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The dynamics of measles in sub-Saharan Africa

Nature volume 451, pages 679684 (07 February 2008) | Download Citation

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Abstract

Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission—generating high amplitude epidemics—within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.

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Acknowledgements

M.J.F. was supported by CDC and WHO. We thank Epicentre/MSF and the Ministry of Health of Niger for access to data and comments throughout the development of this project. We also thank J. Lloyd-Smith for his valuable comments.

Author Contributions The paper was conceived by M.J.F., R.F.G., O.N.B. and B.T.G. Statistical analyses were designed and conducted by M.J.F. Simulation models were developed by M.J.F, R.F.G., N.B., A.J.K.C., O.N.B and B.T.G. Analysis of vaccine strategies was conducted by M.J.F, R.F.G., L.J.W., P.J.G., A.D. and B.T.G. Data collection was coordinated by A.D., R.F.G. and P.J.G. The paper was written by M.J.F. with help from B.T.G., R.F.G., N.B. and O.N.B. All authors discussed the results and edited the manuscript.

Author information

Affiliations

  1. Center for Infectious Disease Dynamics,

    • Matthew J. Ferrari
  2. Department of Biology and,

    • Nita Bharti
    •  & Bryan T. Grenfell
  3. Departments of Biology and Entomology, The Pennsylvania State University, University Park, Pennsylvania 16802, USA

    • Ottar N. Bjørnstad
  4. Epicentre, Paris 75011, France

    • Rebecca F. Grais
    •  & Philippe J. Guerin
  5. DAMTP, Centre for Mathematical Sciences, Wilberforce Road, Cambridge CB3 0WA, UK

    • Andrew J. K. Conlan
  6. Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892, USA

    • Ottar N. Bjørnstad
    •  & Bryan T. Grenfell
  7. World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

    • Lara J. Wolfson
  8. Direction Generale de la Sante Publique, Ministere de la Sante, BP 623, Niamey, Niger

    • Ali Djibo

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Corresponding author

Correspondence to Matthew J. Ferrari.

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https://doi.org/10.1038/nature06509

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