MacKechnie Gabrielle P D, Dalton Milena, Delport Dominic, Vaccher Stefanie
Burnet Institute, Melbourne, VIC 3004, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia.
Vaccines (Basel). 2025 Mar 30;13(4):367. doi: 10.3390/vaccines13040367.
BACKGROUND/OBJECTIVES: Measles is a vaccine-preventable disease with a high level of transmissibility. Outbreaks of measles continue globally, with gaps in healthcare and immunisation resulting in pockets of susceptible individuals. Measles outbreaks have been proposed as a "canary in the coal mine" of under-resourced health systems, uncovering broader system weaknesses. We aim to understand whether under-resourced health systems are associated with increased odds of large measles outbreaks in low- and middle-income countries (LMICs).
We used an ecological study design to identify measles outbreaks that occurred in LMICs between 2010 and 2020. Health systems were represented using a set of health system indicators for the corresponding outbreak country, guided by the World Health Organization's building blocks of health systems framework. These indicators were: the proportion of births delivered in a health facility, the number of nurses and midwives per 10,000 population, and domestic general government health expenditure per capita in USD. We analysed the associations using a predictive model and assessed the accuracy of this model.
The analysis included 78 outbreaks. We found an absence of any association between the included health system indicators and large measles outbreaks. When testing predictive accuracy, the model obtained a Brier score of 0.21, which indicates that the model is not informative in predicting large measles outbreaks. We found that missing data did not affect the results of the model.
Large measles outbreaks were not able to be used to identify under-resourced health systems in LMICs. However, further research is required to understand whether this association may exist when taking other factors, including smaller outbreaks, into account.
背景/目的：麻疹是一种可通过疫苗预防的高传染性疾病。全球范围内麻疹疫情仍在持续，医疗保健和免疫接种方面的差距导致出现易感人群聚集区。麻疹疫情被视为资源匮乏卫生系统的“煤矿中的金丝雀”，揭示了更广泛的系统弱点。我们旨在了解资源匮乏的卫生系统是否与低收入和中等收入国家（LMICs）大规模麻疹疫情的增加几率相关。
我们采用生态研究设计来识别2010年至2020年期间在LMICs发生的麻疹疫情。以世界卫生组织卫生系统框架的构建要素为指导，使用一组针对相应疫情发生国家的卫生系统指标来代表卫生系统。这些指标包括：在医疗机构分娩的比例、每万人口中的护士和助产士数量以及人均国内一般政府卫生支出（以美元计）。我们使用预测模型分析这些关联，并评估该模型的准确性。
分析包括78次疫情。我们发现所纳入的卫生系统指标与大规模麻疹疫情之间不存在任何关联。在测试预测准确性时，该模型的布里尔得分是0.21，这表明该模型在预测大规模麻疹疫情方面没有参考价值。我们发现缺失数据并未影响模型结果。
在LMICs中，大规模麻疹疫情无法用于识别资源匮乏的卫生系统。然而，需要进一步研究以了解在考虑其他因素（包括小规模疫情）时这种关联是否可能存在。
