Estimating the risk and spatial spread of measles in populations with high MMR uptake: Using school-household networks to understand the 2013 to 2014 outbreak in the Netherlands
PLOS Medicine·
- DOI
- 10.1371/journal.pmed.1004466
- PMID
- 39378236
- PMCID
- PMC11495615
- OpenAlex
- W4403213075
- Study type
- Guideline
- Publisher
- Public Library of Science (PLoS)
- Article type
- journal-article
- Integrity
- current
Why this research matters now
Clustering of unvaccinated children across primary and connected secondary schools can sustain sizable measles outbreaks even where national coverage exceeds 95%, suggesting that school-network structure is relevant for outbreak preparedness and response.
Structured evidence summary
Research question
The study examines how contacts between unvaccinated children in schools and households can enable measles outbreaks in a high MMR-uptake country.
Study design
Network-based modelling study using a constructed national school network parameterised by household and school-level administrative data, evaluated against empirical measles case data from a 2013 outbreak.
Population and setting
All primary and secondary schools in the Netherlands, with model parameterisation using Dutch Ministry of Education data and MMR uptake figures; evaluation against postcode-level case data from the 2013 outbreak (2,766 cases).
Main findings
Schools with low MMR uptake were highly connected via household sibling pairs (CHI = 0.63). A network-based model reproduced the observed size and spatial distribution of the 2013 outbreak more closely than alternatives, achieving a case-weighted ROC sensitivity of 0.94 versus 0.17 and 0.26 for simpler models.
Public-health relevance
Clustering of unvaccinated children across primary and connected secondary schools can sustain sizable measles outbreaks even where national coverage exceeds 95%, suggesting that school-network structure is relevant for outbreak preparedness and response.
Important limitations
The authors explicitly state that the framework neglects transmission routes outside of school and household contexts. The summary is also limited to the supplied single-article abstract and metadata and would require the original paper for decision-grade interpretation.
GIDS interpretation
The paper describes a Netherlands-focused modelling and outbreak evaluation tool. Its discoverability is mainly for researchers and policymakers interested in network approaches to measles outbreak analysis; no connection to a live surveillance signal is made.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 18 auditable classifier relationships to diseases, places, topics, and study design.