On vaccine efficacy and reproduction numbers

We consider the impact of a vaccination programme on the transmission potential of the infection in large populations. We define a measure of vaccine efficacy against transmission which combines the possibly random effect of the vaccine on individual susceptibility and infectiousness. This definition extends some previous work in this area to arbitrarily heterogeneous populations with one level of mixing, but leads us to question the usefulness of the concept of vaccine efficacy against infectiousness. We derive relationships between vaccine efficacy against transmission, vaccine coverage and reproduction numbers, which generalise existing results. In particular we show that the projected reproduction number R-V does not depend on the details of the vaccine model, only on its overall effect on transmission. Explicit expressions for R-V and the basic reproduction number R-0 are obtained in a variety of settings. We define a measure of projected effectiveness of a vaccination programme PE = 1 - (R-V/R-0) and investigate its relationship with efficacy against transmission and vaccine coverage. We also study the effective reproduction number R-e(t) at time t. Monitoring R-e(t) over time is an important aspect of programme surveillance. Programme effectiveness PE is less sensitive than R-V or the critical vaccination threshold to model assumptions. On the other hand R-e(t) depends on the details of the vaccine model. (C) 2003 Elsevier Inc. All rights reserved.