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# R nought and vaccine coverage

Dr. Rishi Desai is a pediatric infectious disease physician and former epidemiologist with the Centers for Disease Control and Prevention (CDC).

## Want to join the conversation?

- What is the R nought of the black death(1348-1350) or THE BIGGEST EPIDEMIC IN HISTORY(100 MILLION) someone told me about it.

Does the black death go on now,too?(4 votes)- I live in Arizona, and the disease comes and goes here in the desert. There were something like 15 cases in 2015 in the US and 3 deaths. In Arizona, and nearby states, the wild rodents such as Prairie Dogs are susceptible and their fleas transmit the disease to humans who wander through, especially up on the plateau around Flagstaff and the Grand Canyon. The Plague never quite goes away here, and the number of infected animals varies over time. It is impossible to deflea all the rodent burrows in this vast state, and it is just one of many where the rodents live. Other animals, such as Black-Footed Ferrets and Canada Lynx, both of which eat rodents, tend to carry the bacterium as a result of hanging around the rodent burrows.

When there is an outbreak, officials warn visitors to avoid rodent burrows, wear insect repellent, avoid touching sick or dead rodents, and keep dogs on a leash to limit possible exposure (also to seek medical attention immediately if they have the first symptoms). The number of cases is around 65 or 70 since 1950, of which 10 were fatal. A bad sign is when Prairie Dogs start dying out from long-established colonies, and then the Health Service becomes extra vigilant, posts warning signs, and informs the public of areas to avoid and what to do if bitten by fleas in those areas. There are people whose job it is to collect the fleas from the rodents and test them for the Plague organism to help give early warning on possible outbreaks.(6 votes)

- What is the R nought of polio?That is one of the diseases in a place where a lot of my family lives and I travel to many times in a decade.It's a disease that's under eradication but I just want to know the possibility of me getting it(okay,I have the vaccine,but not a lot of my cousins,so please tell me).(4 votes)
- Wikipedia says the R-nought of polio is about 6, so it's more contagious than Ebola.

Hopefully your family will be able to get the vaccine so they can be safe from the disease.(6 votes)

- What is the estimated R nought of Ebola?(2 votes)
- It's estimated to be about 2.

So, on average, every infected person will infect about two other people if we don't do anything.(6 votes)

- what is the R-nought of rabbies?(2 votes)
- What does R nought stand for? Does it stand for are not?(2 votes)
- As defined at0:01, R nought is a variable which represents the basic reproductive number of a disease.

If R nought is greater than 1, the disease will spread.

If R nought is equal to 1, the disease number will remain stable.

If R nought is less than 1, the disease will die out.(4 votes)

- What is the current R nought for influenza?(1 vote)
- Influenza seems complex and always changing. Depending of the way people have been previously exposed, the R nought is not always the same. I found that when 1918 did have estimated Ro around 2.5-3, other years, influenza Ro is less than 2. Delay for infection is ca. 4-5 days.(2 votes)

- at0:23wut does he mean math thing(1 vote)
- Honestly I think the "D" is like a plauge(1 vote)
- How often does a vaccine not work? Does a vaccine give a person a lifetime of immunity?(1 vote)
- I can't answer the first part, but the answer to the second one is that many vaccinations will not give lifetime immunity without booster shots every so often. The Center for Disease Control (CDC) keeps a vaccination schedule available to help people know when first vaccinations and boosters are recommended. You can find it here: https://www.cdc.gov/vaccines/schedules/(1 vote)

- For the mumps example, what if we could vaccinate over 75% of the people? Why wouldn't we do that if we had the chance? Then we might actually have a <1 R-nought.(1 vote)

## Video transcript

- I have the definition of R nought here and I'm just going to
take some quick notes. It says the number of new cases that an existing case generates on average and it's over the infectious period in a susceptible population. In here, what they're kind of referring to is non-vaccinated population. The way to think about
this is for me anyway, is to kind of put it into math terms. If you have let's say, I'm just going to write these down here. Let's say existing cases here. Existing cases. And you have new cases. You literally can just take the two and just divide them by each other. You could say, new divided by existing is going to be my R
nought, equals R nought. Right? Let's just go through a few scenarios. Let's say R nought is less than one. If it's less than one, let's think of how that might play out. Let's see if two existing cases and you come back and you say, Well, how many new ones are there in my population? There's only one new
person even though you used to have two and so, you
say, okay, that's one divided by two equals .5
and that's less than one. And what does that mean exactly? It means that if you have less than one, overtime, you can see how basically this infection is going to die out. It's not going to spread. It's just going to slowly die out because fewer and fewer
people are going to get it and in this case, maybe
even just one generation down the road, there will
be no one to potentially get this infection. These were always the nice ones because they're going
to die out by themselves and that's always wonderful for humanity when an infection dies out. Another scenario could
be an R nought of one. In this case, you might have two people with an infection and
you follow them overtime and you say, well, how many new people got infected with this infection? and they say, actually
we found two new people that got infected. So, we have two old people, two new people and so, two divided by two equals one and just in terms of keeping track of this infection overtime that means that basically, this is a stable infection. It's not spreading. The numbers are basically always two and it's also not dying out. What's the third scenario? The third one, of course, is
going to be greater than one. So, it's less than one and equal to one. The third scenario is greater than one and you start out with
two again, let's just say and you say, okay, how many new people got this infection? And this one, let's say,
I'm just going to make this really, really contagious. Let's say a lot of people
got this infection. Let's say eight new people
and how many existing? Well, there were only two just
like all the other examples. We have an R nought of four, which is greater than one. And so, what is really happening here? This is an infection that's spreading. This infection is the one
that we're worried about. It's spreading and we
want to either allow it to stabilize. One goal might be, hey,
let's just get this at least stable, right? So that it's not infecting
more and more people. Another goal might be, let's actually eradicate this disease. Let's go all the way
down to this theoretical R nought of zero and what
would R nought of zero, really, what does that mean? It means that this number new is zero. The numerator is zero and that means that there are no new cases and that would mean eradication. So, if you want to eradicate the disease like smallpox, for example, this is what you have to do. You have to figure out how to get all the way down to zero but for most diseases, you just want to stop the spread. You want to stop the spread. If you want to stop the spread, this is the goal that
you have to think about. This is goal number one. Let's put this in the
context of a real infection. Let's take the mumps virus. Mumps causes fevers and headaches and general lousy feelings but also, it swells up your cheeks
because it affects your saliva gland and it makes you look a little bit like a chipmunk. Mumps virus is not a pleasant virus and this infection when
studied has an R nought of about four. It's perfectly modeled with
this picture right here with two going to eight. And fortunate for us,
we have an MMR vaccine and that stands for
Measles, Mumps and Rubella and the measles, mumps, rubella vaccine is given to a lot of folks
and it's going to help us kind of think through
how to stop the spread of mumps, for example. Thinking through this,
if the goal is to stop the spread, what does that mean? It means that our goal R
nought is going to be one in this case and what
is our current R nought? What are we starting from? In this case, it's going to be four. And so, the proportion of people that are still going to get sick. I mean even with this wonderful goal, the proportion that are
still going to get sick are one quarter and actually, I can maybe show them right here. Maybe these two will
still get sick with mumps even if we're able to stop the spread because that's exactly
what happened here, right? But the wonderful news
and this is the good part about this is that you're able to protect this many people with this goal at least. You're able to protect this many people and that basically is reflective as one minus one over four. One minus the goal R nought
over current R nought. This is the math way to
represent this fraction. This represents this fraction right here and this represents this
fraction right there. What proportion need vaccination? What proportion of our
community, let's say, what proportion needs vaccine to at least stop the spread? That's the goal that
we said we have, right? What proportion needs vaccine? We'd say well, it's just what we laid out. It would be one minus the goal R nought, which is one divided by
the current R nought, which is four. We'd say, well, this is
three quarters or 75%. In other words, if we
are able to vaccinate 75% of people, meaning these folks. Six out of eight is 75%. Then we basically have changed
the way that mumps looks. It no longer looks like
an R nought of four. It looks like our goal
R nought, which is one. Now, I'm going to grab another example just to make sure we have a clear handle on how this works. Measles has an R nought of 18. Put into words, that means
for every one existing case, we see 18 new cases over
the infectious period usually a few weeks in a
non-vaccinated population. If that's the case, how many people, what proportion needs
vaccine to stop this spread? We say, okay, well that
means one minus, our goal is to stop the spread, so one divided by, we said the R nought is 18. This is the proportion
that we need to vaccinate and that works out to about 94%. Holy cow, that's much higher
than what we saw with mumps. Let's do one more example. Let's do diphtheria. Kind of hard to spell but D-I-P-T-H, diphtheria has an R nought
of let's say, about six and these values, six,
18, I said mumps was four, really depends on which
study you're looking up but most of these are presented as ranges but in case, if we accept the number six then we say, okay, it's one minus one because that's the goal R nought is one divided by six and that equals 83%. Basically, the higher the R nought, the better your vaccine coverage has to be in order to prevent an
outbreak from happening and of course, we're only
talking about one way to protect folks and
that's through vaccine. The other way to protect folks, of course, is to try to limit the number of new cases by saying, well, let's just
physically surround people and maybe put people in quarantine and having people separated so they can't actually catch infection
like I'm doing here. Maybe doing that can also obviously, prevent new cases from happening. I don't want to imply that
vaccine is the only way but of course, it's a
very, very effective way of preventing diseases from spreading.