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. 2023 Aug;11(8):e1194-e1204.
doi: 10.1016/S2214-109X(23)00220-6.

Health effects of routine measles vaccination and supplementary immunisation activities in 14 high-burden countries: a Dynamic Measles Immunization Calculation Engine (DynaMICE) modelling study

Megan Auzenbergs  1 , Han Fu  2 , Kaja Abbas  3 , Simon R Procter  2 , Felicity T Cutts  2 , Mark Jit  4
Affiliations

Health effects of routine measles vaccination and supplementary immunisation activities in 14 high-burden countries: a Dynamic Measles Immunization Calculation Engine (DynaMICE) modelling study

Megan Auzenbergs et al. Lancet Glob Health. 2023 Aug.

Abstract

Background: WHO recommends at least 95% population coverage with two doses of measles-containing vaccine (MCV). Most countries worldwide use routine services to offer a first dose of measles-containing vaccine (MCV1) and later, a second dose of measles-containing vaccine (MCV2). Many countries worldwide conduct supplementary immunisation activities (SIAs), offering vaccination to all people in a specific age range irrespective of previous vaccination history. We aimed to estimate the relative effects of each dose and delivery route in 14 countries with high measles burden.

Methods: We used an age-structured compartmental dynamic model, the Dynamic Measles Immunization Calculation Engine (DynaMICE), to assess the effects of different vaccination strategies on measles susceptibility and burden during 2000-20 in 14 countries with high measles incidence (containing 53% of the global birth cohort and 78% of the global measles burden). Country-specific routine MCV1 and MCV2 coverage data during 1980-2020 were obtained from the WHO and UNICEF Estimates of National Immunization Coverage database for all modelled countries and SIA data were obtained from the WHO summary of measles and rubella SIAs. We estimated the incremental health effects of different vaccination strategies using prevented cases of measles and deaths from measles and their efficiency using the incremental number needed to vaccinate (NNV) to prevent an additional measles case.

Findings: Compared with no vaccination, MCV1 implementation was estimated to have prevented 824 million cases of measles and 9·6 million deaths from measles, with a median NNV of 1·41 (IQR 1·35-1·44). Adding routine MCV2 to MCV1 was estimated to have prevented 108 million cases and 404 270 deaths, whereas adding SIAs to MCV1 was estimated to have prevented 256 million cases and 4·4 million deaths. Despite larger incremental effects, adding SIAs to MCV1 (median incremental NNV 6·02, 5·30-7·68) showed reduced efficiency compared with adding routine MCV2 (5·41, 4·76-6·11).

Interpretation: Vaccination strategies, including non-selective SIAs, reach a greater proportion of children who are unvaccinated and reduce measles burden more than MCV2 alone, but efficiency is lower because of the wide age range targeted by SIAs. This analysis provides information to help improve the health effects and efficiency of measles vaccination strategies. The interplay between MCV1, MCV2, and SIAs should be considered when planning future measles vaccination strategies.

Funding: Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure 1
Figure 1
Immunisation coverage for MCV1, MCV2, and SIAs (2000–20) SIA coverage was calculated from reported numbers of doses administered and national populations in the SIA target age group. As of 2020, Uganda, DR Congo, and Somalia had not implemented MCV2. Additional years of MCV2 introduction for other countries are available (appendix p 1). MCV1=the first routine dose of measles-containing vaccine. MCV2=the second routine dose of measles-containing vaccine. SIA=supplementary immunisation activity.
Figure 2
Figure 2
Estimated annual measles incidence rate per million population across different vaccination delivery strategies (2000–20) Temporal trends in measles incidence rates vary by different vaccination delivery strategies; the measles burden decreases with additional vaccination delivery strategies. For countries that have not yet introduced MCV2 (ie, Uganda, DR Congo, and Somalia), there are overlapping trends for incidence rates for the delivery strategies of MCV1 and MCV2 (blue lines) and MCV1 only (green lines) and the delivery strategies of MCV1, MCV2, and SIAs (purple lines) and MCV1 and SIAs (red lines). Overlapping trends are also seen in most analysed years in countries that introduced MCV2 after 2017 (ie, Nigeria, Ethiopia, and Madagascar). In Indonesia, the fluctuations seen in the no vaccination strategy are the result of dynamic sizes of the susceptible population affected by natural seasonality of measles transmission. MCV1=the first routine dose of measles-containing vaccine. MCV2=the second routine dose of measles-containing vaccine. SIA=supplementary immunisation activity.
Figure 3
Figure 3
Susceptible population younger than 5 years by vaccination delivery strategy (2000–20) Estimated total numbers of susceptible people younger than 5 years under different vaccination delivery strategies compared with the size of birth cohort. For countries that have not yet introduced MCV2 (ie, Uganda, DR Congo, and Somalia), there are overlapping trends for incidence rates for the delivery strategies of MCV1 and MCV2 (blue lines) and MCV1 only (green lines) and the delivery strategies of MCV1, MCV2, and SIAs (purple lines) and MCV1 and SIAs (red lines). Overlapping trends are also seen in most analysed years in countries that introduced MCV2 in 2017 or later (ie, Nigeria, Ethiopia, and Madagascar). In Indonesia, the fluctuations seen in the no vaccination strategy are the result of dynamic sizes of the susceptible population affected by natural seasonality of measles transmission. MCV1=the first routine dose of measles-containing vaccine. MCV2=the second routine dose of measles-containing vaccine. SIA=supplementary immunisation activity.
Figure 4
Figure 4
Prevented cases and number needed to vaccinate to prevent a measles case under alternative assumptions for early MCV2 introduction and different SIA dose distribution (A) Prevented cases. (B) Number needed to vaccinate to prevent a measles case. In the sensitivity analysis, we modelled the incremental effect and efficiency of vaccination under the alternative assumptions of MCV2 introduction and SIA distribution. The incremental effects of each of the strategies were compared with the strategy in which MCV1 was already in use. The incremental effects of each of the strategies are compared with the strategy in which MCV1 was already in use. In the main analysis, MCV2 was introduced on the basis of its historical WUENIC coverage (dark blue) and SIAs were distributed with an assumption that 7·7% of children were less likely to be reached by vaccination than the rest of the targeted population (red). The alternative MCV2 assumption indicates early introduction of MCV2 in 2000 with coverage inputs from the appendix (p 9; light blue). Three countries that have not yet introduced MCV2 (ie, Uganda, DR Congo, and Somalia) have missing estimates for the original strategy with MCV1 and MCV2. Two alternative assumptions for SIA distribution were evaluated, including prioritisation of children who had not received any MCV doses (pink) and prioritising children who had been previously vaccinated (dark red). MCV=measles-containing vaccine. MCV1=the first routine dose of measles-containing vaccine. MCV2=the second routine dose of measles-containing vaccine. SIA=supplementary immunisation activity. WUENIC=WHO and UNICEF Estimates of National Immunization Coverage.
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References

    1. Dixon MG, Ferrari M, Antoni S, et al. Progress toward regional measles elimination—worldwide, 2000–2020. MMWR Morb Mortal Wkly Rep. 2021;70:1563–1569. - PMC - PubMed
    1. Li X, Mukandavire C, Cucunubá ZM, et al. Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. Lancet. 2021;397:398–408. - PMC - PubMed
    1. Chang AY, Riumallo-Herl C, Salomon JA, Resch SC, Brenzel L, Verguet S. Estimating the distribution of morbidity and mortality of childhood diarrhea, measles, and pneumonia by wealth group in low- and middle-income countries. BMC Med. 2018;16:102. - PMC - PubMed
    1. Santos H, Eilertson K, Lambert B, Hauryski S, Patel M, Ferrari M. Ensemble model estimates of the global burden of measles morbidity and mortality from 2000 to 2019: a modeling study. medRxiv. 2021 doi: 10.1101/2021.08.31.21262916. published online Oct 18. (preprint) - DOI
    1. Toor J, Echeverria-Londono S, Li X, et al. Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world. eLife. 2021;10 - PMC - PubMed

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