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Estimating the measles effective reproduction number in Australia from routine notification data d.

National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.(Submitted: 06 June 2013 Revised version received: 10 October 2013 Accepted: 11 October 2013 Published online: 09 December 2013.)Between 2000 and 2010, the global incidence of measles and the mortality caused by the disease decreased by 66% and 74%, respectively.1 jual agenda louis vuitton The implementation of childhood and supplementary immunization activities by Member States of the World Health Organization (WHO) has largely contributed to these declines. One approach to monitoring measles elimination involves estimating the effective reproduction number (R). R is the average number of secondary cases that result from an infectious case in a particular population (Box 1).12 R depends on the level of susceptibility in the population, in contrast to the basic reproduction number (R0), which is the average number of secondary cases arising from one infectious case in a totally susceptible population. When R is 12 Box 1. Definitions 1. 2. Generation of outbreak spread:11 Same generation: Disease onset date between the first and last case was 0 6 days apart. One generation: Disease onset date between the first and last case was 7 14 days apart. Two generations: Disease onset date between the louis vuitton evidence authentication first and last case was 15 24 days apart. Additional generations: A 10 day difference between the disease onset date of the first and last case added an extra generation. 3. Outbreak reference number: a unique identification number assigned to cases that were determined to be part of the same outbreak on louis vuitton neverfull authentic the basis of epidemiological (and/or virological) evidence. 4. Effective reproduction number (R):12 R = 1: This is a state of endemic equilibrium in which, on average, one case results in one secondary infection. Alternatively, routinely collected notification data can be used to estimate R on a regular basis with minimal resources. These methods to estimate R were described by De Serres et al.12 and require the following data: the proportion of cases imported, the distribution of outbreak sizes and the distribution of the number of generations of spread in each outbreak.12 An assumption required when using these methods is that elimination has already been achieved. Methods based on routinely collected notification data have been used to differing extents internationally11,18 and in Australia. Canada and the United States of America both reported the interruption of indigenous measles transmission by 1998 and used the methods described by De Serres et al. Therefore, the aim of our study was to use routinely collected notification data to estimate R and track measles elimination in Australia. In Australia, measles is a notifiable disease in all states and territories. Confirmed cases require either laboratory confirmed evidence of measles virus infection or both clinical and epidemiological evidence.21 De identified data were obtained from the NNDSS data set for all notified measles cases between 2009 and 2011. Data fields used in the analysis included place (country) of acquisition, outbreak reference number (Box 1) and date of symptom onset (if this was missing, the date of diagnosis was used). A flowchart was developed to link cases for which data on the outbreak reference number were missing (Fig. 1). Fig. 1. Flowchart to determine links between measles cases for which outbreak reference numbers were missing If the place of acquisition was overseas, cases were considered sporadic unless they had the earliest onset date among cases in an identified outbreak and all other cases in the outbreak were locally acquired. If more than 1 case louis vuitton alma epi fuchsia was acquired overseas in the same outbreak, the imported case most temporally similar to locally acquired cases was considered the index case, whereas the other imported case was considered sporadic. All remaining cases for which place of acquisition was local and outbreak reference number was missing were defined as sporadic. For cases belonging to the same outbreak, the generation of the spread of infection was derived from a previously published algorithm (Box 1).11 Three methods were used to estimate R for 2009 to 2011 combined and for 2009, 2010 and 2011 individually.

In method 1, R was estimated as 1 P, where P is equal to the proportion of cases that were imported, as determined from data on place of acquisition. The derivation of this formula is available in the article by De Serres et al.;12 the formula assumes that all cases must be linked to an imported case and depletion of the pool of susceptible individuals can be ignored.


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