Wood James G, Heywood Anita E, Menzies Robert I, McIntyre Peter B, MacIntyre C Raina
School of Public Health and Community Medicine, UNSW, Sydney, Australia.
School of Public Health and Community Medicine, UNSW, Sydney, Australia.
Vaccine. 2015 Feb 25;33(9):1176-81. doi: 10.1016/j.vaccine.2014.12.071. Epub 2015 Jan 22.
Australia has achieved measles elimination as announced in March 2014 by the WHO Western Pacific Regional Committee, based on several lines of evidence. However, despite strong national evidence for elimination, there remains substantial regional variation in vaccine coverage, has resulted in recent outbreaks and potential for increased frequency in the future.
In this study, we apply a multiple cohort model of measles immunity, stratified by age and local geographic area to predict trends in the measles reproduction number R. In addition, we use branching process models of outbreak risks to predict state-level probabilities of the occurrence of measles outbreaks over the next 20 years.
Our results suggest increasing risks of large measles outbreaks over this period, in particular in the states of Queensland and New South Wales. In addition, there is wide variation in predicted R values by smaller geographic areas, although uncertainty in age-specific immunity limits the precision of our results.
Our predictions align with observed outbreaks in Australian states and suggest our approach to determining future outbreak risks could be applied more widely in elimination or near-elimination settings.
根据多项证据，澳大利亚已实现麻疹消除，这是世界卫生组织西太平洋区域委员会在2014年3月宣布的。然而，尽管有强有力的全国性消除证据，但疫苗接种覆盖率仍存在很大的地区差异，导致近期出现疫情，且未来疫情发生频率有可能增加。
在本研究中，我们应用了一个按年龄和当地地理区域分层的麻疹免疫多队列模型，以预测麻疹繁殖数R的趋势。此外，我们使用疫情爆发风险的分支过程模型来预测未来20年各州发生麻疹疫情的概率。
我们的结果表明，在此期间大规模麻疹疫情爆发的风险在增加，特别是在昆士兰州和新南威尔士州。此外，较小地理区域的预测R值存在很大差异，尽管特定年龄免疫的不确定性限制了我们结果的精确性。
我们的预测与澳大利亚各州观察到的疫情一致，并表明我们确定未来疫情爆发风险的方法可在消除或接近消除的环境中更广泛地应用。
