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. 2015 Mar 24;33(13):1568-77.
doi: 10.1016/j.vaccine.2015.02.013. Epub 2015 Feb 18.

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

Affiliations

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

Kimberly M Thompson et al. Vaccine. .

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 1 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.

Keywords: Eradication; Polio; Population immunity; Vaccine.

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Conflict of interest statement

CONFLICTS: None

Figures

Figure 1.
Figure 1.
Number of calendar years during 2000–2014 that each country reported at least one paralytic polio cases caused by a WPV or cVDPV indicating insufficient population immunity to stop or prevent transmission, (a) including years with endemic circulation and (b) including only years with circulation of cVDPVs* or imported WPV after becoming polio-free. Based on the summary table for 2000–2012 data[8] with updated data for 2013 and 2014[1] * Includes years with no WPV circulation with imported or domestic cVDPVs for the following countries (number of calendar years with cVDPV but no WPV): Cambodia (2), China (1), Dominican Republic (2), Ethiopia (2), Haiti (2), Kenya (1), Madagascar (3), Mozambique (1), Myanmar (2), Niger (1), Philippines (1), Somalia (4), South Sudan (1), and Yemen (3)
Figure 2.
Figure 2.
Population immunity in the US general population by serotype for the RC compared to the threshold (EIP*) from 1995 forward, and for hypothetically lower proportion of transmissions via the oropharyngeal route (poro=0.6).
Figure 3.
Figure 3.
Population immunity in Israel by serotype for the RC compared to the threshold (EIP*) and if Israel hypothetically had maintained an IPV/OPV sequential schedule.
Figure 4.
Figure 4.
Population immunity and the impacts of using tOPV or bOPV in RI after 2014 in Israel
Figure 4.
Figure 4.
Population immunity and the impacts of using tOPV or bOPV in RI after 2014 in Israel
Figure 5.
Figure 5.
Overall population immunity in The Netherlands by serotype for the RC compared to the threshold (EIP*) from 1990 forward for all 3 serotypes for different assumptions (i.e., 20%, 40%, and 60%) of relative coverage in the orthodox reformed communities (compared to the general population) and for type 1 the breakdown of population immunity for the orthodox reformed communities and general population separately.
Figure 5.
Figure 5.
Overall population immunity in The Netherlands by serotype for the RC compared to the threshold (EIP*) from 1990 forward for all 3 serotypes for different assumptions (i.e., 20%, 40%, and 60%) of relative coverage in the orthodox reformed communities (compared to the general population) and for type 1 the breakdown of population immunity for the orthodox reformed communities and general population separately.

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References

    1. World Health Organization. Global Polio Eradication Initiative. 2014. - PMC - PubMed
    1. Anis E, Kopel E, Singer S, Kaliner E, Moerman L, Moran-Gilad J, et al. Insidious reintroduction of wild poliovirus into Israel, 2013. Euro Surveillance. 2013;18:pii=20586. - PubMed
    1. Shulman LM, Mendelson E, Anis E, Bassal R, Gdalevich M, Hindiyeh M, et al. Laboratory challenges in response to silent introduction and sustained transmission of wild type 1 poliovirus into Israel in 2013. J Infect Dis. 2014;210:S304–14. - PubMed
    1. Kalkowska DA, Duintjer Tebbens RJ, Grotto I, Shulman LM, Anis E, Wassilak SGF, et al. Modeling options to manage type 1 wild poliovirus imported into Israel in 2013. J Infect Dis. 2014;2014; doi: 0.1093/infdis/jiu674. - PMC - PubMed
    1. World Health Organization. Poliovirus detected from environmental samples in Egypt. Geneva: WHO; 11 February 2013. Available from: http://wwwwhoint/csr/don/2013_02_11/en/ Accessed 27 October 2014. 2013.

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