Modeling poliovirus transmission in Pakistan and Afghanistan to inform vaccination strategies in under-vaccinated subpopulations

Details

• Alternative Title:
  Risk Anal
• Personal Author:
  Duintjer Tebbens, Radboud J. ; Pallansch, Mark A. ; Cochi, Stephen L. ; Ehrhardt, Derek ; Farag, Noha ; Hadler, Stephen ; Hampton, Lee M. ; Martinez, Maureen ; Wassilak, Steve G.F ; Thompson, Kimberly M.
• Description:
  Due to security, access, and programmatic challenges in areas of Pakistan and Afghanistan, both countries continue to sustain indigenous wild poliovirus (WPV) transmission and threaten the success of global polio eradication and oral poliovirus vaccine (OPV) cessation. We fitted an existing differential-equation-based poliovirus transmission and OPV evolution model to Pakistan and Afghanistan using four subpopulations to characterize the well-vaccinated and undervaccinated subpopulations in each country. We explored retrospective and prospective scenarios for using inactivated poliovirus vaccine (IPV) in routine immunization or supplemental immunization activities (SIAs). The undervaccinated subpopulations sustain the circulation of serotype 1 WPV and serotype 2 circulating vaccine-derived poliovirus. We find a moderate impact of past IPV use on polio incidence and population immunity to transmission mainly due to (1) the boosting effect of IPV for individuals with preexisting immunity from a live poliovirus infection and (2) the effect of IPV-only on oropharyngeal transmission for individuals without preexisting immunity from a live poliovirus infection. Future IPV use may similarly yield moderate benefits, particularly if access to undervaccinated subpopulations dramatically improves. However, OPV provides a much greater impact on transmission and the incremental benefit of IPV in addition to OPV remains limited. This study suggests that despite the moderate effect of using IPV in SIAs, using OPV in SIAs remains the most effective means to stop transmission, while limited IPV resources should prioritize IPV use in routine immunization.
• Subjects:
  Afghanistan Disease Eradication Humans Models, Biological Pakistan Poliomyelitis Poliovirus Poliovirus Vaccine, Inactivated Poliovirus Vaccine, Oral Prospective Studies Retrospective Studies Risk Assessment Risk Management Serotyping Vaccination

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• Keywords:
  Dynamic Modeling Polio Eradication Risk Management
• Source:
  Risk Anal. 38(8):1701-1717
• Pubmed ID:
  29314143
• Pubmed Central ID:
  PMC7879700
• Document Type:
  Journal Article
• Funding:
  U2R GH001913/GH/CGH CDC HHSUnited States/
• Volume:
  38
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:6c86919789bf8c1808d0e0cd7148f4a7598a4420e1c53d2d9438a8f02ea9af921ba8a9c8c7dc5c6e4979d4d8656cefbf29e9dec21d0693e9cf484d412b4ae05b
• Download URL:
  https://stacks.cdc.gov/view/cdc/159615/cdc_159615_DS1.pdf
• File Type:
  [PDF - 2.63 MB ]