{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:43:29Z","timestamp":1793655809105,"version":"4.5.1"},"reference-count":47,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2014,8,14]],"date-time":"2014-08-14T00:00:00Z","timestamp":1407974400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Measles vaccination is estimated to have averted 13\u00b78 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (\u2a7e50\u00a0000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.<\/jats:p>","DOI":"10.1017\/s0950268814001988","type":"journal-article","created":{"date-parts":[[2014,8,14]],"date-time":"2014-08-14T14:50:10Z","timestamp":1408027810000},"page":"1457-1466","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":68,"title":["Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa"],"prefix":"10.1017","volume":"143","author":[{"given":"C. J. E.","family":"METCALF","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"TATEM","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. N.","family":"BJORNSTAD","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"LESSLER","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"O'REILLY","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"TAKAHASHI","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"CUTTS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.T.","family":"GRENFELL","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2014,8,14]]},"reference":[{"key":"S0950268814001988_ref31","first-page":"1","article-title":"Minimum levels of coverage needed for rubella vaccination: impact of local demography, seasonality and population heterogeneity","volume":"16","author":"Metcalf","year":"2012","journal-title":"Epidemiology and Infection"},{"key":"S0950268814001988_ref36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0031743"},{"key":"S0950268814001988_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2010.06.011"},{"key":"S0950268814001988_ref18","doi-asserted-by":"publisher","DOI":"10.3201\/eid1303.060391"},{"key":"S0950268814001988_ref26","first-page":"301","article-title":"Rubella vaccines: WHO position paper","volume":"86","year":"2011","journal-title":"Weekly Epidemiological Record"},{"key":"S0950268814001988_ref29","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/7.Supplement_1.S2"},{"key":"S0950268814001988_ref17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040016"},{"key":"S0950268814001988_ref6","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.12.110726"},{"key":"S0950268814001988_ref45","doi-asserted-by":"publisher","DOI":"10.1126\/science.1210554"},{"key":"S0950268814001988_ref33","unstructured":"ICF International. Demographic and Health Surveys (various) [Benin 2001: BJKR41FL.dta, BJGE42FL.dbf; Burkina Faso 2003 BFKR42FL.dta, BFGE43FL.dbf; Burkina Faso 2010: BFKR61FL.dta, BFGE61FL.dbf; Burundi 2010: BUKR61FL.dta, BUGE61FL.dbf; Cameroon 2004: CMKR44FL.dta, CMGE42FL.dbf; Cameroon 2011: CMKR60FL.dta, CMGE61FL.dbf; Congo (DRC 2007: CDKR50FL.dta, CDGE52FL.dbf; Egypt 2000: EGKR41FL.dta, EGGE42FL.dbf; Egypt 2005: EGKR51FL.dta, EGGE52FL.dbf; Egypt 2008: EGKR5AFL.dta, EGGE5DFL.dbf; Ethiopia 2000: ETKR41FL.dta, ETGE42FL.dbf; Ethiopia 2005: ETKR51FL.dta,ETGE52FL.dbf; Ethiopia 2011: ETKR61LF.dta, ETGE61FL.dbf; Ghana 2003: GHKR4BFL.dta, GHGE4BFL.dbf; Ghana 2008: GHKR5AFL.dta, GHGE5AFL.dbf; Guinea 2005: GNKR52FL.dta, GNGE52FL.dbf; Kenya 2003: KEKR42FL.dta, KEGE43FL.dbf; Kenya 2008\u20132009: KEKR52Fl.dta, KEGE52FL.dbf; Lesotho 2004; LSKR41FL.dta, LSGE42FL.dbf; Lesotho 2009: LSKR60FL.dta, LSGE62FL.dbf; Liberia 2007: LBKR51FL.dta, LBGE52FL.dbf, Madagascar 2008\u20132009: MDKR51FL.dta, MDGE53FL.dbf; Malawi 2000: MWKR41FL.dta, MWGE43FL.dbf; Malawi 2004: MWKR4CFl.dta, MWGE4BFL.dbf; Malawi 2010: MWKR4CFL.dta, MWGE4BFL.dbf; Mali 2001: MLKR41FL.dta, MLGE42FL.dbf; Mali 2006: MLKR52FL.dta, MLGE42FL.dbf; Morocco 2003: MAKR42FL.dta, MAGE43FL.dbf; Namibia 2000: NMKR41FL.dta, NMGE42FL.dbf; Namibia 2006: NMKR51FL.dta, NMGE52FL.dbf; Nigeria 2003: NGKR4BFL.dta, NGGE4BFL.dbf; Nigeria 2008: NGKR51FL.dta, NGGE52FL.dbf; Rwanda 2005: RWKR53FL.dta, RWGE54FL.dbf; Rwanda 2010: RWKR61FL.dta, RWGE61FL.dbf; Senegal 2005: SNKR4HFL.dta, SNGE4BFL.dbf; Senegal 2010: SNKR60FL.dta, SNGE61FL.dbf; Sierra Leone 2008: SLKR51FL.dta, SLGE53FL.dbf; Swaziland 2006: SZKR51FL.dta, SZGE53FL.dbf; Tanzania 1999: TZKR41FL.dta, TZGE43FL.dbf; Tanzania 2010: TZKR60FL.dta, TZGE61FL.dbf; Uganda 2000\u20132001: UGKR41FL.dta, UGGE43FL.dbf; Uganda 2006: UGKR51FL.dta, UGGE52FL.dbf; Uganda 2011: UGKR60FL.dta, UGGE61FL.dbf; Zambia 2007L ZNKR51FL.dta, ZMGE52FL.dbf; Zimbabwe 2005\u20132006: ZWKR51FL.dta, ZWGE52FL.dbf], 2012. 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Estimated travel time to the nearest city of 50,000 or more people in year 2000. Ispra, Italy, 2008 (http:\/\/bioval.jrc.ec.europa.eu\/products\/gam\/index.htm). 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