Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar

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Abstract

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.

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Winter, A. K., Wesolowski, A. P., Mensah, K. J., Ramamonjiharisoa, M. B., Randriamanantena, A. H., Razafindratsimandresy, R., … Héraud, J. M. (2018). Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar. American Journal of Epidemiology, 187(10), 2219–2226. https://doi.org/10.1093/aje/kwy114

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