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Measles vaccine efficacy is higher at 12 months than 9 months because of maternal immunity, but delaying vaccination exposes the children most vulnerable to measles mortality to infection. We explored how this trade-off changes as a function of regionally varying epidemiological drivers, e.g. demography, transmission seasonality, and vaccination coverage. High birth rates and low coverage both favour early vaccination, and initiating vaccination at 9-11 months, then switching to 12-14 months can reduce case numbers. Overall however, increasing the age-window of vaccination decreases case numbers relative to vaccinating within a narrow age-window (e.g. 9-11 months). The width of the age-window that minimizes mortality varies as a function of birth rate, vaccination coverage and patterns of access to care. Our results suggest that locally age-targeted strategies, at both national and sub-national scales, tuned to local variation in birth rate, seasonality, and access to care may substantially decrease case numbers and fatalities for routine vaccination.

Original publication

DOI

10.1017/S0950268810001329

Type

Journal article

Journal

Epidemiol Infect

Publication Date

02/2011

Volume

139

Pages

265 - 274

Keywords

Aging, Delivery of Health Care, Female, Humans, Immunity, Maternally-Acquired, Immunization Schedule, Infant, Measles, Measles Vaccine, Models, Theoretical, Pregnancy, Seasons, Vaccination