the pattern of localized extinction associated with measles was discovered by Bartlett in 1957, many models have been developed in an attempt to reproduce this phenomenon. Recently, the use of constant infectious and incubation periods, rather than the more convenient exponential forms, has been presented as a simple means of obtaining realistic persistence levels. However, this result appears at odds with rigorous mathematical theory; here we reconcile these differences. Using a deterministic approach, we parameterize a variety of models to fit the observed biennial attractor, thus determining the level of seasonality by the choice of model. We can then compare fairly the persistence of the stochastic versions of these models, using the 'best-fit' parameters. Finally, we consider the differences between the observed fade-out pattern and the more theoretically appealing 'first passage time'.

Measles antibody levels in a vaccinated population in Brazil

An epidemiological study of measles-specific immunoglobulin G antibody levels was conducted using a representative sample of a vaccinated suburban population in São Paulo State, Brazil. The study aimed to determine immunity status in relation to age and infection or vaccination experience. 549 age-structured samples of sera, collected in 1990, were screened and calibrated to the international reference serum, using measles nucleoprotein in an enzyme immunoassay. In the age group with direct experience of vaccination (9 months to 15 years), whether routine or campaign, over 90% had detectable antibody ⩾50 miu/mL. However, 14% of these had antibody concentrations between 50 and 100 miu/mL and 30% between 50 and 255 miu/mL. In those over 15 years of age, 94% had antibody levels >255 miu/mL, assumed to be the result of past infection. The study suggested that, within highly vaccinated populations, a proportion of individuals had measles antibody levels which may be insufficient to protect against reinfection or clinical disease. The implications of these results, and similar findings elsewhere, in relation to the persistence of measles requires investigation; this has particular relevance in São Paulo following the recent measles outbreak.

Disease extinction and community size: modeling the persistence of measles.

A basic issue in ecology is the relation between extinction and population size. One of the clearest manifestations of a population threshold for extinction is the critical community size below which infections like measles do not persist. The current generation of stochastic models overestimates the observed critical community size for measles, generating much less persistence of infection than is observed. The inclusion of a more biologically realistic model for the duration of infection produced a much closer fit to the actual critical community size and explains previously undescribed high-frequency oscillations in measles incidence.

SEASONALITY AND THE REQUIREMENTS FOR PERPETUATION AND ERADICATION OF VIRUSES IN POPULATIONS

Perpetuation of a virus in a population is distinct from the ability to persist in a cell culture or individual host. Parameters which determine perpetuation include: 1) the size of the population; 2) the turnover of the population; 3) the proportion of immunes in the population; 4) the transmissibility of the infection; and 5) the generation time between sequential infections. These parameters may be grouped into two composite factors which most directly affect transmission dynamics and perpetuation: (a) population turnover per generation period, and (b) transmissibility or the fraction of susceptibles infected per existing infection. Perpetuation in small populations usually requires either the ability to persist in individuals or rapid population turnover. Conversely, human viruses which initiate only acute infections require larger populations to persist. Seasonal variation in transmissibility can greatly increase the minimum population size in which persistence is possible, and we argue that the population size of 500,000 for measles persistence (described by Bartlett) is primarily a consequence of seasonal variation. Computer modelling can be used to examine the effect of changes in parameters which determine the seasonal cycle of virus perpetuation and fadeout. Finally, human infections are reviewed to indicate those which have been eradicated (smallpox), are on the threshold of eradication (poliomyelitis), are possibly eradicable (measles), or could be candidates for future efforts (hepatitis A and hepatitis B). In developing a strategy for eradication two points are of great potential utility: first, the seasonal trough should be exploited as a time for effective intervention; and, second, containment efforts should be directed at epidemiologically important population groupings such as schools.