The effect of heterogeneity in uptake of the measles, mumps, and rubella vaccine on the potential for outbreaks of measles: a modelling study.
The effect of heterogeneity in uptake of the measles, mumps, and rubella vaccine on the potential for outbreaks of measles: a modelling study.
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DOI：
10.1016/s1473-3099(16)00004-9
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Rodewald LE
中科院分区：
文献类型：
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作者：
Glasser JW;Feng Z;Omer SB;Smith PJ;Rodewald LE
旨在预防引入感染者后暴发的疫苗接种计划的目标是保持每个感染者的平均继发感染人数≤1。我们的目标是评估疫苗接种率的异质性和其他特征，这些特征与非随机混合一起可能增加这一数字，并评估减轻其影响的策略。因为大多数美国儿童在自己的社区上小学，所以对进入幼儿园的儿童(在9月1日之前达到5岁)的调查允许评估免疫比例中的空间异质性。我们获得了2008年在圣地亚哥县开始上学的39,132名儿童的结果，那里的一所学校开始爆发麻疹疫情，该学校的40名学生中有12名(30%)有个人信仰的疫苗豁免接种。使用适用于空间分层人群的混合模型，我们计算了MMR疫苗预防的疾病的每个感染者的平均继发感染数量。我们还绘制了圣地亚哥县的638所学校及其最大的地区，包括200所学校(31%)中麻疹的贡献，并确定了合理的干预措施的影响，以减少疫苗接种的异质性。对疫情爆发潜力的影响从可以忽略不计到几乎完全减少。给972名儿童接种个人信仰豁免疫苗与考虑的最有效的干预措施相当，为114所学校的638名儿童接种了疫苗，这些学校90%的学生是免疫的，这使MMR摄入量增加了50%。如果有个人信仰豁免接种疫苗的儿童不仅住在同一个家庭或社区或上同一所学校，而且优先与父母志同道合的其他儿童交往，他们增加疫情的风险可能比迄今所认识到的更大。
The goal of vaccination programs designed to prevent outbreaks following the introduction of infectious persons is maintaining the average number of secondary infections per infectious person ≤ 1. Our aim was to assess heterogeneity in vaccine uptake and other characteristics that, together with non-random mixing, may increase this number and to evaluate strategies to mitigate its impact. Because most US children attend elementary school in their own neighborhoods, surveys of children entering kindergarten (attaining 5 years of age before 1 September) permit assessment of spatial heterogeneity in the proportion immune. We obtained results for 39,132 children who began school in 2008 in San Diego County, where a measles outbreak began in a school 12 of whose 40 students (30%) had personal-belief exemptions to vaccination. Using a mixing model suitable for spatially-stratified populations, we calculated the average numbers of secondary infections per infectious person for the diseases against which MMR vaccine protects. We also mapped contributions to this number for measles in San Diego County's 638 schools and its largest District, comprising 200 schools (31%), and determined the impact of plausible interventions to reduce heterogeneity in vaccine uptake. Impacts ranged from negligible to nearly complete reduction in outbreak potential. Vaccinating the 972 children with personal-belief exemptions was comparable to the most effective intervention considered, vaccinating 638 children attending the 114 schools < 90% of whose students were immune, which increased MMR uptake by 50%. Insofar as children with personal-belief exemptions to vaccination not only live in the same households or neighborhoods or attend the same schools, but associate preferentially with other children with like-minded parents, they increase the risk of outbreaks more than may have been appreciated heretofore.