Past measles outbreaks show epidemics spread via small towns

Preparation of measles vaccine at the Tirana (Albania) Institute of Hygiene and Epidemiology. Two technicians, wearing surgical gowns, are making small openings in eggs. (Credit: World Health Organization/Wikimedia Commons)

In the most detailed study to date of epidemic spread, researchers have modeled measles dynamics based on over 40 years of data collected in England and Wales.

The models—which span the prevaccination period, introduction of measles vaccination, and local elimination by vaccination in the 1990s—reveal that, before the introduction of a vaccine, measles could persist in both large population centers and by spread among sets of smaller towns.

The study also provides critical data on the importance of spatial modeling for the long-term control of global epidemics and could help inform the long-term public health response to the current COVID-19 pandemic.

“During the last 20 years there have been tremendous inroads towards eradicating measles—one of the major killers of children globally—as annual deaths have been driven down from more than a million to less than 200,000,” says Ottar N. Bjørnstad, professor of entomology and biology at Penn State and one of the leaders of the research team.

The gif shows measles outbreaks over time as small dots of color
Animation showing the dynamics of measles outbreaks in England and Wales between 1944 and 1994. New research reveals that, prior to the introduction of the measles vaccine, periodic epidemics from both large population centers and the aggregation of small towns likely drove transmission patterns. (Credit: Alexander D. Becker)

“However, previous efforts to eradicate smallpox and polio highlight the complexity of moving from local control to global eradication. Our study provides critical data on how long-term control efforts will need both general and detailed spatial models to finally stop this deadly disease.”

Prior to the introduction of a vaccine, the number of measles cases in England and Wales would undergo, periodic—often biennial—epidemics. This pattern, driven by herd immunity, is common among a number of diseases and in other locales. The researchers sought to locate the reservoirs where the virus persists in the dips between epidemics, which are the sources for reintroduction of the virus into the general populace in the next major epidemic. This persistence question is central to understanding the dynamics of measles and other viral diseases and for coordinating public health interventions.

The research team combined spatial modeling with the detailed historical data of measles cases in England and Wales to address these questions. The uniquely detailed dataset includes weekly measles reports from almost a thousand locations across England and Wales beginning in 1944 and continuing until the disease was all but locally eliminated by vaccination in the 1990s.

“Previous work stressed the importance of large centers as sources of infection,” says Bryan T. Grenfell, a professor of ecology and evolutionary biology and of public affairs at Princeton University and another leader of the research team. “However, our new modeling shows that local spread among smaller towns can also contribute to persistence of the virus.”

The researchers’ new model quantifies the relative influence of different sources of infection, including major cities, spread among smaller towns, and unidentifiable outside sources. Following the introduction of vaccination, the source of reintroduction shifted from a combination of large centers and local spread to mainly unidentifiable sources, possibly outside of England and Wales.

“Having access to this unique dataset allowed us to test these news models of measles dynamics with unprecedented rigor,” says first author Max S. Y. Lau, assistant professor in the Rollins School of Public Health at Emory University. “Going forward, we can apply what we learn from this test case to understand disease spread beyond measles.”

“Measles has always been the ‘model organism’ of epidemic dynamics—like C. elegans or the fruit fly are for evolution—and, along with influenza, a paradigm for understanding herd immunity,” says Grenfell.

“So, as COVID-19 approaches endemicity, these new models can help us understand and prepare for modeling its spatial spread, as well as understand the impact that the eventual development of a vaccine might have on its dynamics.”

Beyond the COVID-19 pandemic, the models also could help scientists understand how diseases survive and spread at a time when a portion of the public is opposed to vaccines, says coauthor C. Jessica E. Metcalf, assistant professor of ecology and evolutionary biology and public affairs.

“Understanding the drivers of persistence is also of growing importance in a context of growing vaccine hesitancy, which further complicates dynamics and amplifies the challenges of control,” she says.

The researchers add that people should take a wide perspective when applying the results to other diseases.

“Our model and previous experience highlights the complexity of globally eradicating a virus,” says Bjørnstad.

“Smallpox was eradicated by 1977 through a massive global effort of mass-vaccination of all children, followed by targeted efforts in regional hotspots and finally local quarantining and ring vaccination to squash the scourge. Polio, in contrast, while also targeted through vaccination for more than 50 years keeps escaping ‘the final blow’ as it successfully shifts and diffuses across regional pockets of susceptible individuals to evade eradication.”

A paper describing the study appears in Nature Ecology & Evolution. Additional researchers contributed from Princeton and the University of Edinburgh.

The RAPIDD Program of the US Department of Homeland Security and the Fogarty International Centre, the US National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health, and the US National Science Foundation supported the research.

Source: Penn State