Figure 4.

Observed and projected daily estimates of the case reproduction number (R_c) and proportion of decline in R_c attributed to community and public health social distancing during a measles outbreak in an Amish community, Ohio, 2014. A) Observed and projected daily estimates of the case reproduction number (R_c) over sliding 14-day windows; the dotted and dotted-dashed lines show the median R_c of 100 model trajectories without and with the measles-mumps-rubella vaccination campaign, respectively, assuming an initial vaccination coverage of 45%. The diamonds show the observed mean R_c estimate (which included other control measures and changes in community behavior), the bars represent the 90% confidence intervals, and the horizontal dashed line indicates the threshold value R_c = 1. Observed and projected R_c estimates were derived from the likelihood-based estimation procedure and directly from the models, respectively. B) Proportion of decline in R_c attributable to changes in community behavior (social distancing) and other control efforts (isolation, quarantining) during the outbreak; data presented cover the period from the initiation of containment efforts to the time when projected estimates of R_c fall below 1. The reduction in transmissibility that could be ascribed to these factors varied from approximately 30% to 90% during the outbreak.