A modified chain binomial model to analyse the ongoing measles epidemic in Greece, July 2017 to February 2018

Globally, infant and childhood vaccine uptake rates are not high enough to control vaccine preventable diseases, with outbreaks occurring even in high-income countries. This has led a number of high-, middle-and low income countries to enact, strengthen or contemplate mandatory infant and/or childhood immunization to try to address the gap. Mandatory immunization that reduces or eliminates individual choice is often controversial. There is no standard approach to mandatory immunization. What vaccines are included, age groups covered, program flexibility and rigidity e.g. opportunities for opting out, penalties or incentives, degree of enforcement, and whether a compensation program for causally associated serious adverse events following immunization exists vary widely. We present an overview of mandatory immunization with examples in two high- and one low-income countries to illustrate variations, summarize limited outcome data related to mandatory immunization, and suggest key elements to consider when contemplating mandatory infant and/or child immunization. Before moving forward with mandatory immunization, governments need to assure financial sustainability, uninterrupted supply and equitable access to all the population. Other interventions may be more effective and less intrusive than mandatory. If mandatory is implemented, this needs to be tailored to fit the context and the country's culture.

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Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps

MacDonald

Harmon

Dubé

et al. 2018

Vaccine

108

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Taking account of asymptomatic infections: A modeling study of the COVID-19 outbreak on the Diamond Princess cruise ship

Huang

Dunn

et al. 2021

PLoS ONE

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The COVID-19 outbreak on the Diamond Princess (DP) cruise ship has provided empirical data to study the transmission potential of COVID-19 with the presence of pre/asymptomatic cases. We studied the changes in R0 on DP from January 21 to February 19, 2020 based on chain binomial models under two scenarios: no quarantine assuming a random mixing condition, and quarantine of passengers in cabins—passengers may get infected either by an infectious case in a shared cabin or by pre/asymptomatic crew who continued to work. Estimates of R0 at the beginning of the epidemic were 3.27 (95% CI, 3.02–3.54) and 3.78 (95% CI, 3.49–4.09) respectively for serial intervals of 5 and 6 days; and when quarantine started, with the reported asymptomatic ratio 0.505, R0 rose to 4.18 (95%CI, 3.86–4.52) and 4.73 (95%CI, 4.37–5.12) respectively for passengers who might be exposed to the virus due to pre/asymptomatic crew. Results confirm that the higher the asymptomatic ratio is, the more infectious contacts would happen. We find evidence to support a US CDC report that “a high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew.” Our study suggests that if the asymptomatic ratio is high, the conventional quarantine procedure may not be effective to stop the spread of virus.

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A modified chain binomial model to analyse the ongoing measles epidemic in Greece, July 2017 to February 2018

Cited by 2 publications

References 6 publications

Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps

Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps

Taking account of asymptomatic infections: A modeling study of the COVID-19 outbreak on the Diamond Princess cruise ship

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