The Failure of R0

The basic reproductive ratio, R0, is one of the fundamental concepts in mathematical biology. It is a threshold parameter, intended to quantify the spread of disease by estimating the average number of secondary infections in a wholly susceptible population, giving an indication of the invasion stre...

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Bibliographic Details
Published in:Computational and mathematical methods in medicine 2011, Vol.2011 (2011), p.1-17
Main Authors: Li, Jing, Blakeley, Daniel, Smith?, Robert J.
Format: Article
Language:English
Subjects:
Basic Reproduction Number - statistics & numerical data
Bluetongue - epidemiology
Bluetongue - transmission
Cholera - epidemiology
Cholera - transmission
Dengue - epidemiology
Dengue - transmission
Disease Outbreaks - statistics & numerical data
Female
HIV Infections - epidemiology
HIV Infections - transmission
Humans
Influenza, Human - epidemiology
Influenza, Human - transmission
Malaria - epidemiology
Malaria - transmission
Male
Models, Biological
Rift Valley Fever - epidemiology
Rift Valley Fever - transmission
West Nile Fever - epidemiology
West Nile Fever - transmission
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Summary:The basic reproductive ratio, R0, is one of the fundamental concepts in mathematical biology. It is a threshold parameter, intended to quantify the spread of disease by estimating the average number of secondary infections in a wholly susceptible population, giving an indication of the invasion strength of an epidemic: if R01, the disease persists. R0 has been widely used as a measure of disease strength to estimate the effectiveness of control measures and to form the backbone of disease-management policy. However, in almost every aspect that matters, R0 is flawed. Diseases can persist with R01 can die out. We show that the same model of malaria gives many different values of R0, depending on the method used, with the sole common property that they have a threshold at 1. We also survey estimated values of R0 for a variety of diseases, and examine some of the alternatives that have been proposed. If R0 is to be used, it must be accompanied by caveats about the method of calculation, underlying model assumptions and evidence that it is actually a threshold. Otherwise, the concept is meaningless.
ISSN:1748-670X
1748-6718
DOI:10.1155/2011/527610