Realistic population dynamics in epidemiological models: the impact of population decline on the dynamics of childhood infectious diseases. Measles in Italy as an example

Most contributions in the field of mathematical modelling of childhood infectious diseases transmission dynamics have focused on stationary or exponentially growing populations. In this paper an epidemiological model with realistic demography is used to investigate the impact of the non-equilibrium conditions typical of the transition to sustained below replacement fertility (BRF) recently observed in a number of western countries, upon the transmission dynamics of measles. The results depend on the manner we model the relation between the (changing) age distribution of the population and contacts. Under some circumstances the transitional ageing phase typical of BRF populations might complexly interact with epidemiological variables leading to (i) a substantial reduction in the amount of vaccination effort required for eliminating the disease; (ii) a significant magnification of the perverse impact of vaccination in terms of the burden of severe age related morbidity