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Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases

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  • Kimberly M. Thompson
  • Nima D. Badizadegan

Abstract

Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccines formulations and immunization schedules. With endemic measles and rubella transmission interrupted in the region of the Americas, all five other regions of the World Health Organization (WHO) targeting the elimination of measles transmission by 2020, and increasing adoption of rubella vaccine globally, integrated dynamic disease, risk, decision, and economic models can help national, regional, and global health leaders manage measles and rubella population immunity. Despite hundreds of publications describing models for measles or rubella and decades of use of vaccines that contain both antigens (e.g., measles, mumps, and rubella vaccine or MMR), no transmission models for measles and rubella exist to support global policy analyses. We describe the development of a dynamic disease model for measles and rubella transmission, which we apply to 180 WHO member states and three other areas (Puerto Rico, Hong Kong, and Macao) representing >99.5% of the global population in 2013. The model accounts for seasonality, age‐heterogeneous mixing, and the potential existence of preferentially mixing undervaccinated subpopulations, which create heterogeneity in immunization coverage that impacts transmission. Using our transmission model with the best available information about routine, supplemental, and outbreak response immunization, we characterize the complex transmission dynamics for measles and rubella historically to compare the results with available incidence and serological data. We show the results from several countries that represent diverse epidemiological situations to demonstrate the performance of the model. The model suggests relatively high measles and rubella control costs of approximately $3 billion annually for vaccination based on 2013 estimates, but still leads to approximately 17 million disability‐adjusted life years lost with associated costs for treatment, home care, and productivity loss costs of approximately $4, $3, and $47 billion annually, respectively. Combined with vaccination and other financial cost estimates, our estimates imply that the eradication of measles and rubella could save at least $10 billion per year, even without considering the benefits of preventing lost productivity and potential savings from reductions in vaccination. The model should provide a useful tool for exploring the health and economic outcomes of prospective opportunities to manage measles and rubella. Improving the quality of data available to support decision making and modeling should represent a priority as countries work toward measles and rubella goals.

Suggested Citation

  • Kimberly M. Thompson & Nima D. Badizadegan, 2017. "Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases," Risk Analysis, John Wiley & Sons, vol. 37(6), pages 1109-1131, June.
  • Handle: RePEc:wly:riskan:v:37:y:2017:i:6:p:1109-1131
    DOI: 10.1111/risa.12831
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    References listed on IDEAS

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    1. Kimberly M. Thompson & Radboud J. Duintjer Tebbens, 2006. "Retrospective Cost‐Effectiveness Analyses for Polio Vaccination in the United States," Risk Analysis, John Wiley & Sons, vol. 26(6), pages 1423-1440, December.
    2. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Dominika A. Kalkowska & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Characterizing Poliovirus Transmission and Evolution: Insights from Modeling Experiences with Wild and Vaccine‐Related Polioviruses," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 703-749, April.
    3. Geoffard, Pierre-Yves & Philipson, Tomas, 1997. "Disease Eradication: Private versus Public Vaccination," American Economic Review, American Economic Association, vol. 87(1), pages 222-230, March.
    4. Kimberly M. Thompson & Emily A. Simons & Kamran Badizadegan & Susan E. Reef & Louis Z. Cooper, 2016. "Characterization of the Risks of Adverse Outcomes Following Rubella Infection in Pregnancy," Risk Analysis, John Wiley & Sons, vol. 36(7), pages 1315-1331, July.
    5. Kimberly M. Thompson & Cassie L. Odahowski, 2016. "The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies," Risk Analysis, John Wiley & Sons, vol. 36(7), pages 1357-1382, July.
    6. Kimberly M. Thompson, 2016. "Evolution and Use of Dynamic Transmission Models for Measles and Rubella Risk and Policy Analysis," Risk Analysis, John Wiley & Sons, vol. 36(7), pages 1383-1403, July.
    7. Kimberly M. Thompson & Cassie L. Odahowski & James L. Goodson & Susan E. Reef & Robert T. Perry, 2016. "Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories," Risk Analysis, John Wiley & Sons, vol. 36(7), pages 1427-1458, July.
    8. Kimberly M. Thompson & Kasper H. Kisjes, 2016. "Modeling Measles Transmission in the North American Amish and Options for Outbreak Response," Risk Analysis, John Wiley & Sons, vol. 36(7), pages 1404-1417, July.
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    Cited by:

    1. Gilberto Montibeller & L. Alberto Franco & Ashley Carreras, 2020. "A Risk Analysis Framework for Prioritizing and Managing Biosecurity Threats," Risk Analysis, John Wiley & Sons, vol. 40(11), pages 2462-2477, November.
    2. Kimberly M. Thompson, 2017. "Modeling and Managing the Risks of Measles and Rubella: A Global Perspective Part II," Risk Analysis, John Wiley & Sons, vol. 37(6), pages 1041-1051, June.

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