Epidemiology and Infection

  • Epidemiology and Infection / Volume 137 / Issue 05 / May 2009, pp 654-661
  • Copyright © 2008 Cambridge University Press The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: http://dx.doi.org/10.1017/S0950268808001416 (About DOI), Published online: 08 October 2008

Original Papers

Models and Methods

Household structure and infectious disease transmission

T. HOUSEa1 c1 and M. J. KEELINGa1

a1 Department of Biological Sciences, University of Warwick, Coventry, UK


One of the central tenets of modern infectious disease epidemiology is that an understanding of heterogeneities, both in host demography and transmission, allows control to be efficiently optimized. Due to the strong interactions present, households are one of the most important heterogeneities to consider, both in terms of predicting epidemic severity and as a target for intervention. We consider these effects in the context of pandemic influenza in Great Britain, and find that there is significant local (ward-level) variation in the basic reproductive ratio, with some regions predicted to suffer 50% faster growth rate of infection than the mean. Childhood vaccination was shown to be highly effective at controlling an epidemic, generally outperforming random vaccination and substantially reducing the variation between regions; only nine out of over 10 000 wards did not obey this rule and these can be identified as demographically atypical regions. Since these benefits of childhood vaccination are a product of correlations between household size and number of dependent children in the household, our results are qualitatively robust for a variety of disease scenarios.

(Accepted September 05 2008)

(Online publication October 08 2008)


c1 Author for correspondence: Dr T. House, Department of Biological Sciences, University of Warwick, Coventry, CV4 7AL, UK. (Email: T.A.House@warwick.ac.uk)