Epidemic risks of measles and rubella in China: a systematic review and meta-analysis

Seroprevalence studies across various countries can contribute to achieving the elimination target for measles and rubella. However, in the Mainland of China, the concept of herd immunity remains unclear due to the lack of a nationwide serosurvey.

This systematic review and meta-analysis was conducted by retrieving literature reporting the seroprevalence of measles and rubella published between 2012 and 2023. The pooled positive rates and estimated geometric mean concentrations (GMCs) of measles and rubella immunoglobulin G antibodies were calculated.

This study analysed 135 studies on measles and 77 on rubella, including data from 368,023 and 177,422 healthy individuals, respectively. Between 2010 and 2022, the overall pooled positive rates for measles and rubella antibodies were 88.8% and 79.91%, respectively. The age-specific susceptibility analysis showed that infants aged < 1 year had the lowest pooled positive rates. Other age groups had a roughly U-shaped distribution, with relatively higher positive rates and GMC of measles and rubella antibodies in young children and older age groups. However, the positive rates for both measles and rubella antibodies fell below the elimination threshold in almost all age groups other than young children aged 1-4 years, especially in recent years. In addition, antibody positivity rates varied by geographical region and decreased with economic level.

Our findings provide preliminary insights into herd immunity for measles and rubella, highlighting the challenges to achieving their elimination in China.