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

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


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 languageEnglish (US)
Pages (from-to)2219-2226
Number of pages8
JournalAmerican Journal of Epidemiology
Issue number10
StatePublished - Oct 1 2018

All Science Journal Classification (ASJC) codes

  • Epidemiology


  • Madagascar
  • measles
  • rubella
  • serological survey
  • surveillance


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