Dangers of vaccine refusal near the herd immunity threshold: a modelling study

被引:45
作者
Fefferman, Nina H. [1 ,2 ,3 ]
Naumova, Elena N. [2 ,3 ,4 ]
机构
[1] Rutgers State Univ, Dept Ecol Evolut & Nat Resources, New Brunswick, NJ 08901 USA
[2] Rutgers State Univ, Ctr Discrete Math & Theoret Comp Sci DIMACS, Piscataway, NJ USA
[3] Tufts Univ, Initiat Forecasting & Modeling Infect Dis, Medford, MA 02155 USA
[4] Tufts Univ, Dept Civil & Environm Engn, Medford, MA 02155 USA
关键词
EPIDEMIOLOGIC GAME-THEORY; MEASLES OUTBREAK; IMMUNIZATION; CHALLENGES; RUBELLA; POPULATION; EXEMPTIONS; RISKS;
D O I
10.1016/S1473-3099(15)00053-5
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background Childhood vaccination remains the focus of heated public debate. Parents struggle to understand the potential risks associated with vaccination but both parents and physicians assume that they understand the risks associated with infection. This study was done to characterise how modern vaccination practices have altered patient risks from infection. Methods In this modelling study, we use mathematical analysis to explore how modern-era vaccination practices have changed the risks of severe outcomes for some infections by changing the landscape for disease transmission. We show these effects using published data from outbreaks in the USA for measles, chickenpox, and rubella. Calculation of risk estimation was the main outcome of this study. Findings Our calculations show that negative outcomes are 4.5 times worse for measles, 2.2 times worse for chickenpox, and 5.8 times worse for rubella than would be expected in a pre-vaccine era in which the average age at infection would have been lower. Interpretation As vaccination makes preventable illness rarer, for some diseases, it also increases the expected severity of each case. Because estimates of case risks rely on data for severity generated during a pre-vaccine era they underestimate negative outcomes in the modern post-vaccine epidemiological landscape. Physicians and parents should understand when making decisions about their children's health and safety that remaining unvaccinated in a predominantly vaccine-protected community exposes their children to the most severe possible outcomes for many preventable diseases.
引用
收藏
页码:922 / 926
页数:5
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