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

Shi Zhao; Xiujuan Tang; Xue Liang; Marc K C Chong; Jinjun Ran; Salihu S Musa; Guangpu Yang; Peihua Cao; Kai Wang; Benny C Y Zee; Xin Wang; Daihai He; Maggie H Wang

doi:10.2147/IDR.S258035

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

Infect Drug Resist. 2020 Jun 17:13:1851-1861. doi: 10.2147/IDR.S258035. eCollection 2020.

Authors

Shi Zhao^#^{1

2}, Xiujuan Tang^#³, Xue Liang^#⁴, Marc K C Chong^{1

2}, Jinjun Ran⁵, Salihu S Musa⁶, Guangpu Yang⁷, Peihua Cao⁸, Kai Wang⁹, Benny C Y Zee^{1

2}, Xin Wang³, Daihai He⁶, Maggie H Wang^{1

2}

Affiliations

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

^# Contributed equally.

Abstract

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, R _eff(t), and basic reproduction number, R ₀(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 R ₀ is 10.09 (95% CI: 1.73-36.50). We found that R ₀(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, r ₀, was 14.67 (95% CI: 9.01-45.32) under the no-measure scenario, which increased the average R ₀ 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: airport; measles; outbreak; public awareness; reproduction number; statistical modelling.

Grants and funding

Daihai He was supported by General Research Fund (No. 15205119) of Research Grants Council of Hong Kong and an Alibaba (China)-Hong Kong Polytechnic University Collaborative Research project. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.