Measles Outbreaks in a Population with Declining Vaccine Uptake

Jansen, Vincent; Stollenwerk, Nico; Jensen, Henrik Jeldtoft; Ramsay, Mary; Edmunds, W. John; Rhodes, Christopher J.

doi:10.1126/science.1086726

Cited by 322 publications

(259 citation statements)

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“…26). Our theoretical results corroborate previous findings that criticality, and the accompanying power laws, occur naturally in epidemiological situations (23,27,28). Distributions that obey power laws have been associated with events such as forest fires and earthquakes (29).…”

Section: Discussionsupporting

confidence: 89%

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Diversity in pathogenicity can cause outbreaks of meningococcal disease

Stollenwerk

Maiden

Jansen

2004

Proc. Natl. Acad. Sci. U.S.A.

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Neisseria meningitidis, the meningococcus, is a major cause of bacterial meningitis and septicemia worldwide. Infection in most cases leads to asymptomatic carriage and only rarely to disease. Meningococcal disease often occurs in outbreaks, which are both sporadic and highly unpredictable. The occurrence of disease outbreaks in a host population in which the etiological agent is widely carried is not well understood. A potential explanation lies in the fact that meningococci are diverse with respect to diseasecausing potential. We formulated a stochastic mathematical model to investigate whether diversity of the bacterial population is related to outbreaks of meningococcal disease. In the model, strains that occasionally cause the disease appear repeatedly in a population dominated by a nonpathogenic strain. When the pathogenicity, i.e., the disease-causing potential, of the pathogenic lineage was low, the model shows distinct outbreaks, the size distribution of the outbreaks follows a power law, and the ratio of the variance to the mean number of cases is high. Analysis of notification data of meningococcal disease showed that the ratio of the variance to the mean was significantly higher for meningococcal diseases than for other bacterial invasive diseases. This result lends support to the hypothesis that outbreaks of meningococcal disease are caused by diversity in the pathogenicity of meningococcal strains.Neisseria meningitidis ͉ criticality ͉ epidemiology ͉ meningitis ͉ septicemia

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Section: Discussionsupporting

confidence: 89%

“…Under assumption that the number of individuals carrying the invasive strain is small compared with the total population size, the probability of an outbreak to be of size X, p(X), can be found by reducing the transmission dynamics from a continuous time branching process to a discrete, event-based, description (22,23).…”

Section: Resultsmentioning

confidence: 99%

Diversity in pathogenicity can cause outbreaks of meningococcal disease

Stollenwerk

Maiden

Jansen

2004

Proc. Natl. Acad. Sci. U.S.A.

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“…In the United Kingdom, for example, a pertussis vaccine scare in the 1970s caused a decline in the level of vaccine coverage, resulting in substantial increases in morbidity and mortality from whooping cough (4). Currently, measles-mumps-rubella vaccine uptake is declining in the United Kingdom, with mounting concern that widespread outbreaks of measles may recur (5).…”

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confidence: 99%

Vaccination and the theory of games

Bauch

Earn²

2004

Proc. Natl. Acad. Sci. U.S.A.

677

702

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Voluntary vaccination policies for childhood diseases present parents with a subtle challenge: if a sufficient proportion of the population is already immune, either naturally or by vaccination, then even the slightest risk associated with vaccination will outweigh the risk from infection. As a result, individual self-interest might preclude complete eradication of a vaccine-preventable disease. We show that a formal game theoretical analysis of this problem leads to new insights that help to explain human decisionmaking with respect to vaccination. Increases in perceived vaccine risk will tend to induce larger declines in vaccine uptake for pathogens that cause more secondary infections (such as measles and pertussis). After a vaccine scare, even if perceived vaccine risk is greatly reduced, it will be relatively difficult to restore prescare vaccine coverage levels.T he history of vaccination policy includes numerous bouts of public resistance, often in the form of vaccine scares (1-4). In the United Kingdom, for example, a pertussis vaccine scare in the 1970s caused a decline in the level of vaccine coverage, resulting in substantial increases in morbidity and mortality from whooping cough (4). Currently, measles-mumps-rubella vaccine uptake is declining in the United Kingdom, with mounting concern that widespread outbreaks of measles may recur (5).In deciding whether to vaccinate their children, parents consider the risk of morbidity from vaccination, the probability that their child will become infected, and the risk of morbidity from such an infection. The decisions of individual parents are indirectly influenced by the decisions of all other parents, because the sum of these decisions yields the vaccine coverage levels in the population and hence the course of epidemics.Game theory (6-9) attempts to predict individual behavior in such a setting, where the payoff to strategies chosen by individuals depends on the strategies adopted by others in the population. Here, we integrate epidemic modeling (10) into a game theoretical framework to analyze population behavior under voluntary vaccination policies for childhood diseases. This approach allows us to quantify how risk perception influences expected vaccine uptake and coverage levels and what role is played by the epidemiological characteristics of the pathogens.The Vaccination Game Description of Game. For simplicity, we imagine that all individuals are provided with the same information and use this information in the same way to assess risks. An individual's strategy is the probability P that s͞he will choose to vaccinate. The vaccine uptake level in the population is the proportion of newborns who will be vaccinated and hence is the mean of all strategies adopted by individuals in the population. We ignore any delay between changes in vaccine uptake and corresponding changes in overall vaccine coverage in the population; consequently, if no diseaserelated or vaccine-related mortality occurs, then the proportion of the population vaccinated, p, will be ...

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“…Half-lives of protective antibodies have been estimated at 25 years or less (8,9) creating a basis for spontaneous outbreaks in an aging population. In addition, parental concerns over vaccination safety, particularly in the United Kingdom, have contributed to such low vaccination coverage that MV outbreaks have occurred (10). Considering the mortality associated with primary MV infections and with secondary microbial infections because of MV-induced immunosuppression (11,12) and considering that the only drug approved for treatment of some paramyxovirus infections, ribavirin, shows limited efficacy against MV (13), the development of novel therapeutics that control local outbreaks and close the immunization gap in young infants is a priority.…”

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confidence: 99%