Modeling Population Immunity to Support Efforts to End the Transmission of Live Polioviruses

    Authors

    K. M. Thompson; M. A. Pallansch; R. J. D. Tebbens; S. G. Wassilak;S. L. Cochi

    Comments

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    Abbreviated Journal Title

    Risk Anal.

    Keywords

    Immunity; poliovirus; vaccine; VACCINE-DERIVED POLIOVIRUS; UNITED-STATES; PARALYTIC POLIOMYELITIS; ERADICATION; OUTBREAK; EPIDEMIOLOGY; IMMUNIZATION; EFFICACY; POLICIES; IMMUNOGENICITY; Public, Environmental & Occupational Health; Mathematics, ; Interdisciplinary Applications; Social Sciences, Mathematical Methods

    Abstract

    Eradication of wild poliovirus (WPV) types 1 and 3, prevention and cessation of circulating vaccine-derived polioviruses, and achievement and maintenance of a world free of paralytic polio cases requires active risk management by focusing on population immunity and coordinated cessation of oral poliovirus vaccine (OPV). We suggest the need for a complementary and different conceptual approach to achieve eradication compared to the current case-based approach using surveillance for acute flaccid paralysis (AFP) to identify symptomatic poliovirus infections. Specifically, we describe a modeling approach to characterize overall population immunity to poliovirus transmission. The approach deals with the realities that exposure to live polioviruses (e.g., WPV, OPV) and/or vaccination with inactivated poliovirus vaccine provides protection from paralytic polio (i.e., disease), but does not eliminate the potential for reinfection or asymptomatic participation in poliovirus transmission, which may increase with time because of waning immunity. The AFP surveillance system provides evidence of symptomatic poliovirus infections detected, which indicate immunity gaps after outbreaks occur, and this system represents an appropriate focus for controlling disease outbreaks. We describe a conceptual dynamic model to characterize population immunity to poliovirus transmission that helps identify risks created by immunity gaps before outbreaks occur, which provides an opportunity for national and global policymakers to manage the risk of poliovirus and prevent outbreaks before they occur. We suggest that dynamically modeling risk represents an essential tool as the number of cases approaches zero.

    Journal Title

    Risk Analysis

    Volume

    33

    Issue/Number

    4

    Publication Date

    1-1-2013

    Document Type

    Article

    Language

    English

    First Page

    647

    Last Page

    663

    WOS Identifier

    WOS:000317295900005

    ISSN

    0272-4332

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