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doi: 10.1371/journal.pone.0045653. Epub 2012 Oct 1.

The interplay of public intervention and private choices in determining the outcome of vaccination programmes

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The interplay of public intervention and private choices in determining the outcome of vaccination programmes

Alberto d'Onofrio et al. PLoS One.2012.

Abstract

After a long period of stagnation, traditionally explained by the voluntary nature of the programme, a considerable increase in routine measles vaccine uptake has been recently observed in Italy after a set of public interventions aiming to promote MMR immunization, whilst retaining its voluntary aspect. To account for this take-off in coverage we propose a simple SIR transmission model with vaccination choice, where, unlike similar works, vaccinating behaviour spreads not only through the diffusion of "private" information spontaneously circulating among parents of children to be vaccinated, which we call imitation, but also through public information communicated by the public health authorities. We show that public intervention has a stabilising role which is able to reduce the strength of imitation-induced oscillations, to allow disease elimination, and to even make the disease-free equilibrium where everyone is vaccinated globally attractive. The available Italian data are used to evaluate the main behavioural parameters, showing that the proposed model seems to provide a much more plausible behavioural explanation of the observed take-off of uptake of vaccine against measles than models based on pure imitation alone.

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Conflict of interest statement

Competing Interests:The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Dynamics of different models for vaccinating behaviour without and with public intervention.
Top row:G-model with endemic coverageformula image calibrated on Italian uptake of vaccine against measles in 2008; second row:I-model (formula image) with endemic coverageformula image calibrated on Italian uptake of vaccine against measles in 1996; (c) third row:I-model with endemic coverageformula image calibrated on Italian uptake of vaccine against measles in 2008; bottom row: the basic SIR model with constant coverageformula image. The figure reports time trends of the Effective Reproduction Numberformula image (left column), the infective fractionformula image (centre), the vaccinated proportionformula image (right column). Other parameter values:formula image,formula image,formula image yearformula image,formula imagedayformula image. Initial conditions are:formula image.
Figure 2
Figure 2. Dynamics of theG-model triggered by different levels of public intervention as represented through increasing values of.
Top row:formula image set to achieveformula image (Italian measles coverage in 2003); second row:formula image set to achieveformula image (Italian measles coverage in 2008); third row:formula image set to achieve elimination withformula image (WHO target for measles elimination); bottom row:formula image set to achieve thePVEformula image. The figure reports time trends of the: Effective Reproduction Numberformula image (left column), infective fractionformula image (centre), vaccinated proportionformula image (right column). Other parameter values:formula image,formula image,formula imageyearformula image,formula imagedayformula image. Initial conditions:formula image.
Figure 3
Figure 3. The elimination scenario occurring for: dynamics in the components of the hazard of getting vaccinated.
Other parameter values:formula image,formula image,formula image yearformula image,formula image dayformula image.
Figure 4
Figure 4. Dynamics of measles coverage in Italy during 1996–2040.
Prediction of four different models: (a) theI-model withformula image set at its pre-1996 level of 0.56; (b) theI-model, withformula image reduced in order to allow an equilibrium uptake of 90%; (c) theG-model withformula image set at the pre-1996 level andformula image set in order to allow an equilibrium uptake of 90%; (d) theG-model withformula image allowing an equilibrium uptake of 95%. The four models are initialised at 1996 after 20 years of steady dynamics implied by model (a). A flat line at the levelformula image is also added for reference. The four panels are drawn forformula image = 2.5 (North-West),formula image = 3.0 (North-East),formula image = 3.5 (South-West),formula image = 4.0 (South-East). All the four models are initialised from the endemic state of model (a):formula image.
See this image and copyright information in PMC

References

    1. Bauch CT (2005) Imitation dynamics predict vaccinating behaviour. P R Soc B 272: 1669–1675. - PMC - PubMed
    1. Reluga TC, Bauch CT, Galvani AP (2006) Evolving public perceptions and stability in vaccine uptake. Math Biosci 204: 185–198. - PubMed
    1. d’Onofrio A, Manfredi P, Salinelli E (2007) Vaccinating behaviour, information, and the dynamics of SIR vaccine preventable diseases. Theor Popul Biol 71: 301–317. - PubMed
    1. d’Onofrio A, Manfredi P, Poletti P (2011) The impact of vaccine side effects on the natural history of vaccination programmes. J Theor Biol 273: 63–71. - PubMed
    1. d’Onofrio A, Manfredi P, Salinelli E (2008) Fatal SIR diseases and rational exemption to vaccina-tion. Math Med Biol 25: 337–357. - PubMed

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