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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2020

Open Access 01-12-2020 | Vaccination | Research article

Estimating the nationwide transmission risk of measles in US schools and impacts of vaccination and supplemental infection control strategies

Authors: Parham Azimi, Zahra Keshavarz, Jose Guillermo Cedeno Laurent, Joseph G. Allen

Published in: BMC Infectious Diseases | Issue 1/2020

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Abstract

Background

The spread of airborne infectious diseases such as measles is a critical public health concern. The U.S. was certified measles-free in 2000, but the number of measles cases has increased in recent years breaking the record of the nationwide annual number of cases since 1992. Although the characteristics of schools have made them one of the most vulnerable environments during infection outbreaks, the transmission risk of measles among students is not completely understood. We aimed to evaluate how three factors influence measles transmission in schools: personal (vaccination), social (compartmentalizing), and building systems (ventilation, purification, and filtration).

Methods

We used a combination of a newly developed multi-zone transient Wells-Riley approach, a nationwide representative School Building Archetype (SBA) model, and a Monte-Carlo simulation to estimate measles risk among U.S. students. We compared our risk results with the range of reported transmission rates of measles in school outbreaks to validate the risk model. We also investigated the effectiveness of vaccination and ten supplemental infection control scenarios for reducing the risk of measles transmission among students.

Results

Our best nationwide estimate of measles transmission risk in U.S. schools were 3.5 and 32% among all (both unvaccinated and immunized) and unvaccinated students, respectively. The results showed the transmission risk of measles among unvaccinated students is > 70 times higher than properly immunized ones. We also demonstrated that the transmission risk of measles in primary schools (assuming teacher self-contained classrooms) is less than secondary schools (assuming departmentalized systems). For building-level interventions, schools with ductless-with-air-filter and ductless-without-air-filter systems have the lowest and highest transmission risks of measles, respectively. Finally, our simulation showed that infection control strategies could cut the average number of infected cases among all students in half when a combination of advanced air filtration, ventilation, and purification was adopted in the modeled schools.

Conclusions

Our results highlight the primary importance of vaccination for reducing the risk of measles transmission among students. Yet, additional and significant risk reduction can be achieved through compartmentalizing students and enhancing building ventilation and filtration systems.
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Metadata
Title
Estimating the nationwide transmission risk of measles in US schools and impacts of vaccination and supplemental infection control strategies
Authors
Parham Azimi
Zahra Keshavarz
Jose Guillermo Cedeno Laurent
Joseph G. Allen
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Vaccination
Published in
BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-05200-6

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