Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Princeton Environmental Institute, Princeton University, Princeton, New Jersey.
Am J Epidemiol. 2018 Oct 1;187(10):2219-2226. doi: 10.1093/aje/kwy114.
Madagascar reports few measles cases annually and high vaccination campaign coverage. However, the underlying age profile of immunity and risk of a measles outbreak is unknown. We conducted a nested serological survey, testing 1,005 serum samples (collected between November 2013 and December 2015 via Madagascar's febrile rash surveillance system) for measles immunoglobulin G antibody titers. We directly estimated the age profile of immunity and compared these estimates with indirect estimates based on a birth cohort model of vaccination coverage and natural infection. Combining these estimates of the age profile of immunity in the population with an age-structured model of transmission, we further predicted the risk of a measles outbreak and the impact of mitigation strategies designed around supplementary immunization activities. The direct and indirect estimates of age-specific seroprevalence show that current measles susceptibility is over 10%, and modeling suggests that Madagascar may be at risk of a major measles epidemic.
马达加斯加每年报告的麻疹病例很少，疫苗接种活动的覆盖率也很高。然而，麻疹免疫的潜在年龄结构和暴发风险尚不清楚。我们进行了一项巢式血清学调查，检测了 1005 份血清样本（2013 年 11 月至 2015 年 12 月通过马达加斯加发热出疹监测系统采集）的麻疹免疫球蛋白 G 抗体滴度。我们直接估计了人群的免疫年龄结构，并将这些估计与基于疫苗接种覆盖率和自然感染的出生队列模型的间接估计进行了比较。将人群免疫年龄结构的这些估计与麻疹传播的年龄结构模型相结合，我们进一步预测了麻疹暴发的风险和补充免疫活动设计的缓解策略的影响。特定年龄的血清阳性率的直接和间接估计表明，目前麻疹的易感性超过 10%，模型表明马达加斯加可能面临大规模麻疹流行的风险。
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