Sanne Pagh Møller, Maja Mønster Jeppesen, Ismail Gögenur, Lau Caspar Thygesen
Socio-economic disparity in risk of undergoing emergency laparotomy and postoperative mortality
Scandinavian journal of public health
vaccination programmes prevent outbreaks introductions infectious people aim maintain average number secondary infections per infectious person one less aimed assess heterogeneity vaccine uptake characteristics together nonrandom mixing could increase number evaluate strategies could mitigate impact us children attend elementary school neighbourhoods surveys children entering elementary school age 5 years sept 1 allow assessment spatial heterogeneity proportion children immune vaccinepreventable diseases used data 2008 schoolentry survey immunization division california department public health obtain school addresses numbers students enrolled proportions enrolled students received one two doses measles mumps rubella mmr vaccine proportions medical personalbelief exemptions using mixing model suitable spatiallystratified populations projected expected numbers secondary infections per infectious person measles mumps rubella also mapped contributions number measles san diego countys 638 elementary schools largest district comprising 200 schools 31 modelled effect measles realised reproduction number rv following plausible interventions vaccinating children personalbelief exemptions increasing uptake 10 50 lowimmunity schools 90 students immune influential effective daily contact rates 3 contacts interschool 30 lowimmunity schools increasing private school uptake public school average 2008 39 132 children began elementary school san diego county ca usa entry school 97 received least one dose mmr vaccine 25 personalbelief exemptions note substantial heterogeneity immunity throughout county although average population immunities measles mumps rubella 92 87 92 similar populationimmunity thresholds homogeneous randomlymixing populations 91 88 76 accounting heterogeneity nonrandom mixing basic reproduction numbers increased 70 meaning introduced pathogens could cause outbreaks impact modelled interventions ranged negligible nearly complete reduction outbreak potential measles effective intervention lower realised reproduction number rv 339 raising immunity 50 114 schools low immunity rv 102 raising immunity level influential lowimmunity schools also effective rv 202 effectiveness vaccinating 972 children personalbelief exemptions similar targeting lowimmunity schools rv 111 targeting private schools little effect findings suggest increasing vaccine uptake could prevent outbreaks measles san diego 2008 vaccinating children personalbelief exemptions one effective interventions modelled research mixing heterogeneous populations needed none