Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
Department of Mathematics, University of Rajshahi, Rajshahi, Bangladesh.
PLoS One. 2023 Jun 29;18(6):e0283082. doi: 10.1371/journal.pone.0283082. eCollection 2023.
In recent years measles has been one of the most critical public health problem in Bangladesh. Although the Ministry of Health in Bangladesh employs a broad extension of measles control policies, logistical challenges exist, and there is significant doubt regarding the disease burden. Mathematical modelling of measles is considered one of the most effective ways to understand infection transmission and estimate parameters in different countries, such as Bangladesh. In this study, a mathematical modelling framework is presented to explore the dynamics of measles in Bangladesh. We calibrated the model using cumulative measles incidence data from 2000 to 2019. Also, we performed a sensitivity analysis of the model parameters and found that the contact rate had the most significant influence on the basic reproduction number R0. Four hypothetical intervention scenarios were developed and simulated for the period from 2020 to 2035. The results show that the scenario which combines enhanced treatment for exposed and infected population, first and second doses of vaccine is the most effective at rapidly reducing the total number of measles incidence and mortality in Bangladesh. Our findings also suggest that strategies that focus on a single interventions do not dramatically affect the decline in measles incidence cases; instead, those that combine two or more interventions simultaneously are the most effective in decreasing the burden of measles incidence and mortality. In addition, we also evaluated the cost-effectiveness of varying combinations of three basic control strategies including distancing, vaccination and treatment, all within the optimal control framework. Our finding suggested that combines distancing, vaccination and treatment control strategy is the most cost-effective for reducing the burden of measles in Bangladesh. Other strategies can be comprised to measles depending on the availability of funds and policymakers' choices.
近年来，麻疹一直是孟加拉国最严重的公共卫生问题之一。尽管孟加拉国卫生部采取了广泛的扩大麻疹控制政策，但仍存在后勤挑战，而且对疾病负担存在重大疑问。麻疹的数学建模被认为是了解感染传播和估计不同国家（如孟加拉国）参数的最有效方法之一。在这项研究中，提出了一个数学建模框架来探索麻疹在孟加拉国的动态。我们使用 2000 年至 2019 年的麻疹累积发病率数据对模型进行了校准。此外，我们还对模型参数进行了敏感性分析，发现接触率对基本繁殖数 R0 的影响最大。为 2020 年至 2035 年期间制定并模拟了四个假设的干预情景。结果表明，结合强化暴露和感染人群治疗、第一和第二剂疫苗的方案在迅速减少孟加拉国麻疹总发病率和死亡率方面最为有效。我们的研究结果还表明，专注于单一干预措施的策略不会显著影响麻疹发病率的下降；相反，同时结合两种或多种干预措施的策略在降低麻疹发病率和死亡率方面最为有效。此外，我们还在最优控制框架内评估了三种基本控制策略（包括隔离、疫苗接种和治疗）的不同组合的成本效益。我们的研究结果表明，结合隔离、疫苗接种和治疗控制策略是降低孟加拉国麻疹负担的最具成本效益的策略。可以根据资金的可用性和决策者的选择将其他策略纳入麻疹控制。
