Nina H Fefferman1, Elena N Naumova2. 1. Department of Ecology, Evolution, and Natural Resources, Rutgers University, New Brunswick, NJ, USA; Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA. Electronic address: fefferman@aesop.rutgers.edu. 2. Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.
Abstract
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. FUNDING: None.
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. FUNDING: None.
Authors: Melissa S Cruz; Tania M AlarconFalconi; Meghan A Hartwick; Aishwarya Venkat; Hanna Y Ehrlich; Shalini Anandan; Honorine D Ward; Balaji Veeraraghavan; Elena N Naumova Journal: PLoS One Date: 2017-08-18 Impact factor: 3.240
Authors: Dimitrios C Cassimos; Evgnosia Effraimidou; Snezana Medic; Theoharis Konstantinidis; Maria Theodoridou; Helena C Maltezou Journal: Vaccines (Basel) Date: 2020-01-20