Think globally, act locally: the role of local demographics and vaccination coverage in the dynamic response of measles infection to control

Philos Trans R Soc Lond B Biol Sci. 2013 Jun 24;368(1623):20120141. doi: 10.1098/rstb.2012.0141. Print 2013 Aug 5.


The global reduction of the burden of morbidity and mortality owing to measles has been a major triumph of public health. However, the continued persistence of measles infection probably not only reflects local variation in progress towards vaccination target goals, but may also reflect local variation in dynamic processes of transmission, susceptible replenishment through births and stochastic local extinction. Dynamic models predict that vaccination should increase the mean age of infection and increase inter-annual variability in incidence. Through a comparative approach, we assess national-level patterns in the mean age of infection and measles persistence. We find that while the classic predictions do hold in general, the impact of vaccination on the age distribution of cases and stochastic fadeout are mediated by local birth rate. Thus, broad-scale vaccine coverage goals are unlikely to have the same impact on the interruption of measles transmission in all demographic settings. Indeed, these results suggest that the achievement of further measles reduction or elimination goals is likely to require programmatic and vaccine coverage goals that are tailored to local demographic conditions.

Keywords: elimination; mean age at infection; measles; vaccination.

MeSH terms

  • Age Factors
  • Birth Rate
  • Communicable Disease Control / methods*
  • Disease Eradication / methods*
  • Humans
  • Mass Vaccination / methods
  • Mass Vaccination / statistics & numerical data*
  • Measles / epidemiology*
  • Measles / prevention & control*
  • Public Health / methods*