Lessons from the polio endgame: overcoming the failure to vaccinate and the role of subpopulations in maintaining transmission

KM Thompson… - The Journal of Infectious …, 2017 - academic.oup.com
The Journal of Infectious Diseases, 2017academic.oup.com
Background. Recent detections of circulating serotype 2 vaccine-derived poliovirus in
northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and
serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public
health emergencies that require aggressive response. Methods. We demonstrate the
importance of undervaccinated subpopulations, using an existing dynamic poliovirus
transmission and oral poliovirus vaccine evolution model. We review the lessons learned …
Background
Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response.
Methods
We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts.
Results
Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term.
Conclusions
Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.
Oxford University Press
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