Oscillatory fluctuations in the incidence of infectious disease and the impact of vaccination: time series analysis.

This paper uses the techniques of time series analysis (autocorrelation and spectral analysis) to examine oscillatory secular trends in the incidence of infectious diseases and the impact of mass vaccination programmes on these well-documented phenomena. We focus on three common childhood diseases: pertussis and mumps (using published disease-incidence data for England and Wales) and measles (using data from England and Wales, Scotland, North America and France). Our analysis indicates highly statistically significant seasonal and longer-term cycles in disease incidence in the prevaccination era. In general, the longer-term fluctuations (a 2-year period for measles, 3-year periods for pertussis and mumps) account for most of the cyclical variability in these data, particularly in the highly regular measles series for England and Wales. After vaccination, the periods of the longer-term oscillations tend to increase, an observation which corroborates theoretical predictions. Mass immunization against measles (which reduces epidemic fluctuations) magnifies the relative importance of the seasonal cycles. By contrast, we show that high levels of vaccination against whooping cough in England and Wales appear to have suppressed the annual cycle.