The Basic Reproduction Number and the Vaccination Coverage Required to Eliminate Rubella from England and Wales

Bootstrapping is used to estimate the effectiveness of different vaccination strategies for rubella in England and Wales. It is assumed that rubella infection follows the deterministic age-structured model discussed by Dietz and Schenzle (1985). The bootstrap is used to estimate percentile confidence intervals for the basic reproductive number and the minimum elimination proportions under one and two stage vaccination campaigns for rubella. The results of differing mixing assumptions and the effects of kernel smoothing are also considered. Previous estimates of the basic reproduction number and minimum elimination vaccination proportions for rubella and similar diseases are discussed and the results compared with those of the article. For homogeneous mixing only, the estimates are much lower than previous estimates. For more realistic symmetric mixing a worse 'reasonable' vaccination coverage estimate of around 87% of children as young as possible is needed to eliminate rubella in England and Wales.