Epidemics, Air Travel, and Elimination in a Globalized World: The Case of Measles

Abstract

Although the United States (U.S.) declared measles eliminated in 2000, so long as measles circulates globally, continued importations will trigger sporadic U.S. outbreaks. The United States is highly connected to the rest of the world, and importations occur largely as a result of air travel by U.S. residents and international visitors. We developed a model to assess the risk of measles virus importation from Europe, Asia, and Africa through air travel. We projected 308 (95% prediction interval, 151-518) total measles cases imported from 66 countries during 2006-2015; 290 importations were reported. The model projected a spike in importation risk from Israel during October 2018, coincident with large, importationtriggered outbreaks in New York and New Jersey. Our model shows U.S. importation risk primarily originates from European and Asian countries. Models such as this inform preemptive actions to mitigate infectious disease threats, but only if we prioritize global surveillance and data sharing. Abstract word count: 150Manuscript word count: 4,802

Air Passenger Travel and International Surveillance Data Predict Spatiotemporal Variation in Measles Importations to the United States

“…Lack of data with which to validate estimates of country of origin limited our ability to draw conclusions about a causal relationship between model inputs and predicted case origins. Another study [ 30 ] was able to make use of more detailed information about imported case origin and month of detection held internally by the US CDC, which enabled monthly predictions of imported case magnitude and origin that we were unable to produce. Although it would be ideal to perform our analysis and share results in real time, the data necessary to implement such an analysis are not readily available.…”

Air passenger travel and international surveillance data predict spatiotemporal variation in measles importations to the United States

“…Lack of data with which to validate estimates of country of origin limited our ability to draw conclusions about a causal relationship between model inputs and predicted case origins. Another study (45) was able to make use of more detailed information about imported case origin and month of detection held internally by the US CDC, which enabled monthly predictions of imported case magnitude and origin that we were unable to produce. Although it would be ideal to perform our analysis and share results in real time, the data necessary to implement such an analysis are not readily available.…”

Commercially available rapid diagnostic tests for the detection of high priority pathogens: status and challenges

“…We have experienced the long-transmission potential of global air travel during the last twenty years spreading emerging pathogens. 4 The SARS coronavirus emerged in 2002 in China and quickly spread to more than 30 countries, resulting in more than 8000 cases and around 774 deaths worldwide. 29 In 2009, the H1N1 influenza pandemic originated in Mexico and spread worldwide, causing 284 000 deaths.…”

“…tions and animals, resulting in the exchange of pathogens and a speeding up of diseases. 4 Colonization expeditions, the foundation and expansion of cities, the opening of new and exotic trade routes, and lately, the phenomenon of globalization have contributed to the development and improvement of human life and increased risks of pandemics occurring. 5 Simultaneously, scientific advances, an increase in the understanding of diseases, and improved life and hygienic conditions have been instrumental in preventing, controlling, and mitigating disease outbreaks.…”