Managing population immunity to reduce or eliminate the risks of circulation following the importation of polioviruses

    Authors

    K. M. Thompson; D. A. Kalkowska;R. J. D. Tebbens

    Comments

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    Abbreviated Journal Title

    Vaccine

    Keywords

    Polio; Eradication; Population immunity; Vaccine; WILD POLIOVIRUS; UNITED-STATES; POLIOMYELITIS OUTBREAK; POLICY OPTIONS; VACCINE; TRANSMISSION; ERADICATION; NETHERLANDS; DISEASE; ISRAEL; Immunology; Medicine, Research & Experimental

    Abstract

    Poliovirus importations into polio-free countries represent a major concern during the final phases of global eradication of wild polioviruses (WPVs). We extend dynamic transmission models to demonstrate the dynamics of population immunity out through 2020 for three countries that only used inactivated poliovirus vaccine (IPV) for routine immunization: the US, Israel, and The Netherlands. For each country, we explore the vulnerability to re-established transmission following an importation for each poliovirus serotype, including the impact of immunization choices following the serotype 1 WPV importation that occurred in 2013 in Israel. As population immunity declines below the threshold required to prevent transmission, countries become at risk for re-established transmission. Although importations represent stochastic events that countries cannot fully control because people cross borders and polioviruses mainly cause asymptomatic infections, countries can ensure that any importations die out. Our results suggest that the general US population will remain above the threshold for transmission through 2020. In contrast, Israel became vulnerable to re-established transmission of importations of live polioviruses by the late 2000s. In Israel, the recent WPV importation and outbreak response use of bivalent oral poliovirus vaccine (bOPV) eliminated the vulnerability to an importation of poliovirus serotypes 1 and 3 for several years, but not serotype 2. The Netherlands experienced a serotype I WPV outbreak in 1992-1993 and became vulnerable to re-established transmission in religious communities with low vaccine acceptance around the year 2000, although the general population remains well-protected from widespread transmission. All countries should invest in active management of population immunity to avoid the potential circulation of imported live polioviruses. IPV-using countries may wish to consider prevention opportunities and/or ensure preparedness for response. Countries currently using a sequential IPV/OPV schedule should continue to use all licensed OPV serotypes until global OPV cessation to minimize vulnerability to circulation of imported polioviruses. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

    Journal Title

    Vaccine

    Volume

    33

    Issue/Number

    13

    Publication Date

    1-1-2015

    Document Type

    Article

    Language

    English

    First Page

    1568

    Last Page

    1577

    WOS Identifier

    WOS:000352045300009

    ISSN

    0264-410X

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