Top

BMC Medicine

Published in:

01-12-2021 | Vaccination | Research article

Effect of evidence updates on key determinants of measles vaccination impact: a DynaMICE modelling study in ten high-burden countries

Authors: Han Fu, Kaja Abbas, Petra Klepac, Kevin van Zandvoort, Hira Tanvir, Allison Portnoy, Mark Jit

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

Model-based estimates of measles burden and the impact of measles-containing vaccine (MCV) are crucial for global health priority setting. Recently, evidence from systematic reviews and database analyses have improved our understanding of key determinants of MCV impact. We explore how representations of these determinants affect model-based estimation of vaccination impact in ten countries with the highest measles burden.

Methods

Using Dynamic Measles Immunisation Calculation Engine (DynaMICE), we modelled the effect of evidence updates for five determinants of MCV impact: case-fatality risk, contact patterns, age-dependent vaccine efficacy, the delivery of supplementary immunisation activities (SIAs) to zero-dose children, and the basic reproduction number. We assessed the incremental vaccination impact of the first (MCV1) and second (MCV2) doses of routine immunisation and SIAs, using metrics of total vaccine-averted cases, deaths, and disability-adjusted life years (DALYs) over 2000–2050. We also conducted a scenario capturing the effect of COVID-19 related disruptions on measles burden and vaccination impact.

Results

Incorporated with the updated data sources, DynaMICE projected 253 million measles cases, 3.8 million deaths and 233 million DALYs incurred over 2000–2050 in the ten high-burden countries when MCV1, MCV2, and SIA doses were implemented. Compared to no vaccination, MCV1 contributed to 66% reduction in cumulative measles cases, while MCV2 and SIAs reduced this further to 90%. Among the updated determinants, shifting from fixed to linearly-varying vaccine efficacy by age and from static to time-varying case-fatality risks had the biggest effect on MCV impact. While varying the basic reproduction number showed a limited effect, updates on the other four determinants together resulted in an overall reduction of vaccination impact by 0.58%, 26.2%, and 26.7% for cases, deaths, and DALYs averted, respectively. COVID-19 related disruptions to measles vaccination are not likely to change the influence of these determinants on MCV impact, but may lead to a 3% increase in cases over 2000–2050.

Conclusions

Incorporating updated evidence particularly on vaccine efficacy and case-fatality risk reduces estimates of vaccination impact moderately, but its overall impact remains considerable. High MCV coverage through both routine immunisation and SIAs remains essential for achieving and maintaining low incidence in high measles burden settings.

Available only for authorised users

Strebel PM, Papania MJ, Gastañaduy PA, Goodson JL. 37 - Measles Vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, editors. Plotkin's Vaccines (Seventh Edition): Elsevier; 2018. p. 579–618. e21.

Metcalf CJ, Klepac P, Ferrari M, Grais RF, Djibo A, Grenfell BT. Modelling the first dose of measles vaccination: the role of maternal immunity, demographic factors, and delivery systems. Epidemiol Infect. 2011;139(2):265–74. https://doi.org/10.1017/S0950268810001329.CrossRefPubMed

World Health Organization. Measles vaccines: WHO position paper - April 2017. Weekly Epidemiological Record. 2017;92(17):205–27.

World Health Organization. Framework for verifying elimination of measles and rubella. Wkly Epidemiol Rec. 2013;88(9):89–99.

World Health Organization. Global measles and rubella strategic plan : 2012-2020. 2012. https://apps.who.int/iris/bitstream/handle/10665/44855/9789241503396_eng.pdf;jsessionid=53F8DCD4661866648A8A9AD2EFB57FBC?sequence=1. Accessed 4 March 2021.

Gaythorpe KA, Abbas K, Huber J, Karachaliou A, Thakkar N, Woodruff K, et al. Impact of COVID-19-related disruptions to measles, meningococcal A, and yellow fever vaccination in 10 countries. Elife. 2021;10. https://doi.org/10.7554/eLife.67023.

Li X, Mukandavire C, Cucunuba ZM, Echeverria Londono S, Abbas K, Clapham HE, et al. Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. Lancet. 2021;397(10272):398–408. https://doi.org/10.1016/S0140-6736(20)32657-X.CrossRefPubMedPubMedCentral

Toor J, Echeverria-Londono S, Li X, Abbas K, Carter ED, Clapham HE, et al. Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world. Elife. 2021;10. https://doi.org/10.7554/eLife.67635.

Portnoy A, Jit M, Ferrari M, Hanson M, Brenzel L, Verguet S. Estimates of case-fatality ratios of measles in low-income and middle-income countries: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(4):e472–e81. https://doi.org/10.1016/S2214-109X(18)30537-0.CrossRefPubMedPubMedCentral

10.

Prem K, Cook AR, Jit M. Projecting social contact matrices in 152 countries using contact surveys and demographic data. Plos Comput Biol. 2017;13(9):e1005697. https://doi.org/10.1371/journal.pcbi.1005697.CrossRefPubMedPubMedCentral

11.

Prem K, van Zandvoort K, Klepac P, Eggo RM, Davies NG, Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group, et al. Projecting contact matrices in 177 geographical regions: an update and comparison with empirical data for the COVID-19 era. Plos Comput Bio. 2021;17(7):e1009098.CrossRef

12.

Hughes SL, Bolotin S, Khan S, Li Y, Johnson C, Friedman L, et al. The effect of time since measles vaccination and age at first dose on measles vaccine effectiveness - A systematic review. Vaccine. 2020;38(3):460–9. https://doi.org/10.1016/j.vaccine.2019.10.090.CrossRefPubMedPubMedCentral

13.

Portnoy A, Jit M, Helleringer S, Verguet S. Impact of measles supplementary immunization activities on reaching children missed by routine programs. Vaccine. 2018;36(1):170–8. https://doi.org/10.1016/j.vaccine.2017.10.080.CrossRefPubMed

14.

Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, et al. The basic reproduction number (R0) of measles: a systematic review. Lancet Infect Dis. 2017;17(12):e420–e8. https://doi.org/10.1016/S1473-3099(17)30307-9.CrossRefPubMed

15.

Guerra FM, Crowcroft NS, Friedman L, Deeks SL, Halperin SA, Severini A, et al. Waning of measles maternal antibody in infants in measles elimination settings - A systematic literature review. Vaccine. 2018;36(10):1248–55. https://doi.org/10.1016/j.vaccine.2018.01.002.CrossRefPubMed

16.

Verguet S, Johri M, Morris SK, Gauvreau CL, Jha P, Jit M. Controlling measles using supplemental immunization activities: a mathematical model to inform optimal policy. Vaccine. 2015;33(10):1291–6. https://doi.org/10.1016/j.vaccine.2014.11.050.CrossRefPubMedPubMedCentral

17.

World Health Organization. Immunization data portal. 2021. https://immunizationdata.who.int/listing.html. Accessed 20 July 2021.

18.

World Health Organization. Summary of Measles-Rubella Supplementary Immunization Activities, 2000-2020. https://www.who.int/entity/immunization/monitoring_surveillance/data/Summary_Measles_SIAs.xls. Accessed 20 July 2021.

19.

Sudfeld CR, Navar AM, Halsey NA. Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol. 2010;39(Suppl 1):i48–55. https://doi.org/10.1093/ije/dyq021.CrossRefPubMedPubMedCentral

20.

Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Institute for Health Metrics and Evaluation. 2020. http://ghdx.healthdata.org/gbd-results-tool. Accessed 20 May 2020.

21.

Wolfson LJ, Grais RF, Luquero FJ, Birmingham ME, Strebel PM. Estimates of measles case fatality ratios: a comprehensive review of community-based studies. Int J Epidemiol. 2009;38(1):192–205. https://doi.org/10.1093/ije/dyn224.CrossRefPubMed

22.

Global Burden of Disease Study 2019 (GBD 2019) Disability Weights. Institute for Health Metrics and Evaluation. http://ghdx.healthdata.org/record/ihme-data/gbd-2019-disability-weights. Accessed 20 May 2020.

23.

United Nations Deparatment of Economic and Social Affairs. World Population Prospects. 2019. https://population.un.org/wpp/. Accessed 1 March 2020.

24.

Orenstein WA, Papania MJ, Wharton ME. Measles elimination in the United States. J Infect Dis. 2004;189(Suppl 1):S1–3. https://doi.org/10.1086/377693.CrossRefPubMed

25.

Mossong J, Hens N, Jit M, Beutels P, Auranen K, Mikolajczyk R, et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med. 2008;5(3):e74. https://doi.org/10.1371/journal.pmed.0050074.CrossRefPubMedPubMedCentral

26.

Cata-Preta BO, Santos TM, Mengistu T, Hogan DR, Barros AJD, Victora CG. Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low and middle-income countries. Vaccine. 2021;39(32):4564–70. https://doi.org/10.1016/j.vaccine.2021.02.072.CrossRefPubMedPubMedCentral

27.

Simons E, Ferrari M, Fricks J, Wannemuehler K, Anand A, Burton A, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet. 2012;379(9832):2173–8. https://doi.org/10.1016/S0140-6736(12)60522-4.CrossRefPubMed

28.

Causey K, Fullman N, Sorensen RJD, Galles NC, Zheng P, Aravkin A, et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet. 2021;398(10299):522–34. https://doi.org/10.1016/S0140-6736(21)01337-4.CrossRefPubMedPubMedCentral

29.

World Health Organization Regional Office for South-East Asia. Strategic plan for measles and rubella elimination in WHO South-East Asia Region. 2020. https://apps.who.int/iris/handle/10665/330356. Accessed 4 March 2021.

30.

Wallinga J, Levy-Bruhl D, Gay NJ, Wachmann CH. Estimation of measles reproduction ratios and prospects for elimination of measles by vaccination in some Western European countries. Epidemiol Infect. 2001;127(2):281–95. https://doi.org/10.1017/S095026880100601X.CrossRefPubMedPubMedCentral

31.

Funk S, Knapp JK, Lebo E, Reef SE, Dabbagh AJ, Kretsinger K, et al. Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination. BMC Med. 2019;17(1):180. https://doi.org/10.1186/s12916-019-1413-7.CrossRefPubMedPubMedCentral

32.

Local Burden of Disease Vaccine Coverage Collaborators. Mapping routine measles vaccination in low- and middle-income countries. Nature. 2021;589(7842):415–19. https://doi.org/10.1038/s41586-020-03043-4.

33.

GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.CrossRef

34.

World Health Organization. Provisional monthly measles and rubella data. https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/surveillance/monitoring/provisional-monthly-measles-and-rubella-data. Accessed 4 March 2021.

35.

Mere MO, Goodson JL, Chandio AK, Rana MS, Hasan Q, Teleb N, et al. Progress Toward Measles Elimination - Pakistan, 2000-2018. MMWR Morb Mortal Wkly Rep. 2019;68(22):505–10. https://doi.org/10.15585/mmwr.mm6822a4.CrossRefPubMedPubMedCentral

36.

Clark A, Sanderson C. Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet. 2009;373(9674):1543–9. https://doi.org/10.1016/S0140-6736(09)60317-2.CrossRefPubMed

37.

Ramsay ME, Jin L, White J, Litton P, Cohen B, Brown D. The elimination of indigenous measles transmission in England and Wales. J Infect Dis. 2003;187(Suppl 1):S198–207. https://doi.org/10.1086/368024.CrossRefPubMed

Title: Effect of evidence updates on key determinants of measles vaccination impact: a DynaMICE modelling study in ten high-burden countries
Authors: Han Fu
Kaja Abbas
Petra Klepac
Kevin van Zandvoort
Hira Tanvir
Allison Portnoy
Mark Jit
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Vaccination
COVID-19
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02157-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effect of evidence updates on key determinants of measles vaccination impact: a DynaMICE modelling study in ten high-burden countries

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Sensitivity and specificity of the Bamberg Dementia Screening Test’s (BDST) full and short versions: brief screening instruments for geriatric patients that are suitable for infectious environments

Health inequities and clustering of fever, acute respiratory infection, diarrhoea and wasting in children under five in low- and middle-income countries: a Demographic and Health Surveys analysis

Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study

Identification and validation of tissue or ctDNA PTPRD phosphatase domain deleterious mutations as prognostic and predictive biomarkers for immune checkpoint inhibitors in non-squamous NSCLC

Cost-effectiveness modelling to optimise active screening strategy for gambiense human African trypanosomiasis in endemic areas of the Democratic Republic of Congo

The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen—a prospective cohort study