Herd Immunity: Basic Concept and Relevance to Public Health Immunization Practices1

Fox, John P.; Elveback, Lila R.; Scott, W G; Gatewood, Laël C.; Ackerman, Eugene

doi:10.1093/oxfordjournals.aje.a121310

Cited by 204 publications

(80 citation statements)

References 5 publications

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“…It did not consider the possibility that conjugate vaccine will reduce the amount of vaccine-susceptible pneumococcus circulating in the population and hence influence rates of disease in unvaccinated individuals. This phenomenon has been widely observed with other vaccines and is known as ''herd immunity'' [7,8]. Recent data from the USA have shown statistically significant falls in the rate of pneumococcal disease in adults since the widespread introduction of conjugate vaccine [26,27].…”

Section: Introductionmentioning

confidence: 97%

Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects

Lloyd¹,

Patel

Scott

et al. 2007

Eur J Health Econ

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In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at high risk of pneumococcal disease. Recent data suggest that giving conjugate vaccine to all children may lead to a decline in pneumococcal disease in unvaccinated adults, a phenomenon known as herd immunity. This analysis evaluated the cost and economic consequences in Germany of vaccinating (1) children at high risk, (2) all children when considering only benefits for vaccinated individuals and (3) all children when also considering herd immunity benefits. Costs in the model included vaccination, management of meningitis, bacteraemia, pneumonia and acute otitis media, insurance payments to parents and the costs of care for long-term disabilities. The model estimated that the cost-effectiveness of vaccination would be 38,222 euros per life year gained in children at high risk and 100,636 euros per life year gained in all children when not considering herd immunity. When considering herd immunity effects, the model estimated that offering vaccination for all children would reduce adult deaths by 3,027 per year, and vaccination would be broadly cost neutral. The findings are sensitive to the effect of conjugate vaccine on the rates of pneumonia and invasive disease in the elderly. If the herd immunity effect of conjugate vaccination in Germany is similar to that observed elsewhere, offering vaccine to all children will be more attractive than the current policy of restricting vaccination to children at high risk of pneumococcal disease.

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Section: Introductionmentioning

confidence: 97%

Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects

Lloyd¹,

Patel

Scott

et al. 2007

Eur J Health Econ

View full text Add to dashboard Cite

show abstract

“…Hence, protecting a proportion of people in the population from becoming infected can have nonlinear effects on the remainder of the population. [33] If the proportion of a population that is susceptible to an infection is sufficiently low (because other individuals are either infected, naturally immune to infection or vaccine protected), then each infected individual will transmit the disease to fewer than one susceptible person before recovering. Consequently, the prevalence of the infection will decrease over time.…”

Section: Types Of Modelsmentioning

confidence: 99%

Modelling the Epidemiology of Infectious Diseases for Decision Analysis

2011

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The number of economic evaluations related to infectious disease topics has increased over the last 2 decades. However, many such evaluations rely on models that do not take into account unique features of infectious diseases that can affect the estimated value of interventions against them. These include their transmissibility from infected to susceptible individuals, the possibility of acquiring natural immunity following recovery from infection and the uncertainties that arise as a result of their complex natural history and epidemiology. Modellers conducting economic evaluations of infectious disease interventions need to know the main features of different types of infectious disease models, the situations in which they should be applied and the effects of model choices on the cost effectiveness of interventions.

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“…A predetermined threshold for phenotypic coverage of the population is often desirable, based on the characteristics of the disease for which the vaccine is being developed. These are typically set on the basis of the concept of herd immunity and may vary depending on the particular disease which is the target of vaccine development efforts [Fox et al, 1971;Fine, 1993].…”

Section: Selection Of the Hla Alleles In Set A For A Single Populationmentioning

confidence: 99%

Ramifications of HLA class I polymorphism and population genetics for vaccine development

et al. 2000

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HLA polymorphism can complicate the design and development of vaccines, especially those that contain a selected number of epitopes and are directed at pathogens prevalent worldwide. Because of HLA class I restricted antigen recognition and ethnic variation in HLA distribution, such vaccines may not be uniformly effective across populations. We, therefore, considered whether it is possible to assemble a panel of HLA‐A and/or HLA‐B alleles that would allow the formulation of a single vaccine for a set of Caucasian, Black, or Asian populations. In applying an algorithm to predict levels of favorable response, we identified predominant alleles in 15 representative populations. Approximately 80% of the individuals in one African Black population and five Asian populations were positive for at least one of three HLA‐A alleles. Eighty percent coverage was also theoretically possible in five Caucasian populations with only five HLA‐A alleles. Four of five Black populations analyzed also required five alleles, but the allelic combinations differed. Our findings suggest that HLA‐A alleles may be preferred targets because of the increased heterogeneity at HLA‐B, although addition of a single HLA‐B allele to a set of HLA‐A alleles improved coverage. This approach provides for the identification of combinations of alleles that represent a desired percentage of a population and that could be targeted in designing vaccines. For vaccines with known HLA‐restricted epitopes, it allows a prediction of theoretical levels of “responder” and “non‐responder” status. Finally, these results might be used in the analysis of protein sequences to identify potential CD8+ T‐cell epitopes in populations of interest. Biologic variables that may have further relevance are discussed. Genet. Epidemiol. 20:87–106, 2001. © 2001 Wiley‐Liss, Inc.

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Herd Immunity: Basic Concept and Relevance to Public Health Immunization Practices1

Cited by 204 publications

References 5 publications

Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects

Cost-effectiveness of heptavalent conjugate pneumococcal vaccine (Prevenar) in Germany: considering a high-risk population and herd immunity effects

Modelling the Epidemiology of Infectious Diseases for Decision Analysis

Ramifications of HLA class I polymorphism and population genetics for vaccine development

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