Skip to main content
    • Aa
    • Aa

Global importation and population risk factors for measles in New Zealand: a case study for highly immunized populations

  • D. T. S. HAYMAN (a1), J. C. MARSHALL (a1), N. P. FRENCH (a1), T. E. CARPENTER (a2), M. G. ROBERTS (a3) and T. KIEDRZYNSKI (a4)...

As endemic measles is eliminated through immunization, countries must determine the risk factors for the importation of measles into highly immunized populations to target control measures. Despite eliminating endemic measles, New Zealand suffers from outbreaks after introductions from abroad, enabling us to use it as a model for measles introduction risk. We used a generalized linear model to analyze risk factors for 1137 measles cases from 2007 to June 2014, provide estimates of national immunity levels, and model measles importation risk. People of European ethnicity made up the majority of measles cases. Age is a positive risk factor, particularly 0–2-year-olds and 5–17-year-old Europeans, along with increased wealth. Pacific islanders were also at greater risk, but due to 0–2-year-old cases. Despite recent high measles, mumps, and rubella vaccine immunization coverage, overall population immunity against measles remains ~90% and is lower in people born between 1982 and 2005. Greatest measles importation risk is during December, and countries predicted to be sources have historical connections and highest travel rates (Australia and UK), followed by Asian countries with high travel rates and higher measles incidences. Our results suggest measles importation due to travel is seeding measles outbreaks, and immunization levels are insufficient to continue to prevent outbreaks because of heterogeneous immunity in the population, leaving particular age groups at risk.

Corresponding author
*Author for correspondence: D. T. S. Hayman, EpiLab, Infectious Diseases Research Centre, Massey University, Palmerston North 4442, New Zealand. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2. AD Lopez , Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The Lancet 2006; 367(9524): 17471757.

8. M Roberts , M Tobias . Predicting and preventing measles epidemics in New Zealand: application of a mathematical model. Epidemiology and Infection 2000; 124(02): 279287.

11. J Wallinga , Estimation of measles reproduction ratios and prospects for elimination of measles by vaccination in some Western European countries. Epidemiology and Infection 2001; 127(02): 281295.

18. MJ Crawley . The R Book. Chichester, UK: John Wiley & Sons, 2012.

21. S Waaijenborg , Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. Journal of Infectious Diseases 2013; 208(1): 1016.

26. D Hungerford , Effect of socioeconomic deprivation on uptake of measles, mumps and rubella vaccination in Liverpool, UK over 16 years: a longitudinal ecological study. Epidemiology and Infection 2016; 144(06): 12011211.

31. E Miller , Antibodies to measles, mumps and rubella in UK children 4 years after vaccination with different MMR vaccines. Vaccine 1995; 13(9): 799802.

32. N Boulianne , Measles, mumps, and rubella antibodies in children 5–6 years after immunization: effect of vaccine type and age at vaccination. Vaccine 1995; 13(16): 16111616.

33. JP Vandenbroucke , Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4(10): e297.

35. D Hungerford , Risk factors for transmission of measles during an outbreak: matched case–control study. Journal of Hospital Infection 2014; 86(2): 138143.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Hayman supplementary material
Figures S1-S3 and Tables S1-S4

 Word (153 KB)
153 KB


Altmetric attention score

Full text views

Total number of HTML views: 24
Total number of PDF views: 80 *
Loading metrics...

Abstract views

Total abstract views: 358 *
Loading metrics...

* Views captured on Cambridge Core between 17th April 2017 - 22nd September 2017. This data will be updated every 24 hours.