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The present study describes a stochastic individual-based model to assess the relative impact of chemotherapy and vaccination against human hookworm infection and investigates the implications of potential correlations between risk of infection and vaccine efficacy. Vaccination is simulated as a reduction in susceptibility to infection and the model includes population heterogeneities and dynamical waning of protection. To help identify appropriate measures of vaccine impact, we present a novel framework to quantify the vaccine impact on the infection-associated morbidity and introduce a measure of symmetry to study the correspondence between reduction in intensity and reduction in morbidity. Our modelling shows that, in high-transmission settings, the greatest impact of vaccination will be attained when vaccine efficacy is the greatest among individuals harbouring the heaviest worm burdens, and that the decline of morbidity primarily depends on the level of protection attained in the most at risk 8\u201312% of the population. We also demonstrate that if risk of infection and vaccine protection are correlated, there is not always a direct correspondence between the reduction in worm burden and in morbidity, with the precise relationship varying according to transmission setting.<\/jats:p>","DOI":"10.1098\/rsif.2007.1255","type":"journal-article","created":{"date-parts":[[2008,3,10]],"date-time":"2008-03-10T22:55:34Z","timestamp":1205189734000},"page":"1329-1341","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Modelling heterogeneity and the impact of chemotherapy and vaccination against human hookworm"],"prefix":"10.1098","volume":"5","author":[{"given":"L","family":"Sabatelli","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.C","family":"Ghani","sequence":"additional","affiliation":[{"name":"MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College LondonNorfolk Place, London W2 1PG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.C","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.J","family":"Hotez","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Medical Center2300 Eye Street NW, Washington, DC 20037, USA"},{"name":"Human Hookworm Vaccine Initiative, Sabin Vaccine InstituteWashington, DC 20006-4400, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Brooker","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"175","published-online":{"date-parts":[[2008,3,10]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/978-1-4899-2901-3_3","volume-title":"Population dynamics of infectious diseases: theory and applications","author":"Anderson R.M","year":"1982"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/297557a0"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0065-308X(08)60561-8"},{"key":"e_1_3_2_5_1","doi-asserted-by":"crossref","unstructured":"Anderson R.M& May R.M. 1991 Infectious diseases of humans: dynamics and control. 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