Herd immunity against rubella according to a survey of the population in Medellin, Colombia

Abstract

Objective. Calculate the critical proportion (P-c) for achieving herd immunity based on a 2009 population study conducted in Medellin, Colombia, by age, globally and disaggregated by sex, location, and socioeconomic stratum. Methods. A survey of seroprevalence in the population was conducted by means of a random sample of 2 124 individuals aged 6 to 64 that was representative of age, sex, and location. The basic reproduction number was estimated using a quadratic regression of the average IgG titers for rubella by age in unvaccinated individuals with titers greater than or equal to 15 IU/ml. The effective reproduction number (R-e) was calculated with the data on the weighted proportion of protection by age, sex, location, and socioeconomic stratum. Results. Overall, the P-c was 90.0% (95% CI, 88.6-95.2%) and the R-e was 0.95 (95% CI, 0.8-1.8), for a weighted proportion of protection of 89.4% (95% CI, 86.891.6%). Protection was lower than the expected P-c in both sexes, in high and low socioeconomic strata, and in the rural area. In the urban area, protection was greater than the P-c (89.4%, with a 95% CI, 86.6-91.7%, compared to 87.4% and a 95% CI, 85.2-87.8%). Conclusions. The urban area has made progress toward herd immunity, but the overall proportion of protection in women, the rural area, and the high socioeconomic strata must be increased. The effective number may be greater than one, indicating the potential for the spread of the disease.