Demographic transition and the dynamics of measles in six provinces in China: A modeling study.

Friday, 4th of May 2018 Print

PLoS Med. 2017 Apr 4;14(4):e1002255. doi: 10.1371/journal.pmed.1002255. eCollection 2017 Apr.

Demographic transition and the dynamics of measles in six provinces in China: A modeling study.

Li S1 Ma C2 Hao L2 Su Q2 An Z2 Ma F3 Xie S4 Xu A5 Zhang Y6 Ding Z7 Li H8 Cairns L9 Wang H2 Luo H2 Wang N10 Li L2 Ferrari MJ11.

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Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles but the virus remains persistent in much of the world. Here we show that a combination of demographic transition as a result of declining birth rates and reduced measles prevalence due to improved vaccination has shifted the age distribution of susceptibility to measles throughout China.


We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%-97% reduction in transmission rate) in three industrialized eastern provinces during the last decade driving a concomitant increase in both the relative proportion and absolute number of adult cases while three central and western provinces exhibited dynamics consistent with endemic persistence (24%-73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes but campaigns from 2005 onwards reduced the susceptible proportion by 32%-87%. A limitation of this study is that it relies on case surveillance and thus inference may be biased by age-specific variation in measles reporting.


The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence.

PMID: 28376084  PMCID: PMC5380361 DOI: 10.1371/journal.pmed.1002255

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