AGE-RELATED-CHANGES IN THE RATE OF DISEASE TRANSMISSIONS - IMPLICATIONS FOR THE DESIGN OF VACCINATION PROGRAMS
AGE-RELATED-CHANGES IN THE RATE OF DISEASE TRANSMISSIONS - IMPLICATIONS FOR THE DESIGN OF VACCINATION PROGRAMS
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DOI：
10.1017/s002217240006160x
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发表时间：
1985-01-01
影响因子：
--
通讯作者：
MAY, RM
中科院分区：
文献类型：
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作者：
ANDERSON, RM;MAY, RM
数学模型的开发，以帮助调查的影响，在接触感染的社区内的异质性，在设计大规模疫苗接种计划，以控制儿童病毒和细菌感染在发达国家。分析的重点是年龄依赖性的速度，个人获得感染，谁从谁获得感染的问题，和感染易感性的遗传变异的影响。在整个过程中，理论预测的基础上从流行病学研究中获得的参数估计，并与观察到的疾病发病率和年龄分层血清学档案的时间趋势进行比较。对病例通知记录和血清学数据的分析表明，在婴儿、儿童和青少年加成人年龄组中，个人获得许多常见感染的比率分别从中等到高，然后又到低。与基于年龄无关传播的模型的预测相比，发病率的这种明显的年龄依赖性略微降低了根除麻疹等感染所需的群体免疫力的预测水平。然而，母源性免疫在禁止婴儿接种疫苗方面的作用，以及目前在英国进行疫苗接种的年龄组的广泛跨度，认为消除麻疹需要90-94%的群体免疫水平。围绕着明显的年龄相关的趋势，在收购的感染及其相关性的疫苗接种计划的设计解释的问题进行了讨论，在感染易感性和观察流行病在处女人群中的遗传变异的可能作用。异质混合模型提供了预测的血清学和疾病的发病率的影响下，大规模疫苗接种，很好地反映了在英格兰和威尔士观察到的趋势。
Mathematical models are developed to aid in the investiation of the implications of heterogeneity in contact with infection within a community, on the design of mass vaccination programs for the control of childhood viral and bacterial infections in developed countries. Analyses are focused on age-dependency in the rate at which individuals acquire infection, the question of who acquires infection from whom, and the implications of genetic variability in susceptibility to infection. Throughout, theoretical predictions are based on parameter estimates obtained from epidemiological studies and are compared with observed temporal trends in disease incidence and age-stratified serological profiles. Analysis of case notification records and serological data suggest that the rate at which individuals acquire many common infections changes from medium to high and then to low levels in the infant, child and teenage plus adult age groups, respectively. Such apparent age-dependency in attack rate acts to reduce slightly the predicted levels of herd immunity required for the eradication of infections such as measles, when compared with the predictions of models based on age-independent transmission. The action of maternally derived immunity in prohibiting vaccination in infants, and the broad span of age classes over which vaccination currently takes place in the UK however, argue that levels of herd immunity of 90-94% would be required to eliminate measles. Problems surrounding the interpretation of apparent age-related trends in the acquistion of infection and their relevance to the design of vaccination programs are discussed in relation to the possible role of genetically based variation in susceptibility to infection and observations on epidemics in virgin populations. Heterogeneous mixing models provide predictions of changes in serology and disease incidence under the impact of mass vaccination which well mirror observed trends in England and Wales.