Resolving the impact of waiting time distributions on the persistence of measles

Measles epidemics in human populations exhibit what is perhaps the best empirically characterized, and certainly the most studied, stochastic persistence threshold in population biology. A critical community size (CCS) of around 250 000-500 000 separates populations where measles is predominantly persistent from smaller communities where there are frequent extinctions of measles between major epidemics. The fundamental mechanisms contributing to this pattern of persistence, which are long-lasting immunity to re-infection, recruitment of susceptibles, seasonality in transmission, age dependence of transmission and the spatial coupling between communities, have all been quantified and, to a greater or lesser level of success, captured by theoretical models. Despite these successes there has not been a consensus over whether simple models can successfully predict the value of the CCS, or indeed which mechanisms determine the persistence of measles over a broader range of population sizes. Specifically, the level of the CCS has been thought to be particularly sensitive to the detailed stochastic dynamics generated by the waiting time distribution (WTD) in the infectious and latent periods. We show that the relative patterns of persistence between models with different WTDs are highly sensitive to the criterion of comparison-in particular, the statistical measure of persistence that is employed. To this end, we introduce two new statistical measures of persitence-fade-outs post epidemic and fade-outs post invasion. Contrary to previous reports, we demonstrate that, no matter the choice of persistence measure, appropriately parametrized models of measles demonstrate similar predictions for the level of the CCS.