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Modelling the Measles Outbreak at Hong Kong International Airport in 2019: A Data-Driven Analysis on the Effects of Timely Reporting and Public Awareness

Authors Zhao S, Tang X, Liang X, Chong MKC, Ran J, Musa SS, Yang G, Cao P, Wang K, Zee BCY, Wang X, He D, Wang MH

Received 13 April 2020

Accepted for publication 20 May 2020

Published 17 June 2020 Volume 2020:13 Pages 1851—1861


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Shi Zhao,1,2,* Xiujuan Tang,3,* Xue Liang,4,* Marc KC Chong,1,2 Jinjun Ran,5 Salihu S Musa,6 Guangpu Yang,7 Peihua Cao,8 Kai Wang,9 Benny CY Zee,1,2 Xin Wang,3 Daihai He,6 Maggie H Wang1,2

1Division of Biostatistics, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 2Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, People’s Republic of China; 3Shenzhen Center for Disease Control and Prevention, Shenzhen, People’s Republic of China; 4Department of Hematology, The 989th Hospital of the Joint Logistics Support Force of Chinese PLA, Luoyang 471031, People’s Republic of China; 5School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People’s Republic of China; 6Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, People’s Republic of China; 7Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 8Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 9Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi 830011, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shi Zhao; Daihai He Email;

Background: Measles, a highly contagious disease, still poses a huge burden worldwide. Lately, a trend of resurgence threatened the developed countries. A measles outbreak occurred in the Hong Kong International Airport (HKIA) between March and April 2019, which infected 29 airport staff. During the outbreak, multiple measures were taken including daily situation updates, setting up a public enquiry platform on March 23, and an emergent vaccination program targeting unprotected staff. The outbreak was put out promptly. The effectiveness of these measures was unclear.
Methods: We quantified the transmissibility of outbreak in HKIA by the effective reproduction number, Reff(t), and basic reproduction number, R0(t). The reproduction number was modelled as a function of its determinants that were statistically examined, including lags in hospitalization, situation update, and level of public awareness. Then, we considered a hypothetical no-measure scenario when improvements in reporting and public enquiry were absent and calculated the number of infected airport staff.
Results: Our estimated average R0 is 10.09 (95% CI: 1.73− 36.50). We found that R0(t) was positively associated with lags in hospitalization and situation update, while negatively associated with the level of public awareness. The average predicted basic reproduction number, r0, was 14.67 (95% CI: 9.01− 45.32) under the no-measure scenario, which increased the average R0 by 77.57% (95% CI: 1.71− 111.15). The total number of infected staff would be 179 (IQR: 90− 339, 95% CI: 23− 821), namely the measure induced 8.42-fold (95% CI: 0.21− 42.21) reduction in the total number of infected staff.
Conclusion: Timely reporting on outbreak situation and public awareness measured by the number of public enquiries helped to control the outbreak.

Keywords: measles, outbreak, reproduction number, statistical modelling, public awareness, airport

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