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A recent outbreak of measles in Okinawa Prefecture, Japan ended with 33 measles cases whose symptoms were masked because of insufficient protection against the disease (modified measles). Using quantitative modelling, we determined the transmission potential of measles by clinical presentation (classic vs modified measles). We found low ascertainment probabilities among modified measles cases, indicating that intensified public health interventions that specifically target this group should be implemented to better contain outbreaks with modified measles cases.


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