Vaccination and Clinical Severity: Is the Effectiveness of Contact Tracing and Case Isolation Hampered by Past Vaccination?

Kenji Mizumoto, Keisuke Ejima, Taro Yamamoto and Hiroshi Nishiura
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Kenji Mizumoto: School of Public Health, The University of Hong Kong, Level 6, Core F, Cyberport 3, 100 Cyberport Road, Pokfulam, Hong Kong
Keisuke Ejima: School of Public Health, The University of Hong Kong, Level 6, Core F, Cyberport 3, 100 Cyberport Road, Pokfulam, Hong Kong
Taro Yamamoto: Department of International Health, Nagasaki University Institute of Tropical Medicine and GCOE, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
Hiroshi Nishiura: School of Public Health, The University of Hong Kong, Level 6, Core F, Cyberport 3, 100 Cyberport Road, Pokfulam, Hong Kong

IJERPH, 2013, vol. 10, issue 3, 1-14

Abstract: While contact tracing and case isolation are considered as the first choice of interventions against a smallpox bioterrorist event, their effectiveness under vaccination is questioned, because not only susceptibility of host and infectiousness of case but also the risk of severe clinical manifestations among cases is known to be reduced by vaccine-induced immunity, thereby potentially delaying the diagnosis and increasing mobility among vaccinated cases. We employed a multi-type stochastic epidemic model, aiming to assess the feasibility of contact tracing and case isolation in a partially vaccinated population and identify data gaps. We computed four epidemiological outcome measures, i.e. , (i) the threshold of a major epidemic under the interventions; (ii) the expected total number of cases; (iii) the probability of extinction, and (iv) the expected duration of an outbreak, demonstrating that all of these outcomes critically depend on the clinical impact of past vaccination on the diagnosis and movement of vaccinated cases. We discuss that, even in the absence of smallpox in the present day, one should consider the way to empirically quantify the delay in case detection and an increase in the frequency of contacts among previously vaccinated cases compared to unvaccinated during the early stage of an epidemic so that the feasibility of contact tracing and case isolation in a vaccinated population can be explicitly assessed.

Keywords: symptom; immunization; epidemiology; mathematical model; contact tracing (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2013
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