Measles control in Australia – threats, opportunities and future needs
C. Raina MacIntyre a,h , Elizabeth Kpozehouen a , Mohana Kunasekaran a , Kathleen Harriman c , Stephen Conaty d , Alexander Rosewell a , Julian Druce e,g , Nicolee Martin e , Anita E. Heywood a,b , Heather F. Gidding a,b , James Wood a , Sonya Nicholl f. Measles control in Australia – threats, opportunities and future needs. Vaccine,Volume 36, Issue 30, 16 July 2018, Pages 4393-4398. https://doi.org/10.1016/j.vaccine.2018.06.022
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia’s measles elimination status in the context of regional and global measles control.
The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed.
Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
a School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
b National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
c California Department of Public Health, Richmond, CA, USA
d Public Health Unit, South Western Sydney Local Health District, Australia
e Victorian Infectious Diseases Reference Laboratory, Australia
f Immunisation Unit, Health Protection NSW, Australia
g VIDRL, Doherty Institute, Australia
h Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia