Modeling the impact of subclinical measles transmission in vaccinated populations with waning immunity

Joël Mossong*, David James Nokes, William John Edmunds, Martin John Cox, Samuel Ratnam, Claude P. Muller

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

110 Citations (Scopus)


An increasing body of evidence suggests that a substantial proportion of individuals who respond to measles vaccine display an antibody boost accompanied by mild or no symptoms on exposure to wild virus. It is unknown whether this emerging class of individuals can support transmission. The epidemiologic consequences of vaccinated individuals able to transmit virus are investigated using a mathematical model. Parameters for this model are estimated using regression analysis on a Canadian serologic data set. The authors confirm that neutralizing antibodies are decaying significantly in absence of circulating virus. Based on a protective threshold plaque reduction neutralization (PRN) titer of 120, the authors estimate the mean duration of vaccine-induced protection in absence of reexposure to be 25 years (95% confidence interval (CI) 18, 48). After long-term absence of circulating virus, the mathematical model predicts that 80% (95% CI 65, 91) of all seroconverted vaccinees have titers below the protective threshold. In this case, elimination of measles virus cannot be achieved by a single-dose routine vaccination strategy if the basic reproduction number in vaccinated individuals exceeds 1.24 (95% CI 1.10, 1.53). For this reason, there is a need to establish the intensity and duration of infectiousness in vaccinated individuals.

Original languageEnglish
Pages (from-to)1238-1249
Number of pages12
JournalAmerican Journal of Epidemiology
Issue number11
Publication statusPublished - 1 Dec 1999
Externally publishedYes


  • Antibodies, viral
  • Forecasting
  • Measles vaccine
  • Models, statistical
  • Models, theoretical


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