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. 2016 Oct;7(5):340.
doi: 10.4172/2157-7560.1000340. Epub 2016 Oct 3.

Maintenance and Intensification of Bivalent Oral Poliovirus Vaccine Use Prior to its Coordinated Global Cessation

Radboud J Duintjer Tebbens  1 , Lee M Hampton  2 , Steven G F Wassilak  2 , Mark A Pallansch  3 , Stephen L Cochi  2 , Kimberly M Thompson  1
Affiliations

Maintenance and Intensification of Bivalent Oral Poliovirus Vaccine Use Prior to its Coordinated Global Cessation

Radboud J Duintjer Tebbens et al. J Vaccines Vaccin. 2016 Oct.

Abstract

Objective: To examine the impact of different bivalent oral poliovirus vaccine (bOPV) supplemental immunization activity (SIA) strategies on population immunity to serotype 1 and 3 poliovirus transmission and circulating vaccine-derived poliovirus (cVDPV) risks before and after globally-coordinated cessation of serotype 1 and 3 oral poliovirus vaccine (OPV13 cessation).

Methods: We adapt mathematical models that previously informed vaccine choices ahead of the trivalent oral poliovirus vaccine to bOPV switch to estimate the population immunity to serotype 1 and 3 poliovirus transmission needed at the time of OPV13 cessation to prevent subsequent cVDPV outbreaks. We then examine the impact of different frequencies of SIAs using bOPV in high risk populations on population immunity to serotype 1 and 3 transmission, on the risk of serotype 1 and 3 cVDPV outbreaks, and on the vulnerability to any imported bOPV-related polioviruses.

Results: Maintaining high population immunity to serotype 1 and 3 transmission using bOPV SIAs significantly reduces 1) the risk of outbreaks due to imported serotype 1 and 3 viruses, 2) the emergence of indigenous cVDPVs before or after OPV13 cessation, and 3) the vulnerability to bOPV-related polioviruses in the event of non-synchronous OPV13 cessation or inadvertent bOPV use after OPV13 cessation.

Conclusion: Although some reduction in global SIA frequency can safely occur, countries with suboptimal routine immunization coverage should each continue to conduct at least one annual SIA with bOPV, preferably more, until global OPV13 cessation. Preventing cVDPV risks after OPV13 cessation requires investments in bOPV SIAs now through the time of OPV13 cessation.

Keywords: Eradication; OPV; Polio; Risk management; Vaccine choice.

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Conflict of interest statement

Competing Interests None

Figures

Figure 1
Figure 1
Population immunity to WPV1 and WPV3 transmission before and after OPV13 cessation for different routine immunization coverage with 3 non-birth bOPV doses (including IPV co-administration at third dose) in the hypothetical population with an R0 for WPV1 equal to 13*. Increasing population immunity reflects occurrence of an indigenous cVDPV outbreak. A) Lowest coverage that prevents both cVDPV1 and cVDPV3 outbreaks. B) Highest coverage for which a cVDPV1 outbreak occurs (but no cVDPV3 outbreak). C) Lowest coverage that prevents a cVDPV3 outbreak (but which does not prevent a pre-cessation cVDPV1 outbreak). D) Highest coverage for which both a cVDPV1 and a cVDPV3 outbreak occur. *R0 for WPV3=0.75 × R0 for WPV1 (i.e., 0.75 × 13=9.75)
Figure 2
Figure 2
Minimum population immunity to transmission of each WPV serotype at tOPV or OPV13 cessation to prevent a subsequent homotypic cVDPV outbreak in the hypothetical population with an R0 for WPV1 equal to 13*.*R0 for WPV2 = 0.9 × R0 for WPV1 (i.e., 0.9 × 13=11.7) and R0 for WPV3=0.75 × R0 for WPV1 (i.e., 0.75 ×13=9.75)
Figure 3
Figure 3
Population immunity to transmission as a function of the annual number of bOPV SIAs in the hypothetical population with a R0 for WPV1 equal to 13. A) Serotype 1. B) Serotype 3.
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