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🏥 | How should we think about vaccination under the age of 10?Considering from published data [Latest knowledge to prepare for the 7th wave of Corona]

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How should we think about vaccination for children under the age of 10?Considering from published data [Latest knowledge to prepare for the 7th wave of Corona]

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Although vaccination can reduce the risk of infection, more than 8% of the population must be vaccinated to obtain herd immunity with vaccination alone.

The number of new infections with the new coronavirus is making headlines every day.According to the website of the Ministry of Health, Labor and Welfare, on the 11th... → Continue reading

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Collective immunity

Collective immunity(Sudden Meneki,British: herd immunity, herd effect, community immunity, population immunity, social immunity) IsInfectionTo the majority ofImmunologyIt is an indirect protective effect that occurs when you have, and is a means to protect people who are not immune[1][2].. In a population where a large number of people are immune, it is likely that the chain of infection will be broken, and the spread of the disease will be subdued or moderate.[3].. The higher the proportion of people with immunity in a community, the less likely non-immune people will be in contact with infected people.[1].


Personal immunity is the recovery from infectious diseases andvaccinationEarned by[3].. Some people are unable to acquire immunity for medical reasons and collective immunity is an important safeguard against these people[4][5].. When the proportion of people with immunity reaches a certain value, collective immunity will gradually eliminate the disease from the population[5].. If this elimination is achieved worldwide, the number of infections could be permanently reduced to zero, a condition called eradication or eradication.[6].. By this techniquesmallpoxWas eradicated in 1977 and other infectious diseases are being locally excluded.[7].. Collective immunity does not apply to all infectious diseases,Contagion, That is, only applicable to diseases that are transmitted from one person to another[5]. For example,tetanusIs an infectious disease but is not contagious, so collective immunity is not applied[4].

The term "herd immunity" means the immunity of the whole population1923First used in a study investigating disease mortality in a population of mice with varying degrees of immunity[8].

Many children in the 1930smeaslesIt was observed that the immunity against P. aureus temporarily reduced the number of new infections among nonimmunized children, which was recognized as a naturally occurring phenomenon.[9].. AW HedrichBaltimoreOf measles inEpidemiologyAnd noted that after many children acquired immunity to measles, the number of new infections also temporarily decreased among susceptible children.[9].. Despite this finding, efforts to control and eliminate measles were discovered in the 1960s.Measles vaccineDid not succeed until mass vaccination of[9].

After that, induction of collective immunity by vaccination became common, and successful prevention of spread in many infectious diseases.[10].. Mass immunization, discussions on eradication of disease, and cost-benefit analysis of immunization have made "population immunity" widely used.[1].. In the 1970s, the theorem used to calculate the population immune threshold was developed[1].. From the 1960s to the 1970ssmallpoxIn the eradication movement,OutbreakImmunize everyone around the infected to prevent spread(English edition(Ring vaccination)[11].

However, with the general availability of mass vaccination and siege immunization, the complexities and difficulties of mass immunity have emerged. The modeling of the spread of infectious diseases initially made many non-existent assumptions that the entire population was susceptible and mixed well, so more accurate models are being developed.[1].

In recent years, there is a theory that dominant strains of microorganisms may change due to collective immunity, which means that collective immunity acts as a selective pressure against microorganisms, or that collective immunity against one strain causes expansion of other existing strains. To bring[12][13].

But even now,Vaccine evasionThere is a campaign against vaccination, etc., which is a problem of collective immunity[14].In particular, in societies and communities with insufficient immunization coverage, herd immunity is declining or disappearing, and preventable diseases persist or recur.On the other hand, it has been observed that countries with higher vaccination rates for the new coronavirus have more positive cases, and voices of distrust in vaccines are growing.[14][15][16][15][16].

the purpose

Protection of non-immune people

Some people may not be immunized after vaccination or may not be vaccinated for medical reasons[4][18][19].. Also, newborns lose safety reasons and vaccine effects.Passive immunityCannot receive many vaccines due to the presence of[20].HIV / AIDS,Lymphoma,leukemia,Bone marrow Ofcancer,spleenDysfunction,chemical treatment,Radiation therapyPeople who are immunocompromised due to, for example, may have lost their previous immunity, and the vaccine may not be useful due to immunodeficiency.[4][18][20][21].. Vaccines are generally not perfect, and the immune system of some people may not elicit long-term immunity due to an adequate immune response to the vaccine. Therefore, even those who have been vaccinated may have lost their immunity.[1][22][23].. Also, for vaccinesTabooMay exist, which may prevent certain people from getting immunity[18].. These people not only have immunity, but also because of their healthcomplicationsRisk of developing illness is high, but protection may be available if a sufficient proportion of people in the population are immune[4][18][23][24].

If a high level of immunity is acquired in one age group, it can form a group immunity to other age groups.[7].Social Services LizardVaccination of adults reduces the number of newborns at the highest risk of complications[25][26].. This is especially important because most newborn transmissions come from familiar families.[7][23].

Disease type

To childrenPneumococcusVaccination reduces the incidence of pneumococcal infections in younger unvaccinated siblings[27].

Streptococcus pneumoniaeRotavirusVaccination against vaccination has been shown to reduce hospitalizations due to pneumococcal and rotavirus infections in older children and adults who are not usually vaccinated with these vaccines[27][28][29].

influenzaTend to be more severe in the older population than in the younger population, but in this population the effects of the influenza vaccine are lost due to age-related weakening of the immune system[7][30]. But,Seasonal fluIt has been shown that prioritizing vaccination of school-aged children with children will provide some degree of protection even to the elderly.[7][30].

Sexually transmitted diseaseAs for, the high level of immunity in one sex leads to a collective immunity in both sexes[10][31][32].. For sexually transmitted disease vaccines targeting one sex, if the vaccination rate for the target sex is high, sexually transmitted diseases will be significantly reduced in both sexes.[31][32][33].. However, the effect of collective immunity by vaccination against womenHomosexualOf men[32].. If the vaccination rate of the target sex is low, it is necessary to immunize other sex to obtain sufficient protective effect[31][32].. Compromising sexually transmitted diseases is high-risk sexual behavior. The majority of infections occur in people at moderate risk, while the majority of transmissions to others result from people performing high-risk sexual behavior.[10].. For these reasons, immunization of high-risk individuals of both sexes is necessary to establish collective immunity[10][32].

Impact on virus evolution

Selective pressure

Collective immunity is itself against a particular virus(English editionAnd influence the evolution of the virus. In this case, the emergence of new strains called escape mutants that can bypass population immunity and expand more easily[34][35].. At the molecular level, the surface of the virusantigen(Generally viralCapsidProtein)genomeIn the areaMutationAccumulatedEpitopeChanges,Antigen driftA change called[12][36].. In addition,ReassemblyChanges caused by newSerotypeMay be produced,Antigen shiftCalled. This is more likely to happen when multiple stocks are in circulation[34][37].. When such changes occurMemory T cellsCan no longer recognize the virus, leaving people immune to the dominant strain[36][37].. With the fluNorovirusIn both cases, the epidemic is a continuous wave, as the epidemic temporarily induces collective immunity until a new dominant strain emerges.[12][37].. The evolution of this virus has become a challenge for population immunity, and the development of broadly neutralizing antibodies and "universal vaccines" (universal vaccines) that are not limited to the effects on specific serotypes is currently under way. Have been[35][38][39].

Serotype replacement

Because of the high level of immunity to a serotype,PrevalenceDecrease, and other serotypes increase in lieu of it, a phenomenon called serotype replacement or serotype shifting may occur[40][13].. Streptococcus pneumoniaeStreptococcus pneumoniaeAn early vaccine againstDrug resistanceIncluding the type of serotype included in the vaccineNasopharynxSignificantly reduced carriage, but the reduction was completely offset by increased carriage of non-vaccine serotypes[27][40][13][41].. However, serotypes not included in the vaccine were less invasive than serotypes included in the vaccine, so the incidence of disease did not increase proportionately[40].. It is also effective against newly emerging serotypesPneumococcal vaccineWas introduced, and it became possible to counter the increase[27].. Despite the potential for further shifts in the future, strategies to address them include expansion of the serotypes in the vaccine, whole-cell inactivated vaccines containing more surface antigens, or multiple serotypes. Development of vaccines targeting proteins present in[27][42].


AstraZenecavaccineOne of the co-development managers,Oxford UniversityRecognizing that it is impossible to obtain herd immunity while the disease is widespread, he said that even if the vaccine could slow down the spread of the infection, it would not be possible to completely stop the epidemic.He said it should not be a vaccination policy aimed at herd immunity[43].

Eradication of disease

If collective immunity is established and maintained in a population for a sufficient period of time, the disease will be eliminated and transmission will not spread[5].. Eradication of the disease is declared when elimination of the disease is achieved around the world and the number of occurrences is permanently reduced to zero[6].. Eradication of disease controls the spread of infectious diseasespublic healthCan be considered the ultimate impact or result of[6][7].. Eradication of illness can eliminate morbidity and mortality, save money for individuals, health care providers, and governments, and use the resources used to control illness for other things There are advantages such as being able to[6].

So far,RinderpestsmallpoxThe two diseases are collective immunity andvaccinationEradicated by[1][7][44].

NowPolioEfforts have been made to eradicate the disease by means of group immunity, but public anxiety and distrust of modern medicine make eradication difficult.[1][45].. Compulsory vaccination may also be useful in eradication efforts if not enough people are willing to be vaccinated[46][47][48][49].

Free ride to collective immunity (free rider)

An expression that ridicules that a person who chooses not to be vaccinated will be free to ride on the herd immunity created by immunized people.[50].. As the number of free riders in the population increases, preventable diseasesOutbreakIs more likely to occur and is more serious due to the loss of herd immunity[14][15][16][47][49].. The reason for choosing a free ride is the lack of perceptual effectiveness[51]Think that the risk of vaccine is greater than the risk of infection[1][15][16][51]Distrust of vaccines and public health authorities[52],Band wagon effect,Collective thinking[47][53], Social norms andTuning pressure[51], Religious beliefs[15]And so on.

Since patients basically have the right to choose their own medical care (Lisbon Declaration), the expression for medical care has the potential to create discrimination. Although it was originally said that herd immunity was not established for vaccinations such as COVID-19, discrimination based on the choice of vaccination was often a problem.

Mathematical model

InfectiousR0And HIT estimates[54]
diseaseTransmission routeR0HIT
measlesAirborne12 – 18 Feet92-95%
Social Services LizardSplash infection12 – 17 Feet[55]92-94%
diphtheriasaliva6 – 7 Feet83-86%
rubellaSplash infection
smallpoxSplash infection5 – 7 Feet80-86%
PolioFecal mouth infection
Mumps(Mumps)Splash infection4 – 7 Feet75-86%
New coronavirus infection
(Global pandemic of new coronavirus infections)
Splash infection2.5 – 4 Feet[56][57]60-75%
SARSSplash infection2 – 5 Feet[58]50-80%
(West Africa Ebola outbreak in 2014)
body fluid1.5 – 2.5 Feet[59]33-60%
(Influenza epidemic)
Splash infection1.5 – 1.8 Feet[55]33-44%
Herd Immunity Threshold.svg

People who are immune to the disease act as a barrier to the spread of the disease, reducing or preventing transmission to others.[3].. Personal immunity is acquired by artificial means such as natural infection and vaccination[3]..When the proportion of people with immunity reaches a critical ratio called the herd immunity threshold (HIT) or herd immunity level (HIL), the disease is no longer maintained within the population and the spread of the disease ends. To do[5][34].. This threshold isBasic reproduction number R0 Can be calculated fromR0Is the average number of new infections from individual cases in a homogenous, well-mixed population, a fully susceptible population with contact by all[10][34][46].. The proportion of people in a population who are susceptible to infection S Then,

At that point, the transmission is in a steady state.S Is the percentage of people with immunity p Using (1 − p) Can be rewritten as Then, the above equation is transformed as follows.

p Is transformed so that is on the left side of the equation, and pc The value written as is the critical ratio necessary to stop the spread of disease transmission within the population, or the population immune threshold (HIT)[10].R0Acts as an indicator of contagiousness,R0The lower the value, the lower the HIT, whileR0The higher the value, the higher the HIT[34][46]. For example,R0Is 2, the HIT is theoretically only 50%, butR0HIT is 10% when is 90[34]..These calculations assume that the population is completely sensitive, that is, no one is immune to the disease.In reality, immunized people are present in different proportions within the population at any time of any illness.[10].. To take this into consideration, the effective number of reproductions Re(Effective reproductive number,Rt Is also used) t The proportion of susceptible populations inR0By taking the time t An average number of infections caused byReIf is maintained below 1, the number of cases within the population gradually decreases and the disease is eliminated[10][34][60]..When the proportion of people immunized against the disease in a population exceeds HIT, the number of cases decreases faster, outbreaks are less likely to occur, and if they do occur, they are smaller.[1][10].ReIs greater than 1 sickThe number of occurrencesIs no longer seen, and the disease is actively spreading throughout the population, causing more than normal infections[47][60].

There is a second assumption in these calculations that the population is homogeneous and well mixed, that is, all people in the population make contact, but the model of the real population has a limited number of people. Make relatively close contact with othersSocial networkIs more appropriate.In such networks, transmission occurs only between people who are geographically and physically close to each other.[1][46][47].. Disease HIT changes depending on the shape and size of the network, and the number of occurrences is likely to increase or decrease[34][46].. In a non-homogeneous population,R0Is considered an indicator of the number of cases caused by an infectious "typical" person, the value of which will depend on how individuals interact within the network.[1].. Disease transmission can occur more easily in highly connected networks,R0And HIT will be higher than less connected networks[1][47].



The main ways to increase the level of immunity in a population are:vaccinationIs[1][61].. The concept of vaccination isVacciniaBased on the observation that dairy farmers affected by smallpox are immune to smallpox and started as vaccination with cowpox virus to prevent smallpox[45].. Well-developed vaccines provide protection in a much safer way than natural infections. Vaccines generally do not cause the disease they seek to protect andSide effectsIs much less common than natural infection complications[62][63].Immune systemImmunity induced by vaccination is similar to the immunity induced during the course of illness and recovery, as it does not distinguish between natural infection and vaccine and forms active immunity against both[64].. Vaccine manufacturers aim to produce vaccines with a low failure rate (the rate at which immunity is not induced or attenuated) and policy makers aim to recommend their use in order to achieve collective immunity by vaccination.[61].. With the successful introduction and widespread use of vaccines, we observe a sharp decrease in the number of diseases protected by the vaccine, which inevitably reduces the number of hospitalizations and deaths due to the disease.[65][66][67].

Assuming the effectiveness of the vaccine is 100%, the formula for calculating the population immunity threshold is the level of vaccination required to eliminate the disease. Vc Can also be used to calculate[1].. However, the effectiveness of vaccines is often not perfect, so E(Effectiveness) has to be taken into account,VcIs as follows:

E Is (1 − 1/R0), it is impossible to eliminate the disease even if the population is fully vaccinated[1].. Similarly, vaccine-induced immunity can be attenuated, as seen with acellular pertussis vaccines, and thus higher levels of levels are needed to maintain collective immunity.Boosteris necessary[1][25].. Once the epidemic of the disease in the population is over, vaccination is the only way to contribute to this reduction, as natural infections no longer reduce the susceptibility rate in the population[10].. The relationship between the prevalence rate, vaccination rate, and efficacy rate is based on E And the proportion of people who have been vaccinated in the group pv Is the product of[10].

Increasing vaccination coverage or vaccine efficacy further reduces disease incidence[10].. The reduction rate of the number of cases is sickR0Depends onR0The smaller the value of, the sharper the decrease.[10].. Vaccines usually have at least one medical contraindication to a particular population. However, if the vaccine's effectiveness and coverage are high enough, such people can be protected by collective immunity.[19][21][24].. Vaccine effectiveness is often but not alwaysPassive immunityIs reduced by[68][69].. As a result, boosters are recommended for some vaccines and others may not be given until passive immunity disappears.[20][24].

Cost-benefit analysis

Vaccination programCost-benefit analysisOften, collective immunity is taken into account when performing. Positive due to high level of immunityExternalityAre considered to occur and produce additional benefits from reduced disease that do not appear if collective immunity is not formed within the population.[70][71].. Therefore, incorporating population immunity into the cost-benefit analysis will result in a better cost-benefit ratio and an increase in the number of cases prevented by vaccination.[71].. Studies designed to assess the benefits of collective immunity include recording the number of outbreaks in households where members were vaccinated, randomized comparisons of populations in vaccinated and unvaccinated areas, The number of outbreaks before and after the introduction of the vaccination program is being observed.[72].. From these, it was observed that the number of outbreaks may decrease beyond the level expected from only the direct protective effect, suggesting that population immunity contributes to the decrease.[72].. If serotype replacement is taken into account, the benefits expected from vaccination are reduced[71].

Passive immunity

Personal immunity to pathogensantibodyIt is also acquired passively by moving from a person with to another person. As a natural phenomenon, there are migration antibodies, mainlyIgGAntibodyplacenta,colostrumThroughFetusAnd transition to newborns[73][74].. It can also be done artificially, so thatserum,plasmaOf passive immunity is achieved by injecting sucrose into susceptible individuals[64][75].. The protective effect of passive immunity is immediately exerted, but its contribution to collective immunity is temporary because it attenuates in a few weeks to several months.[5][64][76].. With regard to diseases such as influenza and tetanus, where the fetus and newborn are particularly severe, pregnant women may obtain immunity with the aim of transferring antibodies to the child.[19][77][78].. Similarly, antibodies may be prepared to prevent infection or reduce symptoms in high-risk populations who are more likely to be infected or are more likely to develop complications.[75].


[How to use footnotes]
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