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Effectiveness and Timing of Vaccination During School Measles Outbreak

Emerging Infectious Diseases


Axel Antonio Bonai-Marinovi, PhD; Corien Swaan, MD; Ole Wichmann, MD, MCTM; Jim
van Steenberen, MD, PhD; Mir!am "ret#$chmar, PhD
%ac&lt' an( Di$clo$&re$
CM) *elea$e(+ ,-./0.1,/1; 2ali( 3or cre(it thro&h ,-./0.1,/4
CM) 5n3ormation
1. Abstract and Introduction
2. Metho($
3. *e$&lt$
4. Di$c&$$ion
*e3erence$
Abstract and Introduction
Abstract
De$6ite hih vaccination coverae in mo$t )&ro6ean co&ntrie$, lare comm&nit' o&tbrea7$ o3
mea$le$ (o occ&r, normall' cl&$tere( aro&n( $chool$ an( re$&ltin 3rom $&bo6timal vaccination
coverae8 To (etermine whether or when it i$ worth im6lementin o&tbrea7-re$6on$e vaccination
cam6ain$ in $chool$, we &$e( $tocha$tic o&tbrea7 mo(el$ to re6ro(&ce a 6&blic $chool o&tbrea7
in 9erman', where no vaccination cam6ain wa$ im6lemente(8 We a$$&me( 1 $cenario$
coverin the ba$eline vaccination ratio rane :;/84<=;>84<? e$timate( 3or that $chool an(
com6&te( o&tbrea7$ a$$&min vario&$ vaccination (ela'$8 5n one $cenario, reactin :i8e8,
im6lementin o&tbrea7-re$6on$e vaccination cam6ain$? within /1=1> (a'$ avoi(e( lare
o&tbrea7$ an( reactin within @, (a'$ re(&ce( o&tbrea7 $i#e8 5n the other $cenario, reactin
within 0=/> (a'$ avoi(e( lare o&tbrea7$ an( reactin within >, (a'$ re(&ce( the o&tbrea7 $i#e8
The$e are reali$tic time 3rame$ 3or im6lementin $chool o&tbrea7 re$6on$e vaccination
cam6ain$8 Aih ba$eline vaccination ratio$ exten(e( the time nee(e( 3or e33ective re$6on$e8
Introduction
Mea$le$ i$ a hihl' contaio&$ (i$ea$e that ca&$e$ illne$$ an( (eath in (evelo6in an(
in(&$triali#e( co&ntrie$8 Mea$le$ ha$ an e$timate( ba$ic re6ro(&ction n&mber :*,? rane o3 /1=
>,,
B/=@C
meanin that / ca$e intro(&ce( into a $&$ce6tible :naive? 6o6&lation will 6ro(&ce, on
averae, that n&mber o3 $econ(ar' ca$e$8 Worl(wi(e, mea$le$ i$ the main vaccine-6reventable
ca&$e o3 (eath amon chil(ren; D4/ million ca$e$ occ&r ever' 'ear, an( ca$e-3atalit' rate$ 3or
in(&$triali#e( co&ntrie$ are E,8/<=,81<8
B0C
5n 1,,/, the Worl( Aealth Orani#ation :WAO? an(
the Fnite( Gation$ 6&bli$he( a lobal $trateic 6lan 3or mea$le$;
BHC
the aim$ o3 the 6lan are to
$&$tainabl' re(&ce (eath$ 3rom mea$le$ an( to interr&6t mea$le$ vir&$ tran$mi$$ion in co&ntrie$
an( reion$ with elimination ob!ective$8
5n 1,,1, the WAO *eion o3 the America$ wa$ (eclare( 3ree 3rom en(emic mea$le$
tran$mi$$ion, which wa$ achieve( b' im6lementin imm&ni#ation 6roram$ with ver' hih
vaccination coverae :D;@<?8 Thi$ oal ha$ not been achieve( in the WAO )&ro6ean reion, 3or
which the taret 'ear 3or mea$le$ elimination wa$ 1,/,8 Mea$le$ i$ $o hihl' contaio&$ that the
averae vaccination coverae in )&ro6e :-,<=;@<?
B-C
i$ not hih eno&h to 6revent o&tbrea7$
amon nonvaccinate( 6er$on$8 The new taret 'ear 3or mea$le$ elimination in the WAO
)&ro6ean reion i$ 1,/@8
B;C

The onl' mean$ o3 6rotection aain$t mea$le$ are 6rior in3ection or vaccination8 Several $t&(ie$
have 3oc&$e( on the e33ectivene$$ o3 ma$$ o&tbrea7-re$6on$e vaccination cam6ain$ 3or
controllin mea$le$ o&tbrea7$ in $ettin$ where inci(ence an( morbi(it' an( mortalit' rate$ are
hih8 Altho&h $ome $t&(ie$ $&e$t that ma$$ o&tbrea7-re$6on$e vaccination cam6ain$ will not
$to6 mea$le$ e6i(emic$ beca&$e o3 the ra6i( $6rea( o3 the (i$ea$e,
B/,=/1C
other $t&(ie$, which &$e(
more recent (ata, $how that o&tbrea7-re$6on$e vaccination cam6ain$ can $&cce$$3&ll' re(&ce
illne$$ an( (eath8
B/4=/HC
The c&rrent WAO &i(eline$ recommen( ma$$ o&tbrea7-re$6on$e
vaccination cam6ain$ when a mea$le$ o&tbrea7 i$ con3irme( in $ettin$ with a oal o3 re(&cin
(eath$ 3rom mea$le$
B/-C
an( where mo$t mea$le$ ca$e$ occ&r in chil(ren I@ 'ear$ o3 ae8 There i$
no recommen(ation, however, 3or im6lementin o&tbrea7-re$6on$e vaccination cam6ain$ in
$ettin$ where inci(ence an( morbi(it' an( mortalit' rate$ are low, $&ch a$ in the WAO
)&ro6ean reion8 5n the$e $ettin$, beca&$e o3 the hih ba$eline vaccination ratio :B2*?, a $hi3t
in ae (i$trib&tion o3 mea$le$ ca$e$ towar( ol(er nonvaccinate( $chool chil(ren i$ o3ten note(8
B/;C
Con$eJ&entl', o&tbrea7$ initiall' $6rea( within relativel' clo$e( 6o6&lation$ o3 chil(ren, $&ch a$
$chool$ or (a'care center$, beca&$e o3 the hih rate o3 $ocial contact amon nonvaccinate(
chil(ren in the$e e$tabli$hment$8 There3ore, we 3oc&$e( o&r $t&(' on o&tbrea7-re$6on$e
vaccination cam6ain$ that tarete( e$tabli$hment$ with chil(ren where a mea$le$ o&tbrea7 wa$
occ&rrin in $ettin$ with hih B2*$8
A (ela' 3rom (etection o3 an o&tbrea7 to im6lementation o3 an o&tbrea7-re$6on$e vaccination
cam6ain to on$et o3 an e33ective imm&ne re$6on$e o3 tho$e vaccinate( i$ inevitable8 Beca&$e
mea$le$ i$ hihl' contaio&$, man' chil(ren miht become in3ecte( (&rin that (ela'8 Th&$,
whether vaccinatin chil(ren aain$t mea$le$ (&rin a $chool o&tbrea7 wo&l( $&b$tantiall' a33ect
the o&tcome o3 a newl' 3ormin e6i(emic i$ in (o&bt8
B1,C
5n thi$ $t&(', we &$e( $tocha$tic mo(el$
to e$timate the ex6ecte( $i#e o3 an o&tbrea7 in a $chool, (e6en(in on the (ela' between
(etection an( im6lementation o3 com6lete $chool o&tbrea7-re$6on$e vaccination cam6ain8

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