Quantifying Parameter and Structural Uncertainty of Dynamic Disease Transmission Models Using MCMC: An Application to Rotavirus Vaccination in England and Wales

Joke Bilcke*, Ruth Chapman, Christina Atchison, Deborah Cromer, Helen Johnson, Lander Willem, Martin Cox, William Edmunds, Mark Jit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background. Two vaccines (Rotarix and RotaTeq) are highly effective at preventing severe rotavirus disease. Rotavirus vaccination has been introduced in the United Kingdom and other countries partly based on modeling and cost-effectiveness results. However, most of these models fail to account for the uncertainty about several vaccine characteristics and the mechanism of vaccine action. Methods. A deterministic dynamic transmission model of rotavirus vaccination in the United Kingdom was developed. This improves on previous models by 1) allowing for 2 different mechanisms of action for Rotarix and RotaTeq, 2) using clinical trial data to understand these mechanisms, and 3) accounting for uncertainty by using Markov Chain Monte Carlo. Results. In the long run, Rotarix and RotaTeq are predicted to reduce the overall rotavirus incidence by 50% (39%-63%) and 44% (30%-62%), respectively but with an increase in incidence in primary school children and adults up to 25 y of age. The vaccines are estimated to give more protection than 1 or 2 natural infections. The duration of protection is highly uncertain but has only impact on the predicted reduction in rotavirus burden for values lower than 10 y. The 2 vaccine mechanism structures fit equally well with the clinical trial data. Long-term postvaccination dynamics cannot be predicted reliably with the data available. Conclusion. Accounting for the joint uncertainty of several vaccine characteristics resulted in more insight into which of these are crucial for determining the impact of rotavirus vaccination. Data for up to at least 10 y postvaccination and covering older children and adults are crucial to address remaining questions on the impact of widespread rotavirus vaccination.

Original languageEnglish
Pages (from-to)633-647
Number of pages15
JournalMedical Decision Making
Issue number5
Publication statusPublished - 19 Jul 2015

Bibliographical note

Funding Information:
LW is supported by an interdisciplinary PhD grant of the Special Research Fund (Bijzonder Onderzoeksfonds, BOF) of the University of Antwerp. MJ is partly funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. WJE’s partner works for GlaxoSmithKline.

Funding Information:
Financial support for this study was provided in part by a grant from the Department of Health UK (NVEC grant DOH 039/0031). JB is a postdoctoral researcher funded by the Research Foundation–Flanders (FWO).

Publisher Copyright:
© The Author(s) 2015.


  • dynamic transmission model
  • Markov Chain Monte Carlo
  • rotavirus
  • uncertainty
  • vaccination


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