UNSPECIFIED. (2004) Infection, reinfection, and vaccination under suboptimal immune protection: epidemiological perspectives. JOURNAL OF THEORETICAL BIOLOGY, 228 (4). pp. 539-549. ISSN 0022-5193

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Abstract

The SIR (susceptible-infectious-resistant) and SIS (susceptible-infectious-susceptible) frameworks for infectious disease have been extensively studied and successfully applied. They implicitly assume the upper and lower limits of the range of possibilities for host immune response. However, the majority of infections do not fall into either of these extreme categories. We combine two general avenues that straddle this range: temporary immune protection (immunity wanes over time since infection), and partial immune protection (immunity is not fully protective but reduces the risk of reinfection). We present a systematic analysis of the dynamics and equilibrium properties of these models in comparison to SIR and SIS, and analyse the outcome of vaccination programmes. We describe how the waning of immunity shortens inter-epidemic periods, and poses major difficulties to disease eradication. We identify a "reinfection threshold" in transmission when partial immunity is included. Below the reinfection threshold primary infection dominates, levels of infection are low, and vaccination is highly effective (approximately an SIR model). Above the reinfection threshold reinfection dominates, levels of infection are high, and vaccination fails to protect (approximately an SIS situation). This association between high prevalence of infection and vaccine failure emphasizes the problems of controlling recurrent infections in high-burden regions. However, vaccines that induce a better protection than natural infection have the potential to increase the reinfection threshold, and therefore constitute interventions with a surprisingly high capacity to reduce infection where reduction is most needed. (C) 2004 Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Subjects:	Q Science > QH Natural history > QH301 Biology
Journal or Publication Title:	JOURNAL OF THEORETICAL BIOLOGY
Publisher:	ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD
ISSN:	0022-5193
Date:	21 June 2004
Volume:	228
Number:	4
Number of Pages:	11
Page Range:	pp. 539-549
Identification Number:	10.1016/j.jtbi.2004.02.015
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/8317

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