COVID-19:

This is not
the last pandemic
Herd Immunity: Immunological Background
and Vaccine Effectiveness Involvement

Irhamni
Faculty of Medicine, Universitas Diponegoro

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Outline

Vaccinology Immunity

Herd
Immunity
 4 Immunity
• Complex biological system endowed with the capacity
to recognize and tolerate whatever belongs to the
self, and to recognize and reject what is foreign
(non-self).
Physical and bio-chemical barrier and
normal flora
Innate
Cellular and soluble factors
Immunity
Humoral (antibody-
mediated)
Adaptive
Cell-mediated
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How to get the immunity?
Immunity

Innate Adaptive

Active Passive

Natural Natural

Artificial Artificial
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Herd Immunity 101
• The indirect protection from
infection conferred to
susceptible individuals when
a sufficiently large
proportion of immune
individuals exist in a
population.
• Simply defined as immunity in
population level.
7 R0 value
• Expected number of
secondary cases one cases
would produce in completely
susceptible population (e.g.
R0 SARS-CoV-2 = 2 – 2.5)
• Corresponds to the herd
immunity threshold (HIT)
1
HIT = 1 -
R0
• R, Rt , atau Re (?)
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How to get there?
• The worst case scenario? Immunity
• The best case scenario?
• Somewhere in between? Innate Adaptive

Expected number of secondary Active Passive

cases one cases would produce
in completely susceptible
Natural Natural
population

Artificial Artificial
9 R0 value and vaccination (1)
• Population is heterogeneous
1
Is HIT = 1 - simply applicable? NO
R0

1− 1
R0
Vc =
E
Vc : critical vaccine level
E : vaccine effectiveness against transmission
10 R0 value and vaccination (cont’d)
• Vaccine Effectiveness is percentage reduction in the
incidence of disease among vaccinated persons
compared with unvaccinated persons
11 R0 value and vaccination (cont’d)
Vaccine effectiveness

A
𝐴𝐷
= 1- B = 1- Minimized by Minimizing AD
C 𝐵𝐶 and/or Maximizing BC
D
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How to realize them?
Several issue have to tackled in order to realize them,
including:
• Imperfect immunity
• Heterogeneous population-nonrandom mixing
• Nonrandom vaccination
• “Freeloaders”
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Further readings
• Brooks GF, Carroll KC, Butel JS, Morse SA, Mietzner TA. Jawetz, Melnick, and
Adelberg Medical Microbiology. 25th ed. New York: McGraw Hill Medical; 2010.
Chapter 2: Immunology; p. 125-150
• Sherwood, L. Human Physiology: from Cells to Systems. 8th ed. Belmont:
Brooks/Cole, Cengage Learning; 2013 . Chapter 12: Body Defenses; p. 443-
486
• Randolf HE and Berreiro LB. Herd Immunity: Understanding COVID-19.
Immunity. 2020;52(5):737–41
• Fine P, Eames K, Heymann DL. “Herd immunity”: A rough guide. Clin Infect Dis.
2011;52(7):911–6.
• Delamater PL, Street EJ, Leslie TF, Yang YT, Jacobsen KH. Complexity of the
basic reproduction number (R0). Emerg Infect Dis. 2019;25(1):1–4.
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Further readings (cont’d)
• Banaszkiewicz A, Radzikowski A. Efficacy, effectiveness, immunogenicity - are
not the same in vaccinology. World J Gastroenterol. 2013;19(41):7217–8.
• Cohen AL, Taylor T, Farley MM, Schaffner W, Lesher LJ, Gershman KA, et al. An
assessment of the screening method to evaluate vaccine effectiveness: The
case of 7-valent pneumococcal conjugate vaccine in the United States. PLoS
One. 2012;7(8):e41785.
Learn SARS-CoV-2
in Virology…
not Fearology