Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in
Maintaining Transmission
by Kimberly M. Thompson and Radboud J. Duintjer Tebbens, Journal of Infectious Diseases 2017;216(S1):S176-S182, doi:10.1093/infdis/jix108.
Answers to frequently asked questions
What are the study’s main findings?
What are the study’s main recommendations?
Background on polio
What are the study’s main findings?
- The study uses a hypothetical transmission model with different assumptions
to illustrate how an under-vaccinated subpopulation can sustain transmission despite high coverage in
the surrounding population.
- Modeling and experience suggest that the failure to immunize under-vaccinated subpopulations
represents a root cause of polio endgame challenges
related to: (i) interrupting wild poliovirus (WPV) transmission in last endemic countries,
(ii) preventing WPV importation outbreaks, and (iii) preventing or stopping
the emergences of circulating vaccine-derived poliovirus serotype 2
(cVDPV2) likely to occur in the same security-compromised areas that also sustain WPV transmission.
- In some cases, serotype-specific use of oral poliovirus vaccine (OPV) created under-vaccinated subpopulations for other serotypes.
- Reaching under-vaccinated subpopulations with vaccine represents the key for
a successful
polio endgame, but maintaining sufficient population immunity to
transmission everywhere remains a prerequisite.
- After cessation of OPV use, immunodeficient patients that may become
prolonged or chronic
poliovirus excretors represent a particular subpopulation that requires focused risk management.
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What are the study’s main recommendations?
- Future eradication initiatives should learn important lessons from the
polio eradication experience and
create performance expectations for countries to identify and
reach all people living within their borders with maintained
high coverage with appropriate interventions.
- The global capacity created by the Global Polio Eradication Initiative
(GPEI) to manage the risks
related to key subpopulations currently represents a critical global resource
for polio and other infectious diseases, and the study recommends maintaining
this type of global capacity beyond the existence of the GPEI.
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