Preventing epidemics in a community of households

The occurrence of epidemics of vaccine-preventable diseases, and the immunization coverage required to prevent them, is affected by the presence of households and heterogeneity in the community. We consider a community where individuals live in households and are of different types, according to infectivity and/or susceptibility to infection. We describe a method for computing the critical immunization coverage to prevent epidemics in such communities and discuss the effectiveness of immunization strategies. In a heterogeneous community where individuals live in households several immunization strategies are possible and we examine strategies targeting households, randomly selected individuals, or groups with highly intense transmission, such as school children. We compare estimates of the critical immunization coverage if we assume that disease is spread solely by random mixing with estimates which result if we assume the effects of the household structure. Estimates made under these two sets of assumptions differ. The results provide insights into the community effects of vaccination, and the household structure of the community should be taken into account when designing immunization policies.