Basic reproduction number

In epidemiology, the basic reproduction number (sometimes called basic reproductive rate, basic reproductive ratio and denoted R₀, r nought) of an infection is the mean number of secondary cases caused by an individual infected soon after disease introduction into a population with no pre-existing immunity to the disease in the absence of interventions to control the infection. This metric is useful because it helps determine whether or not an infectious disease can spread through a population. The roots of the basic reproduction concept can be traced through the work of Alfred Lotka, Ronald Ross, and others, but its first modern application in epidemiology was by George MacDonald in 1952, who constructed population models of the spread of malaria.

When

R₀ < 1

the infection will die out in the long run (provided infection rates are constant). But if

R₀ > 1

the infection will be able to spread in a population.

Generally, the larger the value of R₀, the harder it is to control the epidemic. For simple models, the proportion of the population that needs to be vaccinated to prevent sustained spread of the infection is given by 1 − 1/R₀. The basic reproductive rate is affected by several factors including the duration of infectivity of affected patients, the infectiousness of the organism, and the number of susceptible people in the population that the affected patients are in contact with.

Other uses

R₀ is also used as a measure of individual reproductive success in population ecology,^[4] evolutionary invasion analysis and life history theory. It represents the average number of offspring produced over the lifetime of an individual (under ideal conditions).

For simple population models, R₀ can be calculated, provided an explicit decay rate (or "death rate") is given. In this case, the reciprocal of the decay rate (usually 1/d) gives the average lifetime of an individual. When multiplied by the average number of offspring per individual per timestep (the "birth rate" b), this gives R₀ = b / d. For more complicated models that have variable growth rates (e.g. because of self-limitation or dependence on food densities), the maximum growth rate should be used.

Limitations of R₀

When calculated from mathematical models, particularly ordinary differential equations, what is often claimed to be R₀ is, in fact, simply a threshold, not the average number of secondary infections. There are many methods used to derive such a threshold from a mathematical model, but few of them always give the true value of R₀. This is particularly problematic if there are intermediate vectors between hosts, such as malaria.

What these thresholds will do is determine whether a disease will die out (if R₀ < 1) or whether it may become endemic (if R₀ > 1), but they generally can not compare different diseases. Therefore, the values from the table above should be used with caution, especially if the values were calculated from mathematical models.

Methods include the survival function, rearranging the largest eigenvalue of the Jacobian matrix, the next-generation method,^[5] calculations from the intrinsic growth rate,^[6] existence of the endemic equilibrium, the number of susceptibles at the endemic equilibrium, the average age of infection ^[7] and the final size equation. Few of these methods agree with one another, even when starting with the same system of differential equations. Even fewer actually calculate the average number of secondary infections. Since R₀ is rarely observed in the field and is usually calculated via a mathematical model, this severely limits its usefulness.^[8]

See also

• E-epidemiology
• Epi Info software program
• Epidemic model
• Epidemiological methods
• Epidemiological Transition

References