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American Journal of Epidemiology Vol. 150, No. 11: 1238-1249
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health

other

Modeling the Impact of Subclinical Measles Transmission in Vaccinated Populations with Waning Immunity

Joël Mossong1,2,, David James Nokes1, William John Edmunds1, Martin John Cox1, Samuel Ratnam3 and Claude P. Muller4

1Department of Biological Sciences, University of Warwick Coventry, England
2CRESIS CRP-Santé Luxembourg
3The Newtoundland Public Health Laboratory, The Leonard A. Miller Center for Health Services. St. John's Newfoundland, Canada
4Laboratoire National de Santé Luxembourg

Reprint requests to Mr. Joel Mossong, CRESIS, CRP-Santé, 57 route d'Arlon, L-1 140 Luxembourg, Luxembourg.

An increasing body of evidence suggests that a substantial proportion of individuals who respond to measles vaccine display an antibody boost accompanied by mild or no symptoms on exposure to wild virus. It is unknown whether this emerging class of individuals can support transmission. The epidemiologic consequences of vaccinated individuals able to transmit virus are investigated using a mathematical model. Parameters for this model are estimated using regression analysis on a Canadian serologic data set. The authors confirm that neutralizing antibodies are decaying significantly in absence of circulating virus. Based on a protective threshold plaque reduction neutralization (PRN) liter of 120, the authors estimate the mean duration of vaccine-induced protection in absence of reexposure to be 25 years (95% confidence interval (Cl) 18, 48). After long-term absence of circulating virus, the mathematical model predicts that 80% (95% Cl 65, 91) of all seroconverted vaccinees have titers below the protective threshold. In this case, elimination of measles virus cannot be achieved by a single-dose routine vaccination strategy if the basic reproduction number in vaccinated individuals exceeds 1.24 (95% Cl 1.10, 1.53). For this reason, there is a need to establish the intensity and duration of infectiousness in vaccinated individuals. Am J Epidemiol 1999; 150: 1238–49.

antibodies; viral; forecasting; measles vaccine; models; statistical; models; theoretical


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