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Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control

Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control
Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control

Although measles incidence has reached historic lows in many parts of the world, the disease still causes substantial morbidity globally. Even where control programs have succeeded in driving measles locally extinct, unless vaccination coverage is maintained at extremely high levels, susceptible numbers may increase sufficiently to spark large outbreaks. Human mobility will drive potentially infectious contacts and interact with the landscape of susceptibility to determine the pattern of measles outbreaks. These interactions have proved difficult to characterise empirically. We explore the degree to which new sources of data combined with existing public health data can be used to evaluate the landscape of immunity and the role of spatial movement for measles introductions by retrospectively evaluating our ability to predict measles outbreaks in vaccinated populations. Using inferred spatial patterns of accumulation of susceptible individuals and travel data, we predicted the timing of epidemics in each district of Pakistan during a large measles outbreak in 2012–2013 with over 30 000 reported cases. We combined these data with mobility data extracted from over 40 million mobile phone subscribers during the same time frame in the country to quantify the role of connectivity in the spread of measles. We investigate how different approaches could contribute to targeting vaccination efforts to reach districts before outbreaks started. While some prediction was possible, accuracy was low and we discuss key uncertainties linked to existing data streams that impede such inference and detail what data might be necessary to robustly infer timing of epidemics.

Measles, mobility, Pakistan, vaccination
0950-2688
1-9
Wesolowski, Amy
343b0df8-5a2f-46e2-9f1c-001d4adf7fb1
Winter, Amy
09b1026c-77e0-48aa-9f09-b2e92e3b8c21
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Qureshi, Taimur
c4da8b5a-aa68-4e66-9e64-ec36dfb35cde
Engø-Monsen, Kenth
1487780b-85d1-4305-bd57-8673a462a509
Buckee, Caroline O.
f4bc891c-4f42-46a6-822d-03fc1f9cd55b
Cummings, Derek A.T.
9a136236-0c3f-49a9-8348-591a759b3f80
Metcalf, C. Jessica E.
ce1431b5-f784-4552-b66c-52fcb08f095c
Wesolowski, Amy
343b0df8-5a2f-46e2-9f1c-001d4adf7fb1
Winter, Amy
09b1026c-77e0-48aa-9f09-b2e92e3b8c21
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Qureshi, Taimur
c4da8b5a-aa68-4e66-9e64-ec36dfb35cde
Engø-Monsen, Kenth
1487780b-85d1-4305-bd57-8673a462a509
Buckee, Caroline O.
f4bc891c-4f42-46a6-822d-03fc1f9cd55b
Cummings, Derek A.T.
9a136236-0c3f-49a9-8348-591a759b3f80
Metcalf, C. Jessica E.
ce1431b5-f784-4552-b66c-52fcb08f095c

Wesolowski, Amy, Winter, Amy, Tatem, Andrew J., Qureshi, Taimur, Engø-Monsen, Kenth, Buckee, Caroline O., Cummings, Derek A.T. and Metcalf, C. Jessica E. (2018) Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control. Epidemiology and Infection, 1-9. (doi:10.1017/S0950268818001449).

Record type: Article

Abstract

Although measles incidence has reached historic lows in many parts of the world, the disease still causes substantial morbidity globally. Even where control programs have succeeded in driving measles locally extinct, unless vaccination coverage is maintained at extremely high levels, susceptible numbers may increase sufficiently to spark large outbreaks. Human mobility will drive potentially infectious contacts and interact with the landscape of susceptibility to determine the pattern of measles outbreaks. These interactions have proved difficult to characterise empirically. We explore the degree to which new sources of data combined with existing public health data can be used to evaluate the landscape of immunity and the role of spatial movement for measles introductions by retrospectively evaluating our ability to predict measles outbreaks in vaccinated populations. Using inferred spatial patterns of accumulation of susceptible individuals and travel data, we predicted the timing of epidemics in each district of Pakistan during a large measles outbreak in 2012–2013 with over 30 000 reported cases. We combined these data with mobility data extracted from over 40 million mobile phone subscribers during the same time frame in the country to quantify the role of connectivity in the spread of measles. We investigate how different approaches could contribute to targeting vaccination efforts to reach districts before outbreaks started. While some prediction was possible, accuracy was low and we discuss key uncertainties linked to existing data streams that impede such inference and detail what data might be necessary to robustly infer timing of epidemics.

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More information

Accepted/In Press date: 18 April 2018
e-pub ahead of print date: 4 June 2018
Keywords: Measles, mobility, Pakistan, vaccination

Identifiers

Local EPrints ID: 421439
URI: https://eprints.soton.ac.uk/id/eprint/421439
ISSN: 0950-2688
PURE UUID: 5798b4e3-ddd2-4471-b771-357e3389d2e9
ORCID for Andrew J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X

Catalogue record

Date deposited: 12 Jun 2018 16:30
Last modified: 14 Mar 2019 01:35

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