The effect of community structure on the immunity coverage required to prevent epidemics

Estimation of the immunity coverage required to effectively control disease transmission is an important public health problem. Using data on the eventual size of a major epidemic, we compare estimates based on the simplifying assumption that the community consists of uniformly mixing individuals with estimates obtained when the more complex community structure is acknowledged. The alternative community structures considered include households and localities that are quite separate. Several inequalities are established for estimates of the critical immunity coverage. For several settings, the coverage estimated by assuming an oversimplified community structure is found to actually be an underestimate. A serious consequence of this finding is that we may be misled into believing that we have estimated an immunity coverage that can prevent epidemics when it in fact cannot. The conclusion is that the heterogeneity in the community must be taken into account when estimating the critical immunity coverage. (C) 1998 Elsevier Science Inc.