Estimating Risk of Measles Virus Transmission in Countries with Measles Elimination Status: A Comparative Measles Seroprevalence Study.
Gong Lin Lin LL, Abudurusuli Guzainuer G, Zheng Fan F, Xie Jia Yuan JY et al.
Measles elimination is threatened by the virus's high infectivity (R 0 = 12-18), waning immunity, and persistent immunity gaps. No global study has compared measles seroprevalence before and after elimination. We assessed whether countries that had eliminated measles achieved and maintained the herd immunity threshold and identified key vulnerabilities. For countries with World Health Organization (WHO)-confirmed measles elimination, we systematically searched PubMed, Web of Science, and Google Scholar for seroprevalence data covering the three years before and the three years after elimination verification. Sample-size-weighted medians and interquartile ranges were calculated to describe seroprevalence, with stratified analyses by age group and country. The overall seroprevalence in the three years before and after elimination verification was also compared. Among 31 countries with measles elimination status (351 datasets comprising 562,772 participants), the overall median seroprevalence was 92.8%. Seroprevalence increased significantly with age ( P < 0.001), from 56.5% among infants (aged 0-1 years) to 96.8% among older adults (aged > 40 years). Twenty-six percent of the countries had a seroprevalence of ≥ 92%, indicating a low risk of measles transmission, whereas 45% had a seroprevalence of < 85%, indicating a substantial transmission risk. The median seroprevalence decreased significantly from 94.9% during the three years before elimination verification to 83.5% during the three years after verification ( P < 0.001). Achieving measles elimination does not guarantee that population-level protection will be sustained. Despite high overall seroprevalence, important immunity gaps persist among infants and young children, and some countries do not maintain the required herd immunity threshold following elimination. Targeted interventions are needed to close immunity gaps and strengthen national population immunity to prevent measles resurgence.