@article{09e9ffa81c0048c6890cd01839ebebdf,
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.",
keywords = "Madagascar, measles, rubella, serological survey, surveillance",
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}",
note = "Funding Information: Author affiliations: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Amy K. Winter, Amy P. Wesolowski, Justin Lessler); Princeton Environmental Institute, Princeton University, Princeton, New Jersey (Keitly J. Mensah); Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar (Miora Bruna Ramamonjiharisoa, Andrianmasina Herivelo Randriamanantena, Richter Razafindratsimandresy, Jean-Michel H{\'e}raud); Mathematical Modeling of Infectious Diseases Unit, Institut Pasteur, Paris, France (Simon Cauchemez); Intercollege Graduate Degree Program in Ecology, Pennsylvania State University, University Park, Pennsylvania (Matt J. Ferrari); and Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey (C. Jess E. Metcalf). This work was funded by the Bill and Melinda Gates Foundation (grant OPP1094793) and the Wellcome Trust (grant 106866/Z/15/Z). We thank the staff of the Direction of the Expanded Program on Immunization from the Malagasy Ministry of Public Health, for their dedicated work toward measles immunization, and all staff of the health sector involved in measles surveillance. We also thank all the staff from the World Health Organization national reference lab at Institut Pasteur de Madagascar for their work regarding testing and database sharing. Conflict of interest: none declared. Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.",
year = "2018",
month = oct,
day = "1",
doi = "10.1093/aje/kwy114",
language = "English (US)",
volume = "187",
pages = "2219--2226",
journal = "American Journal of Epidemiology",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "10",
}