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. 2017 Mar 1;2(1):2381468317697002.
doi: 10.1177/2381468317697002. eCollection 2017 Jan-Jun.

Costs and Benefits of Including Inactivated in Addition to Oral Poliovirus Vaccine in Outbreak Response After Cessation of Oral Poliovirus Vaccine Use

Radboud J Duintjer Tebbens  1 , Kimberly M Thompson  1
Affiliations

Costs and Benefits of Including Inactivated in Addition to Oral Poliovirus Vaccine in Outbreak Response After Cessation of Oral Poliovirus Vaccine Use

Radboud J Duintjer Tebbens et al. MDM Policy Pract. .

Abstract

Background: After stopping serotype 2-containing oral poliovirus vaccine use, serotype 2 poliovirus outbreaks may still occur and require outbreak response supplemental immunization activities (oSIAs). Current oSIA plans include the use of both serotype 2 monovalent oral poliovirus vaccine (mOPV2) and inactivated poliovirus vaccine (IPV). Methods: We used an existing model to compare the effectiveness of mOPV2 oSIAs with or without IPV in response to a hypothetical postcessation serotype 2 outbreak in northwest Nigeria. We considered strategies that co-administer IPV with mOPV2, use IPV only for older age groups, or use only IPV during at least one oSIA. We considered the cost and supply implications and estimated from a societal perspective the incremental cost-effectiveness and incremental net benefits of adding IPV to oSIAs in the context of this hypothetical outbreak in 2017. Results: Adding IPV to the first or second oSIA resulted in a 4% to 6% reduction in expected polio cases compared to exclusive mOPV2 oSIAs. We found the greatest benefit of IPV use if added preemptively as a ring around the initial oSIA target population, and negligible benefit if added to later oSIAs or older age groups. We saw an increase in expected polio cases if IPV replaced mOPV2 during an oSIA. None of the oSIA strategies that included IPV for this outbreak represented a cost-effective or net beneficial intervention compared to reliance on mOPV2 only. Conclusions: While adding IPV to oSIAs results in marginal improvements in performance, the poor cost-effectiveness and current limited IPV supply make it economically unattractive for high-risk settings in which IPV does not significantly affect transmission.

Keywords: IPV; OPV cessation; dynamic modeling; eradication; health economics; polio; risk management.

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Figures

Figure 1
Figure 1
Impact of adding inactivated poliovirus vaccine (IPV) to different outbreak response supplemental immunization activities (oSIAs) that already use serotype 2 monovalent oral poliovirus vaccine. (a) Impact on polio incidence. (b) Impact on population immunity to transmission in comparison to the threshold effective immune proportion (EIP*) needed to stop transmission based on the basic reproduction number (R0) of serotype 2 wild or fully reverted poliovirus
Figure 2
Figure 2
Impact of expanding the second outbreak response supplemental immunization activity (oSIA2) that targets children under 5 years of age with serotype 2 monovalent oral poliovirus vaccine (mOPV2) to older age groups with mOPV2 or with inactivated poliovirus vaccine (IPV). (a) Impact on polio incidence. (b) Impact on population immunity to transmission in comparison to the threshold effective immune proportion (EIP*) needed to stop transmission based on the basic reproduction number (R0) of serotype 2 wild or fully reverted poliovirus
Figure 3
Figure 3
Impact of other possible strategies involving inactivated poliovirus vaccine (IPV) use during outbreak response supplemental immunization activities (oSIAs). (a) Impact on polio incidence. (b) Impact on population immunity to transmission in comparison to the threshold effective immune proportion (EIP*) needed to stop transmission based on the basic reproduction number (R0) of serotype 2 wild or fully reverted poliovirus.
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