The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

CMMID COVID-19 Working Group; C. N. Mburu; J. Ojal; R. Chebet; D. Akech; B. Karia; J. Tuju; A. Sigilai; K. Abbas; M. Jit; S. Funk; G. Smits; P. G.M. van Gageldonk; F. R.M. van der Klis; C. Tabu; D. J. Nokes; Stefan Flasche; J. Anthony G. Scott; Ifedayo Morayo O. Adetifa

doi:10.1186/s12916-021-01906-9

The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

CMMID COVID-19 Working Group, C. N. Mburu^*, J. Ojal, R. Chebet, D. Akech, B. Karia, J. Tuju, A. Sigilai, K. Abbas, M. Jit, S. Funk, G. Smits, P. G.M. van Gageldonk, F. R.M. van der Klis, C. Tabu, D. J. Nokes, Stefan Flasche, J. Anthony G. Scott, Ifedayo Morayo O. Adetifa

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

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Abstract

Background: The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region.

Methods: Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020.

Results: In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives.

Conclusion: While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

Original language	English
Article number	35
Journal	BMC Medicine
Volume	19
Issue number	1
Early online date	3 Feb 2021
DOIs	https://doi.org/10.1186/s12916-021-01906-9
Publication status	E-pub ahead of print - 3 Feb 2021

Bibliographical note

Funding Information: This research is funded by an MRC/DFID African Research Leader Fellowship (MR/S005293/1: IMOA, CNM, RC, and AS). IMOA and JAGS have received grants from the Gavi, the Vaccine Alliance. JA GS is funded by a Wellcome Trust Senior Research Fellowship (214320) and the NIHR Health Protection Research Unit in Immunisation. DJN is funded by the Department of International Development and Wellcome [220985/z/20/z]. We thank Dr. Laura Hammitt, Ms. Angela Karani, the residents of the Kilifi Health and Demographic Surveillance System, and the dedicated team of fieldworkers, administrative staff, clinicians, and laboratory staff who worked on this study. We acknowledge the continued collaboration of colleagues and the leadership in the Kilifi County Department of Health. This report is published with the permission of the Director of the Kenya Medical Research Institute.
This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: MJ). BMGF (OPP1157270: KA). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: MJ). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/137/109: MJ; NIHR200929: MJ; NIHR Global Health Research Unit on Mucosal Pathogens: JO). Wellcome Trust (208812/Z/17/Z: SFlasche; 210758/Z/18/Z: SFunk).
The following authors were part of the Centre for Mathematical Modelling of Infectious Disease 2019-nCoV working group. Each contributed in processing, cleaning, and interpretation of data, interpreted findings, contributed to the manuscript, and approved the work for publication: James D Munday, Carl A B Pearson, Simon R Procter, Oliver Brady, David Simons, Rachel Lowe, W John Edmunds, Katharine Sherratt, Rosanna C Barnard, Alicia Rosello, Adam J Kucharski, Fiona Yueqian Sun, Nikos I Bosse, Petra Klepac, Yang Liu, Kiesha Prem, Gwenan M Knight, Akira Endo, Sam Abbott, Emily S Nightingale, Thibaut Jombart, Jon C Emery, Georgia R Gore-Langton, Joel Hellewell, James W Rudge, Hamish P Gibbs, Kathleen O’Reilly, Kevin van Zandvoort, Yung-Wai Desmond Chan, Damien C Tully, Anna M Foss, Christopher I Jarvis, Katherine E. Atkins, Samuel Clifford, Matthew Quaife, Billy J Quilty, Rein M G J Houben, Rosalind M Eggo, Graham Medley, Sophie R Meakin, Timothy W Russell, Nicholas G. Davies, Charlie Diamond, Arminder K Deol, C Julian Villabona-Arenas, Stéphane Hué, Megan Auzenbergs, Quentin J Leclerc, Amy Gimma.
The following funding sources are acknowledged as providing funding for the working group authors. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: KP, YL; NTD Modelling Consortium OPP1184344: CABP, GFM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO’R, MA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). DTRA (HDTRA1-18-1-0051: JWR). Elrha R2HC/UK DFID/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: JCE, MQ, RMGJH). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, PK, RCB, WJE, YL). This research was partly funded by the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1: AG, CIJ, TJ). HDR UK (MR/S003975/1: RME). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, CD, FYS, YL; Health Protection Research Unit for Immunisation NIHR200929: NGD; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; PR-OD-1017-20002: AR, WJE). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: GRGL, QJL; MC_PC_19065: AG, NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). The authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, JH, KS, NIB, SA, SRM). No funding (AKD, AMF, CJVA, DCT, KEA, SH, YWDC).
Funding
The United Kingdom’s Medical Research Council and the Department for International Development.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © 2021, The Author(s).

Citation: Mburu, C.N., Ojal, J., Chebet, R. et al. The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya. BMC Med 19, 35 (2021).

DOI: https://doi.org/10.1186/s12916-021-01906-9

Keywords

COVID-19
Measles
Outbreak
Supplementary immunisation activities
Vaccination coverage

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

CMMID COVID-19 Working Group, Mburu, C. N., Ojal, J., Chebet, R., Akech, D., Karia, B., Tuju, J., Sigilai, A., Abbas, K., Jit, M., Funk, S., Smits, G., van Gageldonk, P. G. M., van der Klis, F. R. M., Tabu, C., Nokes, D. J., Flasche, S., Scott, J. A. G., & Adetifa, I. M. O. (2021). The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya. BMC Medicine, 19(1), Article 35. Advance online publication. https://doi.org/10.1186/s12916-021-01906-9

@article{49e39c5e2c6f4b2b9b11dc51752fa27b,

title = "The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya",

abstract = "Background: The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods: Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results: In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion: While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.",

keywords = "COVID-19, Measles, Outbreak, Supplementary immunisation activities, Vaccination coverage",

author = "{CMMID COVID-19 Working Group} and Mburu, {C. N.} and J. Ojal and R. Chebet and D. Akech and B. Karia and J. Tuju and A. Sigilai and K. Abbas and M. Jit and S. Funk and G. Smits and {van Gageldonk}, {P. G.M.} and {van der Klis}, {F. R.M.} and C. Tabu and Nokes, {D. J.} and Munday, {James D.} and Pearson, {Carl A.B.} and Procter, {Simon R.} and Oliver Brady and David Simons and Rachel Lowe and William Edmunds and Katharine Sherratt and Barnard, {Rosanna C.} and Alicia Rosello and Kucharski, {Adam J.} and Sun, {Fiona Yueqian} and Bosse, {Nikos I.} and Petra Klepac and Yang Liu and Kiesha Prem and Knight, {Gwenan M.} and Akira Endo and Sam Abbott and Nightingale, {Emily S.} and Thibaut Jombart and Emery, {Jon C.} and Gore-Langton, {Georgia R.} and Joel Hellewell and Rudge, {James W.} and Gibbs, {Hamish P.} and Kathleen O{\textquoteright}Reilly and {van Zandvoort}, Kevin and Chan, {Yung Wai Desmond} and Tully, {Damien C.} and Foss, {Anna M.} and Jarvis, {Christopher I.} and Atkins, {Katherine E.} and Samuel Clifford and Stefan Flasche and Scott, {J. Anthony G.} and Adetifa, {Ifedayo Morayo O.}",

note = "Funding Information: This research is funded by an MRC/DFID African Research Leader Fellowship (MR/S005293/1: IMOA, CNM, RC, and AS). IMOA and JAGS have received grants from the Gavi, the Vaccine Alliance. JA GS is funded by a Wellcome Trust Senior Research Fellowship (214320) and the NIHR Health Protection Research Unit in Immunisation. DJN is funded by the Department of International Development and Wellcome [220985/z/20/z]. We thank Dr. Laura Hammitt, Ms. Angela Karani, the residents of the Kilifi Health and Demographic Surveillance System, and the dedicated team of fieldworkers, administrative staff, clinicians, and laboratory staff who worked on this study. We acknowledge the continued collaboration of colleagues and the leadership in the Kilifi County Department of Health. This report is published with the permission of the Director of the Kenya Medical Research Institute. This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: MJ). BMGF (OPP1157270: KA). This project has received funding from the European Union{\textquoteright}s Horizon 2020 research and innovation programme - project EpiPose (101003688: MJ). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/137/109: MJ; NIHR200929: MJ; NIHR Global Health Research Unit on Mucosal Pathogens: JO). Wellcome Trust (208812/Z/17/Z: SFlasche; 210758/Z/18/Z: SFunk). The following authors were part of the Centre for Mathematical Modelling of Infectious Disease 2019-nCoV working group. Each contributed in processing, cleaning, and interpretation of data, interpreted findings, contributed to the manuscript, and approved the work for publication: James D Munday, Carl A B Pearson, Simon R Procter, Oliver Brady, David Simons, Rachel Lowe, W John Edmunds, Katharine Sherratt, Rosanna C Barnard, Alicia Rosello, Adam J Kucharski, Fiona Yueqian Sun, Nikos I Bosse, Petra Klepac, Yang Liu, Kiesha Prem, Gwenan M Knight, Akira Endo, Sam Abbott, Emily S Nightingale, Thibaut Jombart, Jon C Emery, Georgia R Gore-Langton, Joel Hellewell, James W Rudge, Hamish P Gibbs, Kathleen O{\textquoteright}Reilly, Kevin van Zandvoort, Yung-Wai Desmond Chan, Damien C Tully, Anna M Foss, Christopher I Jarvis, Katherine E. Atkins, Samuel Clifford, Matthew Quaife, Billy J Quilty, Rein M G J Houben, Rosalind M Eggo, Graham Medley, Sophie R Meakin, Timothy W Russell, Nicholas G. Davies, Charlie Diamond, Arminder K Deol, C Julian Villabona-Arenas, St{\'e}phane Hu{\'e}, Megan Auzenbergs, Quentin J Leclerc, Amy Gimma. The following funding sources are acknowledged as providing funding for the working group authors. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: KP, YL; NTD Modelling Consortium OPP1184344: CABP, GFM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO{\textquoteright}R, MA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). DTRA (HDTRA1-18-1-0051: JWR). Elrha R2HC/UK DFID/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: JCE, MQ, RMGJH). This project has received funding from the European Union{\textquoteright}s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, PK, RCB, WJE, YL). This research was partly funded by the Global Challenges Research Fund (GCRF) project {\textquoteleft}RECAP{\textquoteright} managed through RCUK and ESRC (ES/P010873/1: AG, CIJ, TJ). HDR UK (MR/S003975/1: RME). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, CD, FYS, YL; Health Protection Research Unit for Immunisation NIHR200929: NGD; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; PR-OD-1017-20002: AR, WJE). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: GRGL, QJL; MC_PC_19065: AG, NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). The authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, JH, KS, NIB, SA, SRM). No funding (AKD, AMF, CJVA, DCT, KEA, SH, YWDC). Funding The United Kingdom{\textquoteright}s Medical Research Council and the Department for International Development. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Publisher Copyright: {\textcopyright} 2021, The Author(s). Citation: Mburu, C.N., Ojal, J., Chebet, R. et al. The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya. BMC Med 19, 35 (2021). DOI: https://doi.org/10.1186/s12916-021-01906-9",

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CMMID COVID-19 Working Group, Mburu, CN, Ojal, J, Chebet, R, Akech, D, Karia, B, Tuju, J, Sigilai, A, Abbas, K, Jit, M, Funk, S, Smits, G, van Gageldonk, PGM, van der Klis, FRM, Tabu, C, Nokes, DJ, Flasche, S, Scott, JAG & Adetifa, IMO 2021, 'The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya', BMC Medicine, vol. 19, no. 1, 35. https://doi.org/10.1186/s12916-021-01906-9

TY - JOUR

T1 - The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

AU - CMMID COVID-19 Working Group

AU - Mburu, C. N.

AU - Ojal, J.

AU - Chebet, R.

AU - Akech, D.

AU - Karia, B.

AU - Tuju, J.

AU - Sigilai, A.

AU - Abbas, K.

AU - Jit, M.

AU - Funk, S.

AU - Smits, G.

AU - van Gageldonk, P. G.M.

AU - van der Klis, F. R.M.

AU - Tabu, C.

AU - Nokes, D. J.

AU - Munday, James D.

AU - Pearson, Carl A.B.

AU - Procter, Simon R.

AU - Brady, Oliver

AU - Simons, David

AU - Lowe, Rachel

AU - Edmunds, William

AU - Sherratt, Katharine

AU - Barnard, Rosanna C.

AU - Rosello, Alicia

AU - Kucharski, Adam J.

AU - Sun, Fiona Yueqian

AU - Bosse, Nikos I.

AU - Klepac, Petra

AU - Liu, Yang

AU - Prem, Kiesha

AU - Knight, Gwenan M.

AU - Endo, Akira

AU - Abbott, Sam

AU - Nightingale, Emily S.

AU - Jombart, Thibaut

AU - Emery, Jon C.

AU - Gore-Langton, Georgia R.

AU - Hellewell, Joel

AU - Rudge, James W.

AU - Gibbs, Hamish P.

AU - O’Reilly, Kathleen

AU - van Zandvoort, Kevin

AU - Chan, Yung Wai Desmond

AU - Tully, Damien C.

AU - Foss, Anna M.

AU - Jarvis, Christopher I.

AU - Atkins, Katherine E.

AU - Clifford, Samuel

AU - Flasche, Stefan

AU - Scott, J. Anthony G.

AU - Adetifa, Ifedayo Morayo O.

N1 - Funding Information: This research is funded by an MRC/DFID African Research Leader Fellowship (MR/S005293/1: IMOA, CNM, RC, and AS). IMOA and JAGS have received grants from the Gavi, the Vaccine Alliance. JA GS is funded by a Wellcome Trust Senior Research Fellowship (214320) and the NIHR Health Protection Research Unit in Immunisation. DJN is funded by the Department of International Development and Wellcome [220985/z/20/z]. We thank Dr. Laura Hammitt, Ms. Angela Karani, the residents of the Kilifi Health and Demographic Surveillance System, and the dedicated team of fieldworkers, administrative staff, clinicians, and laboratory staff who worked on this study. We acknowledge the continued collaboration of colleagues and the leadership in the Kilifi County Department of Health. This report is published with the permission of the Director of the Kenya Medical Research Institute. This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: MJ). BMGF (OPP1157270: KA). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: MJ). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/137/109: MJ; NIHR200929: MJ; NIHR Global Health Research Unit on Mucosal Pathogens: JO). Wellcome Trust (208812/Z/17/Z: SFlasche; 210758/Z/18/Z: SFunk). The following authors were part of the Centre for Mathematical Modelling of Infectious Disease 2019-nCoV working group. Each contributed in processing, cleaning, and interpretation of data, interpreted findings, contributed to the manuscript, and approved the work for publication: James D Munday, Carl A B Pearson, Simon R Procter, Oliver Brady, David Simons, Rachel Lowe, W John Edmunds, Katharine Sherratt, Rosanna C Barnard, Alicia Rosello, Adam J Kucharski, Fiona Yueqian Sun, Nikos I Bosse, Petra Klepac, Yang Liu, Kiesha Prem, Gwenan M Knight, Akira Endo, Sam Abbott, Emily S Nightingale, Thibaut Jombart, Jon C Emery, Georgia R Gore-Langton, Joel Hellewell, James W Rudge, Hamish P Gibbs, Kathleen O’Reilly, Kevin van Zandvoort, Yung-Wai Desmond Chan, Damien C Tully, Anna M Foss, Christopher I Jarvis, Katherine E. Atkins, Samuel Clifford, Matthew Quaife, Billy J Quilty, Rein M G J Houben, Rosalind M Eggo, Graham Medley, Sophie R Meakin, Timothy W Russell, Nicholas G. Davies, Charlie Diamond, Arminder K Deol, C Julian Villabona-Arenas, Stéphane Hué, Megan Auzenbergs, Quentin J Leclerc, Amy Gimma. The following funding sources are acknowledged as providing funding for the working group authors. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: KP, YL; NTD Modelling Consortium OPP1184344: CABP, GFM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO’R, MA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). DTRA (HDTRA1-18-1-0051: JWR). Elrha R2HC/UK DFID/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: JCE, MQ, RMGJH). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, PK, RCB, WJE, YL). This research was partly funded by the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1: AG, CIJ, TJ). HDR UK (MR/S003975/1: RME). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, CD, FYS, YL; Health Protection Research Unit for Immunisation NIHR200929: NGD; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; PR-OD-1017-20002: AR, WJE). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: GRGL, QJL; MC_PC_19065: AG, NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). The authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, JH, KS, NIB, SA, SRM). No funding (AKD, AMF, CJVA, DCT, KEA, SH, YWDC). Funding The United Kingdom’s Medical Research Council and the Department for International Development. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Publisher Copyright: © 2021, The Author(s). Citation: Mburu, C.N., Ojal, J., Chebet, R. et al. The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya. BMC Med 19, 35 (2021). DOI: https://doi.org/10.1186/s12916-021-01906-9

PY - 2021/2/3

Y1 - 2021/2/3

N2 - Background: The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods: Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results: In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion: While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

AB - Background: The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods: Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results: In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion: While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

KW - COVID-19

KW - Measles

KW - Outbreak

KW - Supplementary immunisation activities

KW - Vaccination coverage

UR - http://www.scopus.com/inward/record.url?scp=85100461807&partnerID=8YFLogxK

U2 - 10.1186/s12916-021-01906-9

DO - 10.1186/s12916-021-01906-9

M3 - Article

C2 - 33531015

AN - SCOPUS:85100461807

SN - 1741-7015

VL - 19

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 35

ER -

The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

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UN SDGs

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