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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Amy Winter, Amy Wesolowski, Keitly Mensah, Miora Bruna Ramamonjiharisoa, Andrianmasina Herivelo Randriamanantena, et al.. Revealing Measles Outbreak Risk With a Nested Immunoglobulin G Serosurvey in Madagascar. American Journal of Epidemiology, Oxford University Press (OUP), 2018, 187 (10), pp.2219 - 2226. ⟨10.1093/aje/kwy114⟩. ⟨pasteur-01920183v2⟩

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