The Path to Measles Elimination in the United States

Abstract

The eradication of infectious diseases has been of key interest for many years. While the World Health Organization (WHO) and other health organizations typically track the progress of disease eradication based on whether regions are meeting their eradication targets, being able to quantify and/or visually track the eradication of a disease could prove beneficial. This thesis creates the “canonical path” to the elimination of measles in the United States (US), using similar methods as defined by Graham et al. [1]. We build on preliminary work conducted to fulfill the requirements of an Honours Bachelor of Science in Integrated Science at McMaster University, and the analysis conducted by Graham et al. [1], through the investigation of the sensitivity of the path to changes in its definition, as well how the path changes when we change the characteristics of the disease. This thesis demonstrates the ability to use a canonical path on a smaller, country-level scale, by using United States (US) state level data to create the US canonical path. We also determine the model structures necessary to simulate the canonical path, which suggests that the canonical path method is most useful for eradicable diseases for which we have ample knowledge of the disease, including the natural history of infection and vaccination. We also predict how the path is affected by the pattern of seasonality and by the natural history of infection. Overall, the analysis suggests that the more this method is implemented for other countries that have eliminated measles or for other diseases for which we have achieved elimination, we may gain insight of the successes and failures of elimination strategies. This knowledge could help the WHO and other organizations improve their disease elimination and eradication strategies in the future.