Modelling the first dose of measles vaccination: the role of maternal immunity, demographic factors, and delivery systems.
Measles vaccine efficacy is higher at 12 months than 9 months because of maternal immunity, but delaying vaccination exposes the children most vulnerable to measles mortality to infection. We explored how this trade-off changes as a function of regionally varying epidemiological drivers, e.g. demography, transmission seasonality, and vaccination coverage. High birth rates and low coverage both favour early vaccination, and initiating vaccination at 9-11 months, then switching to 12-14 months can reduce case numbers. Overall however, increasing the age-window of vaccination decreases case numbers relative to vaccinating within a narrow age-window (e.g. 9-11 months). The width of the age-window that minimizes mortality varies as a function of birth rate, vaccination coverage and patterns of access to care. Our results suggest that locally age-targeted strategies, at both national and sub-national scales, tuned to local variation in birth rate, seasonality, and access to care may substantially decrease case numbers and fatalities for routine vaccination.
Metcalf
C J E
CJ
Department of Ecology and Evolutionary Biology, Princeton University, NJ 0854, USA. cmetcalf@princeton.edu
Klepac
P
P
Ferrari
M
M
Grais
R F
RF
Djibo
A
A
Grenfell
B T
BT
D000375:Aging; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007115:Immunization Schedule; D007223:Infant; D008457:Measles / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D008962:Models, Theoretical; D011247:Pregnancy; D012621:Seasons; D014611:Vaccination
D008458:Measles Vaccine