1
|
Gupta N, Grobusch MP, Jokelainen P, Wyllie AL, Barac A, Mora-Rillo M, Gkrania-Klotsas E, Pellejero-Sagastizabal G, Paño-Pardo JR, Duizer E, Lescure FX. Poliomyelitis in Gaza. Clin Microbiol Infect 2024:S1198-743X(24)00485-3. [PMID: 39395624 DOI: 10.1016/j.cmi.2024.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/03/2024] [Accepted: 10/05/2024] [Indexed: 10/14/2024]
Affiliation(s)
- Nitin Gupta
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection and Immunity, Amsterdam Public Health, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Pikka Jokelainen
- Infectious Disease Preparedness and One Health, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Anne L Wyllie
- Department of Global, Environmental, and Occupational Health, University of Maryland School of Public Health, College Park, Maryland, USA; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Marta Mora-Rillo
- High-Level Isolation Unit, Infectious Diseases Unit, La Paz University Hospital, IdiPAZ, Madrid, Spain; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Effrossyni Gkrania-Klotsas
- Department of Infectious Diseases, Cambridge University Hospitals & The Clinical School, University of Cambridge, Cambridge, United Kingdom; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Galadriel Pellejero-Sagastizabal
- Servicio de Enfermedades Infecciosas / Division of Infectious Diseases, Hospital Clínico Universitario Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón) 50009 Zaragoza, Spain; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas / Division of Infectious Diseases, Hospital Clínico Universitario Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón) 50009 Zaragoza, Spain; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - Erwin Duizer
- Centre for Infectious Diseases Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease
| | - F-Xavier Lescure
- Infectious and Tropical Diseases Department, APHP, Bichat Hospital and Université Paris Cité, Inserm, IAME, F-75018 Paris, France; Emerging Infections Subcommittee, European Society of Clinical Microbiology and Infectious Disease.
| |
Collapse
|
2
|
Dolgova AS, Kanaeva OI, Antonov SA, Shabalina AV, Klyuchnikova EO, Sbarzaglia VA, Gladkikh AS, Ivanova OE, Kozlovskaya LI, Dedkov VG. Qualitative real-time RT-PCR assay for nOPV2 poliovirus detection. J Virol Methods 2024; 329:114984. [PMID: 38885908 DOI: 10.1016/j.jviromet.2024.114984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Based on the success of the Sabin2-based vaccine, a next-generation nOPV2 poliovirus vaccine has been developed. For epidemic monitoring and conducting epidemiological investigations, it is necessary to have a diagnostic assay with the ability to differentiate this variant from others. Here we describe such a real-time RT-PCR assay. The region with the cre insertion in the 5'-UTR was chosen as the target, and the limit of detection was 103 copies/mL (2.5×103 copies/mL using Probit analysis) determined using armored RNA particles. Sensitivity and specificity were 86.28 - 100 % and 76.84 - 100 %, respectively (with 95 % CI). Thus, this method can be effectively used when it is necessary to make a differential diagnosis of poliovirus strains.
Collapse
Affiliation(s)
- A S Dolgova
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia.
| | - O I Kanaeva
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - S A Antonov
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - A V Shabalina
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - E O Klyuchnikova
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - V A Sbarzaglia
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - A S Gladkikh
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - O E Ivanova
- Federal State Autonomous Scientific Institution "Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences" (Institute of Poliomyelitis), Moscow, Russia; Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - L I Kozlovskaya
- Federal State Autonomous Scientific Institution "Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences" (Institute of Poliomyelitis), Moscow, Russia; Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V G Dedkov
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia; Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
3
|
Ivanova OE, Eremeeva TP, Baykova OY, Krasota AY, Yakovchuk EV, Shustova EY, Malyshkina LP, Mustafina ANI, Mikhailova YM, Chirova AV, Cherepanova EA, Morozova NS, Gladkikh AS, Dolgova AS, Dedkov VG, Totolian AA, Kozlovskaya LI. Detection of Polioviruses Type 2 among Migrant Children Arriving to the Russian Federation from a Country with a Registered Poliomyelitis Outbreak. Vaccines (Basel) 2024; 12:718. [PMID: 39066356 PMCID: PMC11281678 DOI: 10.3390/vaccines12070718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
The widespread use of the oral poliovaccine from Sabin strains (tOPV) radically reduced poliomyelitis incidence worldwide. However, OPV became a source of neurovirulent vaccine-derived polioviruses (VDPVs). Currently, circulating type 2 VDPVs (cVDPV2) are the leading cause of poliomyelitis. The novel OPV type 2 vaccine (nOPV2), based on genetically modified Sabin strain with increased genetic stability and reduced risk of cVDPV formation, has been used to combat cVDPV2 outbreaks, including one in Tajikistan in 2021. In order to identify the importation of cVDPV2 and nOPV2-derivates, stool samples from 12,127 healthy migrant children under 5 years of age arriving from Tajikistan were examined in Russia (March 2021-April 2022). Viruses were isolated in cell culture and identified via intratype differentiation RT-PCR, VP1 and whole-genome sequencing. cVDPV2 isolates closely related with the Tajikistan one were isolated from two children, and nOPV2-derived viruses were detected in specimens from 106 children from 37 regions of Russia. The duration of nOPV2 excretion ranged from 24 to 124 days post-vaccination. nOPV2 isolates contained 27 mutations per genome (0.36%) on average, with no critical genetic changes, which confirms the genetic stability of nOPV2 during field use. The possibility of epidemiologically significant poliovirus introduction into polio-free countries has been confirmed. The screening of special populations, including migrants, is required to maintain epidemiological well-being.
Collapse
Affiliation(s)
- Olga E. Ivanova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Tatiana P. Eremeeva
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Olga Y. Baykova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Alexandr Y. Krasota
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Elizaveta V. Yakovchuk
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Elena Y. Shustova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Lyudmila P. Malyshkina
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Aida N.-I. Mustafina
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
| | - Yulia M. Mikhailova
- Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection” (FBHI FCH&E), 117105 Moscow, Russia; (Y.M.M.); (A.V.C.); (E.A.C.); (N.S.M.)
| | - Alina V. Chirova
- Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection” (FBHI FCH&E), 117105 Moscow, Russia; (Y.M.M.); (A.V.C.); (E.A.C.); (N.S.M.)
| | - Evgeniya A. Cherepanova
- Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection” (FBHI FCH&E), 117105 Moscow, Russia; (Y.M.M.); (A.V.C.); (E.A.C.); (N.S.M.)
| | - Nadezhda S. Morozova
- Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection” (FBHI FCH&E), 117105 Moscow, Russia; (Y.M.M.); (A.V.C.); (E.A.C.); (N.S.M.)
| | - Anna S. Gladkikh
- Saint-Petersburg Pasteur Institute, Federal Service on Consumers’ Rights Protection and Human Well-Being Surveillance, 197101 Saint-Petersburg, Russia; (A.S.G.); (A.S.D.); (V.G.D.); (A.A.T.)
| | - Anna S. Dolgova
- Saint-Petersburg Pasteur Institute, Federal Service on Consumers’ Rights Protection and Human Well-Being Surveillance, 197101 Saint-Petersburg, Russia; (A.S.G.); (A.S.D.); (V.G.D.); (A.A.T.)
| | - Vladimir G. Dedkov
- Saint-Petersburg Pasteur Institute, Federal Service on Consumers’ Rights Protection and Human Well-Being Surveillance, 197101 Saint-Petersburg, Russia; (A.S.G.); (A.S.D.); (V.G.D.); (A.A.T.)
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Areg A. Totolian
- Saint-Petersburg Pasteur Institute, Federal Service on Consumers’ Rights Protection and Human Well-Being Surveillance, 197101 Saint-Petersburg, Russia; (A.S.G.); (A.S.D.); (V.G.D.); (A.A.T.)
| | - Liubov I. Kozlovskaya
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (T.P.E.); (O.Y.B.); (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| |
Collapse
|
4
|
Bandyopadhyay AS, Lopez Cavestany R, Blake IM, Macklin G, Cooper L, Grassly N, Nery ALMDS, Mach O. Use of inactivated poliovirus vaccine for poliovirus outbreak response. THE LANCET. INFECTIOUS DISEASES 2024; 24:e328-e342. [PMID: 38012892 DOI: 10.1016/s1473-3099(23)00505-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023]
Abstract
With continued wild poliovirus transmission in Afghanistan and Pakistan and circulating vaccine-derived poliovirus in certain countries, there exists an ongoing risk of importation of polioviruses into other countries, including those that have been polio-free for decades. Diversifying the poliovirus outbreak response toolkit is essential to account for different public health and epidemiological contexts. In this Personal View, we discuss data on intestinal and pharyngeal mucosal immunity induced by inactivated poliovirus vaccine (IPV), previous programmatic experience of poliovirus outbreak response with IPV, and outbreak response guidelines in countries that exclusively use IPV. With recent reports of poliovirus detection in polio-free countries such as the USA and the UK, it is important to assess the interplay of virus transmission dynamics, vaccine impact on preventing paralysis and virus spread, and regulatory complexities of using oral poliovirus vaccine (OPV) and IPV options for outbreak response. As the global eradication programme navigates through cessation of routine OPV use with replacement by IPV and stockpiling of novel OPVs, clarity on the impact of IPV use will be important for informed decision making by global, regional, and national policy makers.
Collapse
Affiliation(s)
| | | | - Isobel M Blake
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Grace Macklin
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Laura Cooper
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nicholas Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| |
Collapse
|
5
|
Thompson KM, Kalkowska DA, Routh JA, Brenner IR, Rosenberg ES, Zucker JR, Langdon-Embry M, Sugerman DE, Burns CC, Badizadegan K. Modeling Poliovirus Transmission and Responses in New York State. J Infect Dis 2024; 229:1097-1106. [PMID: 37596838 PMCID: PMC11284859 DOI: 10.1093/infdis/jiad355] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In July 2022, New York State (NYS) reported a case of paralytic polio in an unvaccinated young adult, and subsequent wastewater surveillance confirmed sustained local transmission of type 2 vaccine-derived poliovirus (VDPV2) in NYS with genetic linkage to the paralyzed patient. METHODS We adapted an established poliovirus transmission and oral poliovirus vaccine evolution model to characterize dynamics of poliovirus transmission in NYS, including consideration of the immunization activities performed as part of the declared state of emergency. RESULTS Despite sustained transmission of imported VDPV2 in NYS involving potentially thousands of individuals (depending on seasonality, population structure, and mixing assumptions) in 2022, the expected number of additional paralytic cases in years 2023 and beyond is small (less than 0.5). However, continued transmission and/or reintroduction of poliovirus into NYS and other populations remains a possible risk in communities that do not achieve and maintain high immunization coverage. CONCLUSIONS In countries such as the United States that use only inactivated poliovirus vaccine, even with high average immunization coverage, imported polioviruses may circulate and pose a small but nonzero risk of causing paralysis in nonimmune individuals.
Collapse
Affiliation(s)
| | | | - Janell A Routh
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - I Ravi Brenner
- Office of Public Health, New York State Department of Health, Albany, New York, USA
| | - Eli S Rosenberg
- Office of Public Health, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, New York, USA
| | - Jane R Zucker
- New York City Department of Health and Mental Hygiene, New York, New York, USA
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - David E Sugerman
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
6
|
Cooper LV, Erbeto TB, Danzomo AA, Abdullahi HW, Boateng K, Adamu US, Shuaib F, Modjirom N, Gray EJ, Bandyopadhyay AS, Zipursky S, Okiror SO, Grassly NC, Blake IM. Effectiveness of poliovirus vaccines against circulating vaccine-derived type 2 poliomyelitis in Nigeria between 2017 and 2022: a case-control study. THE LANCET. INFECTIOUS DISEASES 2024; 24:427-436. [PMID: 38246190 DOI: 10.1016/s1473-3099(23)00688-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Between 2018 and 2022, Nigeria experienced continuous transmission of circulating vaccine-derived type 2 poliovirus (cVDPV2), with 526 cases of cVDPV2 poliomyelitis detected in total and approximately 180 million doses of monovalent type 2 oral poliovirus vaccine (mOPV2) and 450 million doses of novel type 2 oral poliovirus vaccine (nOPV2) delivered in outbreak response campaigns. Inactivated poliovirus vaccine (IPV) was introduced into routine immunisation in 2015, with a second dose added in 2021. We aimed to estimate the effectiveness of nOPV2 against cVDPV2 paralysis and compare nOPV2 effectiveness with that of mOPV2 and IPV. METHODS In this retrospective case-control study, we used acute flaccid paralysis (AFP) surveillance data in Nigeria from Jan 1, 2017, to Dec 31, 2022, using age-matched, onset-matched, and location-matched cVDPV2-negative AFP cases as test-negative controls. We also did a parallel prospective study from March, 2021, using age-matched community controls from the same settlement as the cases. We included children born after May, 2016, younger than 60 months, for whom polio immunisation history (doses of OPV from campaigns and IPV) was reported. We estimated the per-dose effectiveness of nOPV2 against cVDPV2 paralysis using conditional logistic regression and compared nOPV2 effectiveness with that of mOPV2 and IPV. FINDINGS In the retrospective case-control study, we identified 509 cVDPV2 poliomyelitis cases in Nigeria with case verification and paralysis onset between Jan 1, 2017, and Dec 31, 2022. Of these, 82 children were excluded for not meeting inclusion criteria, and 363 (85%) of 427 eligible cases were matched to 1303 test-negative controls. Cases reported fewer OPV and IPV doses than test-negative controls (mean number of OPV doses 5·9 [SD 4·2] in cases vs 6·7 [4·3] in controls; one or more IPV doses reported in 95 [26%] of 363 cases vs 513 [39%] of 1303 controls). We found low per-dose effectiveness of nOPV2 (12%, 95% CI -2 to 25) and mOPV2 (17%, 3 to 29), but no significant difference between the two vaccines (p=0·67). The estimated effectiveness of one IPV dose was 43% (23 to 58). In the prospective study, 181 (46%) of 392 eligible cases were matched to 1557 community controls. Using community controls, we found a high effectiveness of IPV (89%, 95% CI 83 to 93, for one dose), a low per-dose effectiveness of nOPV2 (-23%, -45 to -5) and mOPV2 (1%, -23 to 20), and no significant difference between the per-dose effectiveness of nOPV2 and mOPV2 (p=0·12). INTERPRETATION We found no significant difference in estimated effectiveness of the two oral vaccines, supporting the recommendation that the more genetically stable nOPV2 should be preferred in cVDPV2 outbreak response. Our findings highlight the role of IPV and the necessity of strengthening routine immunisation, the primary route through which IPV is delivered. FUNDING Bill & Melinda Gates Foundation and UK Medical Research Council.
Collapse
Affiliation(s)
- Laura V Cooper
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Tesfaye B Erbeto
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Abba A Danzomo
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Hamisu W Abdullahi
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | - Kofi Boateng
- World Health Organization Nigeria Country Office, Abuja, Nigeria
| | - Usman S Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Ndoutabe Modjirom
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | - Elizabeth J Gray
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Simona Zipursky
- Polio Eradication, World Health Organization, Geneva, Switzerland
| | | | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Isobel M Blake
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
7
|
Faye M, Fernandez-Garcia MD. The oral poliovirus vaccine-a solution and a concern for eradication. THE LANCET. INFECTIOUS DISEASES 2024; 24:336-337. [PMID: 38237613 DOI: 10.1016/s1473-3099(23)00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Martin Faye
- Virology Department, Institut Pasteur de Dakar, Dakar 220, Senegal.
| | - Maria Dolores Fernandez-Garcia
- Enterovirus and Viral Gastroenteritis Unit/National Polio Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
8
|
Bashorun AO, Kotei L, Jawla O, Jallow AF, Saidy AJ, Kinteh MA, Kujabi A, Jobarteh T, Kanu FJ, Donkor SA, Ezeani E, Fofana S, Njie M, Ceesay L, Jafri B, Williams A, Jeffries D, Kotanmi B, Mainou BA, Ooko M, Clarke E. Tolerability, safety, and immunogenicity of the novel oral polio vaccine type 2 in children aged 6 weeks to 59 months in an outbreak response campaign in The Gambia: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2024; 24:417-426. [PMID: 38237616 PMCID: PMC10954559 DOI: 10.1016/s1473-3099(23)00631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Novel oral polio vaccine type 2 (nOPV2) has been used to interrupt circulating vaccine-derived poliovirus type 2 outbreaks following its WHO emergency use listing. This study reports data on the safety and immunogenicity of nOPV2 over two rounds of a campaign in The Gambia. METHODS This observational cohort study collected baseline symptoms (vomiting, diarrhoea, irritability, reduced feeding, and reduced activity) and axillary temperature from children aged 6 weeks to 59 months in The Gambia before a series of two rounds of a nOPV2 campaign that took place on Nov 20-26, 2021, and March 19-22, 2022. Serum and stool samples were collected from a subset of the participants. The same symptoms were re-assessed during the week following each dose of nOPV2. Stool samples were collected on days 7 and 28, and serum was collected on day 28 following each dose. Adverse events, including adverse events of special interest, were documented for 28 days after each campaign round. Serum neutralising antibodies were measured by microneutralisation assay, and stool poliovirus excretion was measured by real-time RT-PCR. FINDINGS Of the 5635 children eligible for the study, 5504 (97·7%) received at least one dose of nOPV2. There was no increase in axillary temperature or in any of the baseline symptoms following either rounds of the campaigns. There were no adverse events of special interest and no other safety signals of concern. Poliovirus type 2 seroconversion rates were 70% (95% CI 62 to 78; 87 of 124 children) following one dose of nOPV2 and 91% (85 to 95; 113 of 124 children) following two doses. Poliovirus excretion on day 7 was lower after the second round (162 of 459 samples; 35·3%, 95% CI 31·1 to 39·8) than after the first round (292 of 658 samples; 44·4%, 40·6 to 48·2) of the campaign (difference -9·1%; 95% CI -14·8 to -3·3), showing the induction of mucosal immunity. INTERPRETATION In a campaign in west Africa, nOPV2 was well tolerated and safe. High rates of seroconversion and evidence of mucosal immunity support the licensure and WHO prequalification of this vaccine. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Adedapo O Bashorun
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Larry Kotei
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ousubie Jawla
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Abdoulie F Jallow
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Aisha J Saidy
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ma-Ansu Kinteh
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Arafang Kujabi
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Tijan Jobarteh
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Francis John Kanu
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Simon A Donkor
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Esu Ezeani
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Mbye Njie
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Lamin Ceesay
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Basit Jafri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Williams
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Jeffries
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Brezesky Kotanmi
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bernardo A Mainou
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Ooko
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ed Clarke
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
| |
Collapse
|
9
|
Kalkowska DA, Badizadegan K, Routh JA, Burns CC, Rosenberg ES, Brenner IR, Zucker JR, Langdon-Embry M, Thompson KM. Modeling undetected poliovirus circulation following the 2022 outbreak in the United States. Expert Rev Vaccines 2024; 23:186-195. [PMID: 38164695 PMCID: PMC11284832 DOI: 10.1080/14760584.2023.2299401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND New York State (NYS) reported a polio case (June 2022) and outbreak of imported type 2 circulating vaccine-derived poliovirus (cVDPV2) (last positive wastewater detection in February 2023), for which uncertainty remains about potential ongoing undetected transmission. RESEARCH DESIGN AND METHODS Extending a prior deterministic model, we apply an established stochastic modeling approach to characterize the confidence about no circulation (CNC) of cVDPV2 as a function of time since the last detected signal of transmission (i.e. poliovirus positive acute flaccid myelitis case or wastewater sample). RESULTS With the surveillance coverage for the NYS population majority and its focus on outbreak counties, modeling suggests a high CNC (95%) within 3-10 months of the last positive surveillance signal, depending on surveillance sensitivity and population mixing patterns. Uncertainty about surveillance sensitivity implies longer durations required to achieve higher CNC. CONCLUSIONS In populations that maintain high overall immunization coverage with inactivated poliovirus vaccine (IPV), rare polio cases may occur in un(der)-vaccinated individuals. Modeling demonstrates the unlikeliness of type 2 outbreaks reestablishing endemic transmission or resulting in large absolute numbers of paralytic cases. Achieving and maintaining high immunization coverage with IPV remains the most effective measure to prevent outbreaks and shorten the duration of imported poliovirus transmission.
Collapse
Affiliation(s)
| | | | - Janell A. Routh
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C. Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eli S. Rosenberg
- Office of Public Health, New York State Department of Health, Albany, NY, USA
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY, USA
| | - I. Ravi Brenner
- Office of Public Health, New York State Department of Health, Albany, NY, USA
| | - Jane R. Zucker
- New York City Department of Health and Mental Hygiene, New York, NY, USA
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kimberly M. Thompson
- Kid Risk, Inc, Orlando, FL, USA
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| |
Collapse
|
10
|
Walter KS, Altamirano J, Huang C, Carrington YJ, Zhou F, Andrews JR, Maldonado Y. Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns. NPJ Vaccines 2023; 8:137. [PMID: 37749086 PMCID: PMC10520055 DOI: 10.1038/s41541-023-00740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from children receiving OPV and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Overall, 61% (11/18) of OPV-1, 71% (34/48) OPV-2, and 96% (54/56) OPV-3 samples with available data had evidence of a reversion at the key 5' UTR attenuating position and 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutations in the VP1 gene. Our results are consistent with previous work documenting rapid reversion to virulence of OPV and underscores the need for intensive surveillance following OPV use.
Collapse
Affiliation(s)
- Katharine S Walter
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84105, USA.
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - ChunHong Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuan J Carrington
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Zhou
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
11
|
Yeh MT, Smith M, Carlyle S, Konopka-Anstadt JL, Burns CC, Konz J, Andino R, Macadam A. Genetic stabilization of attenuated oral vaccines against poliovirus types 1 and 3. Nature 2023; 619:135-142. [PMID: 37316671 PMCID: PMC10322712 DOI: 10.1038/s41586-023-06212-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
Vaccination with Sabin, a live attenuated oral polio vaccine (OPV), results in robust intestinal and humoral immunity and has been key to controlling poliomyelitis. As with any RNA virus, OPV evolves rapidly to lose attenuating determinants critical to the reacquisition of virulence1-3 resulting in vaccine-derived, virulent poliovirus variants. Circulation of these variants within underimmunized populations leads to further evolution of circulating, vaccine-derived poliovirus with higher transmission capacity, representing a significant risk of polio re-emergence. A new type 2 OPV (nOPV2), with promising clinical data on genetic stability and immunogenicity, recently received authorization from the World Health Organization for use in response to circulating, vaccine-derived poliovirus outbreaks. Here we report the development of two additional live attenuated vaccine candidates against type 1 and 3 polioviruses. The candidates were generated by replacing the capsid coding region of nOPV2 with that from Sabin 1 or 3. These chimeric viruses show growth phenotypes similar to nOPV2 and immunogenicity comparable to their parental Sabin strains, but are more attenuated. Our experiments in mice and deep sequencing analysis confirmed that the candidates remain attenuated and preserve all the documented nOPV2 characteristics concerning genetic stability following accelerated virus evolution. Importantly, these vaccine candidates are highly immunogenic in mice as monovalent and multivalent formulations and may contribute to poliovirus eradication.
Collapse
Affiliation(s)
- Ming Te Yeh
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew Smith
- National Institute for Biological Standards and Control, South Mimms, UK
| | - Sarah Carlyle
- National Institute for Biological Standards and Control, South Mimms, UK
| | - Jennifer L Konopka-Anstadt
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA.
| | - Andrew Macadam
- National Institute for Biological Standards and Control, South Mimms, UK.
| |
Collapse
|
12
|
Kennedy SB, Macklin GR, Mason Ross G, Lopez Cavestany R, Moukom RA, Jones KAV, Mainou BA, Massaquoi MBF, Kieh MWS, Mach O. Poliovirus antibodies following two rounds of campaigns with a type 2 novel oral poliovirus vaccine in Liberia: a clustered, population-based seroprevalence survey. Lancet Glob Health 2023; 11:e917-e923. [PMID: 37202026 PMCID: PMC10187988 DOI: 10.1016/s2214-109x(23)00116-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Novel oral poliovirus vaccine type 2 (nOPV2) was administered in Liberia in response to an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) in 2021. We conducted a serological survey of polio antibodies after two national campaigns with nOPV2. METHODS This clustered, cross-sectional, population-based seroprevalence survey was conducted in children aged 0-59 months, more than 4 weeks after the second nOPV2 vaccination round. We used a clustered sampling method in four geographical regions of Liberia, followed by a simple random sampling of households. One eligible child was randomly selected per household. Dried blood spot specimens were taken and vaccination history was recorded. The antibody titres against all three poliovirus serotypes were assessed using standard microneutralisation assays done at the US Centers for Disease Control and Prevention in Atlanta, GA, USA. FINDINGS Analysable data were obtained from 436 (87%) of 500 enrolled participants. Of these, 371 (85%) children were reported via parental recall to have received two nOPV2 doses, 43 (10%) received one dose, and 22 (5%) received no doses. The seroprevalence against type 2 poliovirus was 38·3% (95% CI 33·7-43·0; 167 of 436 participants). No significant difference was observed between type 2 seroprevalence in children aged 6 months or older who were reported to have received two doses of nOPV2 (42·1%, 95% CI 36·8-47·5; 144 of 342), one dose (28·0%, 12·1-49·4; seven of 25), or no doses (37·5%, 8·5-75·5; three of eight; p=0·39). The seroprevalence against type 1 was 59·6% (54·9-64·3; 260 of 436), and the seroprevalence against type 3 was 53·0% (48·2-57·7; 231 of 436). INTERPRETATION Unexpectedly, the data showed low type 2 seroprevalence after two reported doses of nOPV2. This finding is probably affected by the lower oral poliovirus vaccine immunogenicity previously demonstrated in resource-limited settings, with high prevalence of chronic intestinal infections in children and other factors discussed herein. Our results provide the first assessment of nOPV2 performance in outbreak response in the African region. FUNDING WHO and Rotary International.
Collapse
Affiliation(s)
- Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia; West African Consortium for Clinical Research on Epidemic Pathogens (WAC-CREP), Monrovia, Liberia
| | - Grace R Macklin
- Polio Eradication, World Health Organization, Geneva, Switzerland.
| | - Gloria Mason Ross
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia; West African Consortium for Clinical Research on Epidemic Pathogens (WAC-CREP), Monrovia, Liberia
| | | | - Richelot A Moukom
- World Health Organisation African Regional Office, Brazzaville, Republic of the Congo
| | | | | | - Moses B F Massaquoi
- West African Consortium for Clinical Research on Epidemic Pathogens (WAC-CREP), Monrovia, Liberia
| | - Mark W S Kieh
- West African Consortium for Clinical Research on Epidemic Pathogens (WAC-CREP), Monrovia, Liberia
| | - Ondrej Mach
- Polio Eradication, World Health Organization, Geneva, Switzerland
| |
Collapse
|
13
|
Mbani CJ, Nekoua MP, Moukassa D, Hober D. The Fight against Poliovirus Is Not Over. Microorganisms 2023; 11:1323. [PMID: 37317297 DOI: 10.3390/microorganisms11051323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Abstract
Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.
Collapse
Affiliation(s)
- Chaldam Jespère Mbani
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | | | - Donatien Moukassa
- Laboratoire de Biologie Cellulaire et Moléculaire, Faculté des Sciences et Technique, Université Marien Ngouabi, Brazzaville BP 69, Congo
| | - Didier Hober
- Laboratoire de Virologie URL3610, Université de Lille, CHU Lille, 59000 Lille, France
| |
Collapse
|
14
|
Kalkowska DA, Badizadegan K, Thompson KM. Outbreak management strategies for cocirculation of multiple poliovirus types. Vaccine 2023:S0264-410X(23)00429-2. [PMID: 37121801 DOI: 10.1016/j.vaccine.2023.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
Prior modeling studies showed that current outbreak management strategies are unlikely to stop outbreaks caused by type 1 wild polioviruses (WPV1) or circulating vaccine-derived polioviruses (cVDPVs) in many areas, and suggested increased risks of outbreaks with cocirculation of more than one type of poliovirus. The surge of type 2 poliovirus transmission that began in 2019 and continues to date, in conjunction with decreases in preventive supplemental immunization activities (SIAs) for poliovirus types 1 and 3, has led to the emergence of several countries with cocirculation of more than one type of poliovirus. Response to these emerging cocirculation events is theoretically straightforward, but the different formulations, types, and inventories of oral poliovirus vaccines (OPVs) available for outbreak response present challenging practical questions. In order to demonstrate the implications of using different vaccine options and outbreak campaign strategies, we applied a transmission model to a hypothetical population with conditions similar to populations currently experiencing outbreaks of cVDPVs of both types 1 and 2. Our results suggest prevention of the largest number of paralytic cases occurs when using (1) trivalent OPV (tOPV) (or coadministering OPV formulations for all three types) until one poliovirus outbreak type dies out, followed by (2) using a type-specific OPV until the remaining poliovirus outbreak type also dies out. Using tOPV first offers a lower overall expected cost, but this option may be limited by the willingness to expose populations to type 2 Sabin OPV strains. For strategies that use type 2 novel OPV (nOPV2) concurrently administered with bivalent OPV (bOPV, containing types 1 and 3 OPV) emerges as a leading option, but questions remain about feasibility, logistics, type-specific take rates, and coadministration costs.
Collapse
|
15
|
Thompson KM. Effectiveness of a new vaccine for outbreak response and the increasingly complicated polio endgame. Lancet Glob Health 2022; 10:e1697-e1698. [PMID: 36400075 DOI: 10.1016/s2214-109x(22)00452-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
|