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Even though endemic outbreaks of common childhood diseases, such as measles, have been eliminated in some regions after prolonged mass-vaccination efforts, we are still being constantly reminded that reducing vaccination coverage of children in a community poses the risk of a reimported disease outbreak with potentially dire consequences to infants and immuno-compromised individuals.  We are also being persuaded that implementing strict vaccination compliance will prevent an outbreak and protect vaccine-ineligible infants via the herd-immunity effect.

There is no question that a disease outbreak can happen in a non-immune community, if a virus gets there.  The real question is, how well can high-vaccination compliance ensure herd immunity and protect a community from an outbreak?

Herd Immunity, a Key Principle

Herd immunity is not an immunologic idea, but rather an epidemiologic construct, which theoretically predicts successful disease control when a certain pre-calculated percentage of people in the population are immune from disease.  A scholarly article on herd immunity states:

"Along with the growth of interest in herd immunity, there has been a proliferation of views of what it means or even of whether it exists at all. Several authors have written of data on measles, which "challenge" the principle of herd immunity and others cite widely divergent estimates (from 70 to 95 percent) of the magnitude of the herd immunity threshold required for measles eradication."[1]

Herd immunity has been deemed instrumental in rapid disease eradication.  Relying upon the meticulous work of Dr. A. W. Hedrich, who documented annual measles attack rates in relation to the proportion of naturally immune people in the 1900s-1930s, the United States Public Health Service had confidently announced in 1967 its intent to swiftly eradicate measles in the USA over the Winter by vaccinating a sufficient number of still susceptible children. Mass vaccination was implemented, but the expected herd-immunity effect did not materialize and measles epidemics did not stop in 1967.

The concept of herd immunity has been used to justify the idea of vaccinating children against a mild disease, who do not personally benefit from such vaccination, to protect a vulnerable but vaccine-ineligible segment of the population.  For example, rubella is not dangerous for children.  However, for pregnant women who have not become immune from rubella prior to pregnancy, a rubella infection poses a danger during the first trimester by increasing the risk of fetal developmental abnormalities (congenital rubella).  Obviously, vaccination with a live-attenuated viral vaccine, such as the rubella vaccine, is contraindicated during pregnancy.