Skip to main content Accesibility Help

Measles hotspots and epidemiological connectivity

  • N. BHARTI (a1), A. DJIBO (a2), M. J. FERRARI (a1), R. F. GRAIS (a3), A. J. TATEM (a4), C. A. McCABE (a5), O. N. BJORNSTAD (a1) (a6) (a7) and B. T. GRENFELL (a1) (a7)...

Though largely controlled in developed countries, measles remains a major global public health issue. Regional and local transmission patterns are rooted in human mixing behaviour across spatial scales. Identifying spatial interactions that contribute to recurring epidemics helps define and predict outbreak patterns. Using spatially explicit reported cases from measles outbreaks in Niger, we explored how regional variations in movement and contact patterns relate to patterns of measles incidence. Because we expected to see lower rates of re-introductions in small, compared to large, populations, we measured the population-size corrected proportion of weeks with zero cases across districts to understand relative rates of measles re-introductions. We found that critical elements of spatial disease dynamics in Niger are agricultural seasonality, transnational contact clusters, and roads networks that facilitate host movement and connectivity. These results highlight the need to understand local patterns of seasonality, demographic characteristics, and spatial heterogeneities to inform vaccination policy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Measles hotspots and epidemiological connectivity
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Measles hotspots and epidemiological connectivity
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Measles hotspots and epidemiological connectivity
      Available formats
Corresponding author
*Author for correspondence: Dr N. Bharti, Penn State University, 208 Mueller Laboratory, University Park, PA 16802, USA. (Email:
Hide All
1.Cliff, AD, Haggett, P, Smallman-Raynor, M. Measles: An Historical Geography of a Major Human Viral Disease from Global Expansion to Local Retreat, 1840–1990. Oxford, UK; Cambridge, MA, USA: Blackwell, 1993, 462 pp.
2.McLean, AR, Anderson, RM. Measles in developing countries. 2. The predicted impact of mass vaccination. Epidemiology and Infection 1988; 100: 419442.
3.Strebel, P, et al. The unfinished measles immunization agenda. Journal of Infectious Diseases 2003; 187: S1S7.
4.Nandy, R, et al. Case-fatality rate during a measles outbreak in Eastern Niger in 2003. Clinical Infectious Diseases 2006; 42: 7.
5.Grais, RF, et al. Unacceptably high mortality related to measles epidemics in Niger, Nigeria, and Chad. PLOS Medicine 2007; 4: 122129.
6.Fine, PEM, Clarkson, JA. Measles in England and Wales.1. An analysis of factors underlying seasonal patterns. International Journal of Epidemiology 1982; 11: 5–14.
7.Fine, PEM, Clarkson, JA. Measles in England and Wales. 3. Assessing Published predictions of the impact of vaccination on incidence. International Journal of Epidemiology 1983; 12: 332339.
8.Bolker, B, Grenfell, B. Space, persistence and dynamics of measles epidemics. Philosophical Transactions of the Royal Society of London Series B: Biological Sciences 1995; 348: 309320.
9.Earn, DJD, et al. A simple model for complex dynamical transitions in epidemics. Science 2000; 287: 667670.
10.Grenfell, BT, Bjornstad, ON, Kappey, J. Travelling waves and spatial hierarchies in measles epidemics. Nature 2001; 414: 716723.
11.Bjornstad, ON, Finkenstadt, BF, Grenfell, BT. Dynamics of measles epidemics: Estimating scaling of transmission rates using a time series SIR model. Ecological Monographs 2002; 72: 169184.
12.Schenzle, D. An age-structured model of pre- and post-vaccination measles transmission. IMA Journal of Mathematics Applied in Medicine and Biology 1984; 1: 169191.
13.Bartlett, MS. Measles periodicity and community size. Journal of the Royal Statistical Society Series A: General 1957; 120: 4870.
14.Ferrari, MJ, et al. The dynamics of measles in sub-Saharan Africa. Nature 2008; 451: 679684.
15.Niger Ministry of Health. Written communication, 2008.
16.Faulkingham, RH, Thorbahn, PF. Population dynamics and drought: a village in Niger. Population Studies 1975; 29: 463477.
17.Raynaut, C. Societies and nature in the Sahel: ecological diversity and social dynamics. Global Environmental Change 2001; 11: 9–18.
18.Rain, D. Eaters of the Dry Season: Circular Labor Migration in the West African Sahel. Boulder, CO: Westview Press, 1999, 266 pp.
19.Grenfell, BT, Bjornstad, ON, Finkenstadt, BF. Dynamics of measles epidemics: scaling noise, determinism, and predictability with the TSIR model. Ecological Monographs 2002; 72: 185202.
20.Central Intelligence Agency. World Factbook. Washington, D.C.: Central Intelligence Agency, 2009.
21.WHO. World health statistics: health service coverage indicators. WHO Global Health Atlas. World Health Organization, 2003.
22.IRIN News. Nigeria: Measles kills more than 500 children so far in 2005. IRIN. Abuja: UN Office for the Coordination of Humanitarian Affairs, 2005.
23.Costa, GD.Measles outbreak hits Northern Nigerian state. Voice of America. Abuja (, 2008.
24.Keeling, MJ, Grenfell, BT. Understanding the persistence of measles: reconciling theory, simulation and observation. Proceedings of the Royal Society of London Series B: Biological Sciences 2002; 269: 335343.
25.Xia, YC, Bjornstad, ON, Grenfell, BT. Measles metapopulation dynamics: a gravity model for epidemiological coupling and dynamics. American Naturalist 2004; 164: 267281.
26.Bjornstad, ON, Grenfell, BT. Hazards, spatial transmission and timing of outbreaks in epidemic metapopulations. Environmental and Ecological Statistics, 2008; 15: 265277.
27.World Health Organization Regional Office for Africa. Evaluation guidelines for measles supplemental immunization activities, 2006.
28.Yameogo, KR, et al. Migration as a risk factor for measles after a mass vaccination campaign, Burkina Faso, 2002. International Journal of Epidemiology 2005; 34: 556564.
29.Camargo, MCC, et al. Predictors related to the occurence of a measles epidemic in the city of Sao Paulo in 1997. Revista Panamericana de Salud Pública 2000; 7: 359365.
30.Moran, PAP. Notes on continuous stochastic phenomena. Biometrika 1950; 37: 1723.
31.Wolfson, LJ, et al. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study. Lancet 2007; 369: 191200.
32.NOAA National Weather Service. NOAA CPC Morphing Technique (‘CMORPH’). 2009.
33.Hijmans, R, et al. Global Administrative Areas (version 0.9). University of California, Berkeley, Museum of Vertebrate Zoology, and the International Rice Research Institute, 2008.
34.Balk, D, et al. Determining global population distribution: methods, applications and data. Advances in Parasitology 2006; 62: 119156.
35.Center for International Earth Science Information Network (CIESIN). Columbia University and Centro Internacional de Agricultura Tropical (CIAT). Gridded Population of the World Version 3 (GPWv3): Population Density Grids. Palisades: Socioeconomic Data and Applications Center (SEDAC), Columbia University, 2005.
36.FEWS NET. Africa Data Dissemination Service.
37.National Imagery and Mapping Agency. VMAP0. National Imagery and Mapping Agency, 1997.
38.Miles WFS. Development, not division: local versus external perceptions of the Niger-Nigeria boundary. Journal of Modern African Studies 2005; 43: 297320.
39.Vennemann, K. The population of Niger – distribution and development. In: von Oppen, M, ed. Adapted Farming in West Africa: Issues, Potentials and Perspectives. University of Hohenheim, 2000, pp. 8388.
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

Bharti supplementary material

 Word (144 KB)
144 KB
Supplementary materials

Bharti supplementary material
Figure S1.doc

 Word (197 KB)
197 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed