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J Biopharm Stat. 2006;16(4):453-62.

Evaluation of the indirect effects of a pneumococcal vaccine in a community-randomized study.

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  • 1Center for American Indian Health, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.


When a sufficiently high proportion of a population is immunized with a vaccine, reduction in secondary transmission of disease can confer significant protection to unimmunized population members. We propose a straightforward method to estimate the degree of this indirect effect of vaccination in the context of a community-randomized vaccine trial. A conditional logistic regression model that accounts for within-randomization unit correlation over time is described, which models risk of disease as a function of community-level covariates. The approach is applied to an example data set from a pneumococcal conjugate vaccine study, with study arm and immunization levels forming the covariates of interest for the investigation of indirect effects.

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