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Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options

Published online by Cambridge University Press:  15 May 2009

H. R. Babad ,
D. J. Nokes ,
N. J. Gay ,
E. Miller ,
P. Morgan-Capner  and
R. M. Anderson
H. R. Babad
Affiliation:
Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS
D. J. Nokes*
Affiliation:
Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS
N. J. Gay
Affiliation:
Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
E. Miller
Affiliation:
Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
P. Morgan-Capner
Affiliation:
Public Health Laboratory, Royal Preston Hospital, Sharoe Green Lane North, Preston PR2 4HG
R. M. Anderson
Affiliation:
Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS
*
* Author and address for correspondence.
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Summary

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Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0–2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination.

Type
Research Article
Information
Epidemiology & Infection , Volume 114 , Issue 2 , April 1995 , pp. 319 - 344
Copyright
Copyright © Cambridge University Press 1995

References

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