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

Amy K. Winter; Amy P. Wesolowski; Keitly J. Mensah; Miora Bruna Ramamonjiharisoa; Andrianmasina Herivelo Randriamanantena; Richter Razafindratsimandresy; Simon Cauchemez; Justin Lessler; Matt J. Ferrari; C. Jess E. Metcalf; Jean Michel Héraud

doi:10.1093/aje/kwy114

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

Amy K. Winter, Amy P. Wesolowski, Keitly J. Mensah, Miora Bruna Ramamonjiharisoa, Andrianmasina Herivelo Randriamanantena, Richter Razafindratsimandresy, Simon Cauchemez, Justin Lessler, Matt J. Ferrari, C. Jess E. Metcalf, Jean Michel Héraud

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16 Scopus citations

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.

Original language	English (US)
Pages (from-to)	2219-2226
Number of pages	8
Journal	American Journal of Epidemiology
Volume	187
Issue number	10
DOIs	https://doi.org/10.1093/aje/kwy114
State	Published - Oct 1 2018

All Science Journal Classification (ASJC) codes

Epidemiology

Keywords

Madagascar
measles
rubella
serological survey
surveillance

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10.1093/aje/kwy114

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Winter, A. K., Wesolowski, A. P., Mensah, K. J., Ramamonjiharisoa, M. B., Randriamanantena, A. H., Razafindratsimandresy, R., Cauchemez, S., Lessler, J., Ferrari, M. J., Metcalf, C. J. E., & 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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title = "Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar",

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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author = "Winter, {Amy K.} and Wesolowski, {Amy P.} and Mensah, {Keitly J.} and Ramamonjiharisoa, {Miora Bruna} and Randriamanantena, {Andrianmasina Herivelo} and Richter Razafindratsimandresy and Simon Cauchemez and Justin Lessler and Ferrari, {Matt J.} and Metcalf, {C. Jess E.} and H{\'e}raud, {Jean Michel}",

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Winter, AK, Wesolowski, AP, Mensah, KJ, Ramamonjiharisoa, MB, Randriamanantena, AH, Razafindratsimandresy, R, Cauchemez, S, Lessler, J, Ferrari, MJ, Metcalf, CJE & Héraud, JM 2018, 'Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar', American Journal of Epidemiology, vol. 187, no. 10, pp. 2219-2226. https://doi.org/10.1093/aje/kwy114

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AU - Wesolowski, Amy P.

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AU - Randriamanantena, Andrianmasina Herivelo

AU - Razafindratsimandresy, Richter

AU - Cauchemez, Simon

AU - Lessler, Justin

AU - Ferrari, Matt J.

AU - Metcalf, C. Jess E.

AU - Héraud, Jean Michel

N1 - Publisher Copyright: © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

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N2 - 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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Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar

Abstract

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