Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar

Amy K. Winter, Amy Wesolowski, Keitly J. Mensah, Miora Bruna Ramamonjiharisoa, Andrianmasina Herivelo Randriamanantena, Richter Razafindratsimandresy, Simon Cauchemez, Justin T Lessler, Matt J. Ferrari, C. Jess E. Metcalf, Jean Michel Héraud

Research output: Contribution to journalArticle


Madagascar reports few measles cases annually and high vaccination campaign coverage. However, the underlying age profile of immunity and risk of a measles outbreak is unknown. We conducted a nested serological survey, testing 1,005 serum samples (collected between November 2013 and December 2015 via Madagascar's febrile rash surveillance system) for measles immunoglobulin G antibody titers. We directly estimated the age profile of immunity and compared these estimates with indirect estimates based on a birth cohort model of vaccination coverage and natural infection. Combining these estimates of the age profile of immunity in the population with an age-structured model of transmission, we further predicted the risk of a measles outbreak and the impact of mitigation strategies designed around supplementary immunization activities. The direct and indirect estimates of age-specific seroprevalence show that current measles susceptibility is over 10%, and modeling suggests that Madagascar may be at risk of a major measles epidemic.

Original languageEnglish (US)
Pages (from-to)2219-2226
Number of pages8
JournalAmerican Journal of Epidemiology
Issue number10
Publication statusPublished - Oct 1 2018



  • Madagascar
  • measles
  • rubella
  • serological survey
  • surveillance

ASJC Scopus subject areas

  • Epidemiology

Cite this

Winter, A. K., Wesolowski, A., Mensah, K. J., Ramamonjiharisoa, M. B., Randriamanantena, A. H., Razafindratsimandresy, R., ... Héraud, J. M. (2018). Revealing Measles Outbreak Risk with a Nested Immunoglobulin G Serosurvey in Madagascar. American Journal of Epidemiology, 187(10), 2219-2226.