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The potential
risk of increasing the burden of infection after immunisation originates from the fact
that a vaccination programme tends to increases the average age at infection of the
non-immunised. This has been shown both by mathematical models and by experience in
many countries and for a number of diseases. The figure shows how the average age at infection changes with vaccination coverage for
two different average ages at which children are vaccinated. (It is based on a simple
model assuming homogeneous mixing of a population with an age structure of the type of
developed countries.) This effect can also be intuitively understood. As vaccination coverage increases the
spread of the infection decreases and the chances of an unimmunised individual to get
infected also decrease, on average. For the same chances to be accumulated as prior to
vaccination, more time has to elapse, on average; therefore, there is an increase in the
average age at infection. The younger the age at which vaccination is given, the larger the effect (because more
children would avoid infection). If vaccination coverage is below a certain threshold, this (expected)
relative
increase of disease occurrence in older age-groups may be accompanied by an
absolute
increase of diseased adults; and, if the clinical consequences of the disease are more
severe in adults, the overall disease burden
in the population will be larger. (Source of figure: Anderson R, May R.
Infectious diseases of humans.
Oxford:
OUP; 1991. p.93.)
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