Risk analysis for the reintroduction and transmission of measles in the post-elimination period in the Americas/ Analisis del riesgo de reintroduccion y transmision del sarampion durante el periodo posterior a la eliminacion en la Region de las Americas/ Analise do risco de reintroducao e transmissao do sarampo no periodo pos-eliminacao nas Americas

Objective. To propose and test a model for analyzing municipalities' level of risk of reintroduction and transmission of the measles virus in the post-elimination period in the Americas. Methods. An ecological-analytical study was conducted using data on the measles epidemic that occurred in 2013-2015 in northeastern Brazil. The variables for analysis were selected after an extensive review of scientific literature on the risk of importation of measles cases. A univariate analysis considering the presence or absence of confirmed cases of measles in 184 municipalities in the state of Ceara, Brazil, was carried out to evaluate the association between the dependent variable and 23 independent variables, grouped into four categories: 1) characteristics of the municipalities; 2) quality indicators for immunization programs and epidemiological surveillance; 3) organizational structure for the public health response; and 4) selected impact indicators. A P value < 0.05 was considered significant. All variables with P < 0.200 were analyzed using multivariate logistic regression. Based on the results, the municipalities were categorized by four levels of risk ("low," "medium," "high," and "very high"). Results. The model sensitivity was 95% for concordance between municipalities classified as "high risk" and "very high risk" and those that had an epidemic between 2013 and 2015 in Ceara. Of the 38 municipalities that had an epidemic, 76% (29/38) were classified as "high risk" and "very high risk"; 146 municipalities did not report cases (P < 0.0002). Conclusions. Given the imminent risk of reintroduction of measles circulation in the post-elimination period in the Americas, this model may be useful in identifying areas at greater risk for reintroduction and continued transmission of measles. Knowledge of vulnerable areas could trigger appropriate surveillance and monitoring to prevent sustained transmission. Keywords Epidemiology; risk assessment; disease eradication; Brazil. Objetivo. Proponer y poner a prueba un modelo para analizar el nivel de riesgo de reintroduccion y transmision del virus del sarampion que existe en los municipios durante el periodo posterior a la eliminacion en la Region de las Americas. Metodos. Se realizo un estudio ecologico y analitico empleando datos sobre la epidemia de sarampion que afecto al noreste del Brasil del 2013 al 2015. Las variables para el analisis se seleccionaron despues de efectuar un amplio examen de las publicaciones cie