title: Distinguishing vaccine efficacy and effectiveness.
abstract: BACKGROUND
  Mathematical models of disease transmission and vaccination typically assume that protective vaccine efficacy (i.e. the relative reduction in the transmission rate among vaccinated individuals) is equivalent to direct effectiveness of vaccine. This assumption has not been evaluated.
  
  
  METHODS
  We used dynamic epidemiological models of influenza and measles vaccines to evaluate the common measures of vaccine effectiveness in terms of both the protection of individuals and disease control within populations. We determined how vaccine-mediated reductions in attack rates translate into vaccine efficacy as well as into the common population measures of 'direct', 'indirect', 'total', and 'overall' effects of vaccination with examples of compartmental models of influenza and measles vaccination.
  
  
  RESULTS
  We found that the typical parameterization of vaccine efficacy using direct effectiveness of vaccine can lead to the underestimation of the impact of vaccine. Such underestimation occurs when the vaccine is assumed to offer partial protection to every vaccinated person, and becomes worse when the level of vaccine coverage is low. Nevertheless, estimates of 'total', 'indirect' and 'overall' effectiveness increase with vaccination coverage in the population. Furthermore, we show how the measures of vaccine efficacy and vaccine effectiveness can be correctly calculated.
  
  
  CONCLUSIONS
  Typical parameterization of vaccine efficacy in mathematical models may underestimate the actual protective effect of the vaccine, resulting in discordance between the actual effects of vaccination at the population level and predictions made by models. This work shows how models can be correctly parameterized from clinical trial data.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA. eshim@pitt.edu
authors.forename: Eunha
authors.initials: E
authors.lastname: Shim
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D006801:Humans; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D032541:Mass Vaccination; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine; D008962:Models, Theoretical; D011157:Population Dynamics
chemical_list: D007252:Influenza Vaccines; D008458:Measles Vaccine