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Estimation of the basic reproduction number of measles during an outbreak in a partially vaccinated population
1Department of Biological Sciences, University of Warwick, Coventry, UK.
Abstract:
From March to July 1996 a measles outbreak occurred in northern Luxembourg with 110 reported cases centered around two primary schools (85 cases) and the surrounding community (25 cases). Eighty four suspected cases were confirmed serologically. Vaccine coverage was estimated from questionnaire-based surveys at the two primary schools to be 70 and 76%, respectively. Vaccine efficacy during the outbreak was estimated to be 94.6% [95% confidence interval (CI) 90.4-97.0]. Using the information from the, school surveys, we obtained estimates of the basic reproduction number of measles of 7.7 (95% CI 4.4-11.0) and 6.2 (95% CI 3.5-8.9), respectively. Assuming a 95% vaccine efficacy, these estimates correspond to minimal vaccine coverages of 91.6% (95% CI 81.4-95.7) and 88.3% (95% CI 75.5-93.4) which would have been necessary to minimize the chances of a major outbreak occurring. We can confirm that major outbreaks in similar school settings can only be prevented if vaccination coverage exceeds 90%.
Insights
A 1996 measles outbreak in Luxembourg highlighted the critical need for high vaccination coverage. To prevent major outbreaks, especially in schools, vaccination rates must exceed 90%.
Area of Science:
- Epidemiology
- Public Health
- Immunization
Background:
- Measles outbreaks pose a significant public health risk, particularly in school settings.
- Understanding transmission dynamics and vaccine effectiveness is crucial for outbreak control.
Purpose of the Study:
- To analyze a measles outbreak in northern Luxembourg from March to July 1996.
- To estimate vaccine coverage, vaccine efficacy, and the basic reproduction number (R0) during the outbreak.
- To determine the minimum vaccination coverage required to prevent major measles outbreaks in school environments.
Main Methods:
- Serological confirmation of suspected measles cases.
- Questionnaire-based surveys to estimate vaccine coverage in primary schools.
- Calculation of vaccine efficacy and basic reproduction number (R0) using outbreak data and survey results.
Main Results:
- 110 measles cases were reported, primarily linked to two primary schools.
- Estimated vaccine coverage was 70% and 76% in the affected schools.
- Vaccine efficacy was calculated at 94.6%, with estimated R0 values of 7.7 and 6.2.
- Minimal vaccination coverage required to prevent major outbreaks was estimated between 88.3% and 91.6%.
Conclusions:
- High vaccination coverage, exceeding 90%, is essential for preventing major measles outbreaks in school settings.
- The study reinforces the importance of robust immunization programs to maintain community immunity.
- Effective measles control relies on achieving and sustaining high vaccine uptake rates.
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