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IJE Advance Access originally published online on January 30, 2008
International Journal of Epidemiology 2008 37(2):356-367; doi:10.1093/ije/dyn007
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Predicted impact of the HIV-1 epidemic on measles in developing countries: results from a dynamic age-structured model

Susana Scott1,*, Joel Mossong2, William J Moss3, Felicity T Cutts1 and Simon Cousens1

1 London School of Hygiene and Tropical Medicine, London, UK.
2 Laboratoire National de Santé, Luxembourg, Luxembourg.
3 Department of Epidemiology and W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

* Corresponding author. Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: susana.scott{at}lshtm.ac.uk


  Abstract

Background: Although measles incidence has been reduced to low levels in many countries, the potential exists for HIV-1 infection to enhance measles virus (MV) transmission and hinder measles control and elimination efforts.

Methods: HIV-1 infection was incorporated into an age-structured, deterministic compartmental model of MV transmission. Parameter estimates were obtained from published studies. The model was then adapted to simulate the introduction of antiretroviral therapy (ART).

Results: The model suggests that prior to the introduction of ART, HIV-1 infection has little impact on the transmission dynamics of MV. High mortality rates in HIV-1-infected children without access to ART counteract the higher rates of vaccine failure, shorter duration of maternal antibody protection and longer duration of infectiousness in HIV-1-infected children, as many of these children die before they are able to contribute to MV transmission. The introduction of ART into the model resulted in an increase in measles prevalence.

Conclusions: High overall mortality among HIV-1-infected children without access to ART limits the impact of the HIV-1 epidemic on MV transmission and may help to explain the initial success of measles control strategies in Africa. The scaling-up of ART should improve children's survival but could lead to an increase in measles prevalence in the absence of sustained measles control efforts. Further study of the duration of immunity in HIV-1-infected children receiving ART and their response to revaccination is needed to determine whether a second dose of measles vaccine will protect these children and further reduce MV transmission.

Keywords Measles, HIV-1, mathematical model, disease transmission, antiretroviral therapy, measles vaccine, Africa

Accepted 7 January 2008


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