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Thompson KM, Kalkowska DA, Badizadegan K. Polio health economics: assessing the benefits and costs of polio, non-polio, and integrated activities of the Global Polio Eradication Initiative. Gates Open Res 2022; 6:5. [PMID: 35280345 PMCID: PMC8881365 DOI: 10.12688/gatesopenres.13524.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Investments made by countries and donors to support polio eradication and the Global Polio Eradication Initiative (GPEI) over the past 35 years provided financial support for significant health interventions beyond the prevention of polio. Prior economic analyses that sought to quantify the economic benefits of some interventions encountered insufficient data and evidence associated with non-polio-specific activities. The 2022-2026 GPEI Strategic Plan explicitly identified integration and gender equity as funded mandates that must move forward in parallel with polio eradication, but these goals remain vaguely defined from a health economic perspective. Methods: To ensure unambiguous and full accounting for all financial investments in the GPEI, polio eradication, and other desirable objectives, we identify the health economic analysis methods and inputs needed to ensure transparent financial accountability and cost-effective use of funds. Results: Sufficient inputs and methods exist to characterize the health and economic benefits of polio-specific activities, but we identified the need for additional information and method development for some non-polio-specific and cost-sharing activities. Donors who seek to support non-polio-specific objectives as part of the GPEI may want to provide dedicated support financing for which it may be difficult to apply typical health economic criteria and to expect net health and/or net economic benefits. Conclusions: Given the mixture of funding sources provided to the GPEI, which includes support by governments and private donors, we recommend that the GPEI separately account for financial needs that represent necessities for polio eradication from those used for other stated objectives. An added layer of specificity that identifies all funds according to each activity, the accountable party and/or parties, and the associated measurable health or other outcome(s), will enable improved health economic analyses and reporting to donors who seek to track returns on their investments.
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Lesmanawati DAS, Veenstra P, Moa A, Adam DC, MacIntyre CR. A rapid risk analysis tool to prioritise response to infectious disease outbreaks. BMJ Glob Health 2021; 5:bmjgh-2020-002327. [PMID: 32513862 PMCID: PMC7282290 DOI: 10.1136/bmjgh-2020-002327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/12/2023] Open
Abstract
Epidemics are influenced by both disease and societal factors and can grow exponentially over short time periods. Epidemic risk analysis can help in rapidly predicting potentially serious outcomes and flagging the need for rapid response. We developed a multifactorial risk analysis tool 'EpiRisk' to provide rapid insight into the potential severity of emerging epidemics by combining disease-related parameters and country-related risk parameters. An initial set of 18 disease and country-related risk parameters was reduced to 14 following qualitative discussions and the removal of highly correlated parameters by a correlation and clustering analysis. Of the remaining parameters, three risk levels were assigned ranging from low (1) moderate (2) and high (3). The total risk score for an outbreak of a given disease in a particular country is calculated by summing these 14 risk scores, and this sum is subsequently classified into one of four risk categories: low risk (<21), moderate risk (21-29), high risk (30-37) and extreme risk (>37). Total risk scores were calculated for nine retrospective outbreaks demonstrating an association with the actual impact of those outbreaks. We also evaluated to what extent the risk scores correlate with the number of cases and deaths in 61 additional outbreaks between 2002 and 2018, demonstrating positive associations with outbreak severity as measured by the number of deaths. Using EpiRisk, timely intervention can be implemented by predicting the risk of emerging outbreaks in real time, which may help government and public health professionals prevent catastrophic epidemic outcomes.
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Affiliation(s)
- Dyah A S Lesmanawati
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia.,District Health Office, Yogyakarta City, Yogyakarta, Indonesia
| | | | - Aye Moa
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia
| | - Dillon C Adam
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia.,Arizona State University College of Health Solutions, Phoenix, Arizona, USA
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3
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Khaliq A, Yousafzai MT, Haq S, Yaseen R, Qureshi S, Rind F, Padhani ZA, Khan A, Kazi AM, Qamar FN. A review of toolkits and case definitions for detecting enteric fever outbreaks in Asian and African countries from 1965-2019. J Glob Health 2021; 11:04031. [PMID: 34131486 PMCID: PMC8183158 DOI: 10.7189/jogh.11.04031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This review assessed the case definitions, diagnostic criteria, antimicrobial resistance, and methods used for enteric fever outbreaks and utilization of any unified outbreak score or checklist for early identification and response in Asia and Africa from 1965-2019. Methods We searched enteric fever outbreaks using PubMed, Google Scholar, and the Cochrane library. Studies describing a single outbreak event of enteric fever in Asia and Africa from 1965-2019 were reviewed. We excluded case reports, letter to editors, studies reporting typhoid in conjunction with other diseases, the Centers for Disease Control and Prevention (CDC) trip reports, the World Health Organization (WHO) bulletins report, data from mathematical modeling and simulation studies, reviews and ProMed alert. Also, non-typhoidal salmonella outbreaks were excluded. Results A total of 5063 articles were identified using the key terms and 68 studies were selected for data extraction. Most (48, 71%) outbreaks were from Asian countries, 20 (29%) were reported from Africa. Only 15 studies reported the case definition used for case identification during an outbreak and 8 of those were from Asia. A third (20, 29%) of the studies described antibiotic resistance pattern. 43 (63%) studies contained information regarding the source of the outbreak. Outcomes (hospitalization and deaths) were reported in a quarter of studies. Only 23 (29%) of the studies reported outbreak control strategies while none reported any unified outbreak score or a checklist to identify the outbreak. Conclusion This review highlights the variability in detection and reporting methods for enteric fever outbreaks in Asia and Africa. No standardized case definitions or laboratory methods were reported. Only a few studies reported strategies for outbreak control. There is a need for the development of a unified outbreak score or a checklist to identify and report enteric fever outbreaks globally.
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Affiliation(s)
- Asif Khaliq
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,Kirby Institute, University of New South Wales, Australia
| | - Salman Haq
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Rahima Yaseen
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Fahad Rind
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University Hospital, Karachi
| | - Ayub Khan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Abdul Momin Kazi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
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Capeding MR, Gomez-Go GD, Oberdorfer P, Borja-Tabora C, Bravo L, Carlos J, Tangsathapornpong A, Uppala R, Laoprasopwattana K, Yang Y, Han S, Wittawatmongkol O. Safety and immunogenicity of a new inactivated polio vaccine made from Sabin strains: a randomized, double-blind, active-controlled, phase 2/3 seamless study. J Infect Dis 2020; 226:308-318. [PMID: 33351072 PMCID: PMC9400411 DOI: 10.1093/infdis/jiaa770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background A new inactivated polio vaccine made from Sabin strains (sIPV) was developed as part of the global polio eradication initiative. Methods This randomized, double-blind, active-controlled, phase 2/3 seamless study was conducted in 2 stages. Healthy infants aged 6 weeks were randomly assigned to receive 3 doses of 1 of 4 study vaccines at 6, 10, and 14 weeks of age (336 received low-, middle-, or high-dose sIPV, or conventional IPV [cIPV] in stage I, and 1086 received lot A, B, or C of the selected sIPV dose, or cIPV in stage II). The primary outcome was the seroconversion rate 4 weeks after the third vaccination. Results In stage I, low-dose sIPV was selected as the optimal dose. In stage II, consistency among the 3 manufacturing lots of sIPV was demonstrated. The seroconversion rates for Sabin and wild strains of the 3 serotypes after the 3-dose primary series were 95.8% to 99.2% in the lot-combined sIPV group and 94.8% to 100% in the cIPV group, proving the noninferiority of sIPV compared to cIPV. No notable safety risks associated with sIPV were observed. Conclusions Low-dose sIPV administered as a 3-dose vaccination was safe and immunogenic compared to cIPV. Clinical Trials Registration NCT03169725.
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Affiliation(s)
- Maria Rosario Capeding
- Department of Microbiology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Peninnah Oberdorfer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Charissa Borja-Tabora
- Clinical Research Division, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Lulu Bravo
- Department of Pediatrics, University of the Philippines Manila, Manila, Philippines
| | - Josefina Carlos
- Department of Pediatrics, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | - Rattapon Uppala
- Department of Pediatrics, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | | | - Yunjeong Yang
- Life Sciences, LG Chem, Ltd., Seoul, Republic of Korea
| | - Song Han
- Life Sciences, LG Chem, Ltd., Seoul, Republic of Korea
| | - Orasri Wittawatmongkol
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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5
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Thompson KM, Kalkowska DA. Review of poliovirus modeling performed from 2000 to 2019 to support global polio eradication. Expert Rev Vaccines 2020; 19:661-686. [PMID: 32741232 PMCID: PMC7497282 DOI: 10.1080/14760584.2020.1791093] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Over the last 20 years (2000-2019) the partners of the Global Polio Eradication Initiative (GPEI) invested in the development and application of mathematical models of poliovirus transmission as well as economics, policy, and risk analyses of polio endgame risk management options, including policies related to poliovirus vaccine use during the polio endgame. AREAS COVERED This review provides a historical record of the polio studies published by the three modeling groups that primarily performed the bulk of this work. This review also systematically evaluates the polio transmission and health economic modeling papers published in English in peer-reviewed journals from 2000 to 2019, highlights differences in approaches and methods, shows the geographic coverage of the transmission modeling performed, identified common themes, and discusses instances of similar or conflicting insights or recommendations. EXPERT OPINION Polio modeling performed during the last 20 years substantially impacted polio vaccine choices, immunization policies, and the polio eradication pathway. As the polio endgame continues, national preferences for polio vaccine formulations and immunization strategies will likely continue to change. Future modeling will likely provide important insights about their cost-effectiveness and their relative benefits with respect to controlling polio and potentially achieving and maintaining eradication.
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Ajisegiri WS, Chughtai AA, MacIntyre CR. A Risk Analysis Approach to Prioritizing Epidemics: Ebola Virus Disease in West Africa as a Case Study. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:429-441. [PMID: 28810081 PMCID: PMC5949606 DOI: 10.1111/risa.12876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 05/23/2023]
Abstract
The 2014 Ebola virus disease (EVD) outbreak affected several countries worldwide, including six West African countries. It was the largest Ebola epidemic in the history and the first to affect multiple countries simultaneously. Significant national and international delay in response to the epidemic resulted in 28,652 cases and 11,325 deaths. The aim of this study was to develop a risk analysis framework to prioritize rapid response for situations of high risk. Based on findings from the literature, sociodemographic features of the affected countries, and documented epidemic data, a risk scoring framework using 18 criteria was developed. The framework includes measures of socioeconomics, health systems, geographical factors, cultural beliefs, and traditional practices. The three worst affected West African countries (Guinea, Sierra Leone, and Liberia) had the highest risk scores. The scores were much lower in developed countries that experienced Ebola compared to West African countries. A more complex risk analysis framework using 18 measures was compared with a simpler one with 10 measures, and both predicted risk equally well. A simple risk scoring system can incorporate measures of hazard and impact that may otherwise be neglected in prioritizing outbreak response. This framework can be used by public health personnel as a tool to prioritize outbreak investigation and flag outbreaks with potentially catastrophic outcomes for urgent response. Such a tool could mitigate costly delays in epidemic response.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
- College of Public Service & Community SolutionsArizona State UniversityPhoenixAZUSA
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Alawieh A, Sabra Z, Langley EF, Bizri AR, Hamadeh R, Zaraket FA. Assessing the impact of the Lebanese National Polio Immunization Campaign using a population-based computational model. BMC Public Health 2017; 17:902. [PMID: 29178859 PMCID: PMC5702188 DOI: 10.1186/s12889-017-4909-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background After the re-introduction of poliovirus to Syria in 2013, Lebanon was considered at high transmission risk due to its proximity to Syria and the high number of Syrian refugees. However, after a large-scale national immunization initiative, Lebanon was able to prevent a potential outbreak of polio among nationals and refugees. In this work, we used a computational individual-simulation model to assess the risk of poliovirus threat to Lebanon prior and after the immunization campaign and to quantitatively assess the healthcare impact of the campaign and the required standards that need to be maintained nationally to prevent a future outbreak. Methods Acute poliomyelitis surveillance in Lebanon was along with the design and coverage rate of the recent national polio immunization campaign were reviewed from the records of the Lebanese Ministry of Public Health. Lebanese population demographics including Syrian and Palestinian refugees were reviewed to design individual-based models that predicts the consequences of polio spread to Lebanon and evaluate the outcome of immunization campaigns. The model takes into account geographic, demographic and health-related features. Results Our simulations confirmed the high risk of polio outbreaks in Lebanon within 10 days of case introduction prior to the immunization campaign, and showed that the current immunization campaign significantly reduced the speed of the infection in the event poliomyelitis cases enter the country. A minimum of 90% national immunization coverage was found to be required to prevent exponential propagation of potential transmission. Conclusions Both surveillance and immunization efforts should be maintained at high standards in Lebanon and other countries in the area to detect and limit any potential outbreak. The use of computational population simulation models can provide a quantitative approach to assess the impact of immunization campaigns and the burden of infectious diseases even in the context of population migration.
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Affiliation(s)
- Ali Alawieh
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA.,Electrical and Computer Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Zahraa Sabra
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.,Electrical and Computer Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - E Farris Langley
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.,Head, Primary Health Care Department, Director of Immunization Program, Lebanese Ministry of Public Health, Beirut, Lebanon.,National Certification Committee, Polio Eradication Initiative - Lebanon, Beirut, Lebanon
| | - Randa Hamadeh
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.,Head, Primary Health Care Department, Director of Immunization Program, Lebanese Ministry of Public Health, Beirut, Lebanon.,National Certification Committee, Polio Eradication Initiative - Lebanon, Beirut, Lebanon
| | - Fadi A Zaraket
- Electrical and Computer Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon.
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8
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Ma L, Cai W, Sun M, Cun Y, Zhou J, Liu J, Hu W, Zhang X, Song S, Jiang S, Liao G. Analyzed immunogenicity of fractional doses of Sabin-inactivated poliovirus vaccine (sIPV) with intradermal delivery in rats. Hum Vaccin Immunother 2016; 12:3125-3131. [PMID: 27558963 DOI: 10.1080/21645515.2016.1214347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The live-attenuated oral polio vaccine (OPV) will be no longer used when wild poliovirus (WPV) eliminating in worldwide, according to GPEI (the Global Polio Eradication Initiative) Reports. It is planning to replace OPV by Sabin-based inactivated poliovirus vaccine (sIPV) in developing countries, with purpose of reducing of the economic burden and maintaining of the appropriate antibody levels in population. It studied serial fractional doses immunized by intradermal injection (ID) in rats, to reduce consume of antigen and financial burden, maintaining sufficient immunogenicity; Methods: Study groups were divided in 4 groups of dose gradient, which were one-tenth (1/10), one-fifth (1/5), one-third (1/3) and one-full dose (1/1), according to the volume of distribution taken from the same batch of vaccine (sIPV). Wistar rats were injected intradermally with the needle and syringe sing the mantoux technique taken once month for 3 times. It was used as positive control that intramuscular inoculation (IM) was injected with one-full dose (1/1) with same batch of sIPV. PBS was used as negative control. Blood samples were collected via tail vein. After 30 d with 3 round of immunization, it analyzed the changes of neutralization antibody titers in the each group by each immunization program end; Results: The results of seroconversion had positive correlation with different doses in ID groups. The higher concentration of D-antigen (D-Ag) could conduct higher seroconversion. Furthermore, different types of viruses had different seroconversion trend. It showed that the geometric mean titers (GMTs) of each fractional-dose ID groups increased by higher concentration of D-Ag, and it got significant lower than the full-dose IM group. At 90th days of immunization, the GMTs for each poliovirus subtypes of fractional doses were almost higher than 1:8, implied that it could be meaning positive seroprotection titer for polio vaccine types, according to WHO suggestion; Conclusions: The fractional dose with one-fifth (1/5) could be used by intradermal injection to prevent poliovirus infection, if there were more human clinical detail research consistent with this findings in rats.
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Affiliation(s)
- Lei Ma
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Wei Cai
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Mingbo Sun
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Yina Cun
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Jian Zhou
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Jing Liu
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Wenzhu Hu
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Xinwen Zhang
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Shaohui Song
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Shude Jiang
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
| | - Guoyang Liao
- a The Fifth Department of Biological Products , Institute of Medical Biology, Chinese Academy of Medical Science, Peking Union Medical College , Kunming , Yunnan Province , People's Republic of China
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Wolff C, Roesel S, Lipskaya G, Landaverde M, Humayun A, Withana N, Ramamurty N, Tomori O, Okiror SO, Salla M, Dowdle W. Progress toward laboratory containment of poliovirus after polio eradication. J Infect Dis 2014; 210 Suppl 1:S454-8. [PMID: 25316867 DOI: 10.1093/infdis/jit821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The first steps (phase 1) toward laboratory containment of poliovirus after eradication are a national survey of biomedical facilities and a global inventory of such facilities retaining wild poliovirus (WPV) infectious and potentially infectious materials. METHODS We reviewed published reports on national laboratory surveys and inventories of WPV materials from each of the 3 polio-free World Health Organization (WHO) regions (the European Region, completed in 2006; the Western Pacific Region, completed in 2008; and the Region of the Americas, completed in 2010), as well as reports on progress in polio-free countries of the remaining 3 regions (the African Region, the Eastern Mediterranean Region, and the WHO South-East Asia Region). RESULTS Containment phase 1 activities are complete in 154 of 194 WHO Member States (79%), including all countries and areas of the polio-free regions and most polio-free countries in the remaining 3 regions. A reported 227 209 biomedical facilities were surveyed, with 532 facilities in 45 countries identified as retaining WPV-associated infectious or potentially infectious materials. CONCLUSIONS Completion of containment phase 1 global activities is achievable within the time frame set by the Polio Eradication and Endgame Strategic Plan 2013-2018.
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Affiliation(s)
| | | | | | | | - Asghar Humayun
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Nalini Ramamurty
- World Health Organization, Regional Office for Southeast Asia, New Delhi, India
| | | | | | - Mbaye Salla
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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10
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Verdijk P, Rots NY, van Oijen MG, Weldon WC, Oberste MS, Okayasu H, Sutter RW, Bakker WA. Safety and immunogenicity of a primary series of Sabin-IPV with and without aluminum hydroxide in infants. Vaccine 2014; 32:4938-44. [DOI: 10.1016/j.vaccine.2014.07.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/20/2014] [Accepted: 07/08/2014] [Indexed: 02/08/2023]
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11
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Development of thermostable lyophilized inactivated polio vaccine. Pharm Res 2014; 31:2618-29. [PMID: 24760448 PMCID: PMC4197379 DOI: 10.1007/s11095-014-1359-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/15/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of current study was to develop a dried inactivated polio vaccine (IPV) formulation with minimal loss during the drying process and improved stability when compared with the conventional liquid IPV. METHODS Extensive excipient screening was combined with the use of a Design of Experiment (DoE) approach in order to achieve optimal results with high probability. RESULTS Although it was shown earlier that the lyophilization of a trivalent IPV while conserving its antigenicity is challenging, we were able to develop a formulation that showed minimal loss of potency during drying and subsequent storage at higher temperatures. CONCLUSION This study showed the potential of a highly stable and safe lyophilized polio vaccine, which might be used in developing countries without the need of a cold-chain.
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12
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Verdijk P, Rots NY, Bakker WAM. Clinical development of a novel inactivated poliomyelitis vaccine based on attenuated Sabin poliovirus strains. Expert Rev Vaccines 2014; 10:635-44. [DOI: 10.1586/erv.11.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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13
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Safety and immunogenicity of inactivated poliovirus vaccine based on Sabin strains with and without aluminum hydroxide: A phase I trial in healthy adults. Vaccine 2013; 31:5531-6. [DOI: 10.1016/j.vaccine.2013.09.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/27/2013] [Accepted: 09/10/2013] [Indexed: 12/20/2022]
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14
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Thomassen YE, van Eikenhorst G, van der Pol LA, Bakker WAM. Isoelectric Point Determination of Live Polioviruses by Capillary Isoelectric Focusing with Whole Column Imaging Detection. Anal Chem 2013; 85:6089-94. [DOI: 10.1021/ac400968q] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yvonne E. Thomassen
- Institute for Translational Vaccinology, P.O. Box 450, 3720
AL Bilthoven, The Netherlands
| | - Gerco van Eikenhorst
- Institute for Translational Vaccinology, P.O. Box 450, 3720
AL Bilthoven, The Netherlands
| | - Leo A. van der Pol
- Institute for Translational Vaccinology, P.O. Box 450, 3720
AL Bilthoven, The Netherlands
| | - Wilfried A. M. Bakker
- Institute for Translational Vaccinology, P.O. Box 450, 3720
AL Bilthoven, The Netherlands
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15
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Thompson KM, Pallansch MA, Duintjer Tebbens RJ, Wassilak SG, Kim JH, Cochi SL. Preeradication vaccine policy options for poliovirus infection and disease control. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2013; 33:516-43. [PMID: 23461599 PMCID: PMC7941951 DOI: 10.1111/risa.12019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc., , 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832, USA.
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Thompson KM. Modeling poliovirus risks and the legacy of polio eradication. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2013; 33:505-15. [PMID: 23550939 PMCID: PMC7896538 DOI: 10.1111/risa.12030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This introduction to the special issue on modeling poliovirus risks provides context about historical efforts to manage polioviruses and reviews the insights from models developed to support risk management and policy development. Following an overview of the contents of the special issue, the introduction explores the road ahead and offers perspective on the legacy of polio eradication.
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Maher D. The human qualities needed to complete the global eradication of polio. Bull World Health Organ 2013; 91:283-9. [PMID: 23599552 PMCID: PMC3629453 DOI: 10.2471/blt.12.111831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/27/2022] Open
Abstract
Although the 99% decrease seen in global polio incidence between 1988 and 2000 represented remarkable progress towards polio eradication, tackling the last 1% of polio has proved tantalizingly difficult. Pockets of endemic transmission currently persist both on the border between Afghanistan and Pakistan and in northern Nigeria. These pockets have permitted the reinfection of countries that were previously polio-free. Global strategic plans for polio eradication set out the activities, resources and financing needed to overcome the managerial, technical and security challenges faced by those tasked with the interruption of poliovirus transmission. However, polio eradication also depends on the less tangible but equally important human qualities of energy, realism, articulacy, determination, imagination, collaboration, adaptability, tactical awareness, innovation, openness and nimbleness (the initial letters of which give the acronym "ERADICATION"). By paying attention to these human qualities, the stakeholders involved may be more likely to achieve global polio eradication.
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Affiliation(s)
- Dermot Maher
- The Wellcome Trust, 215 Euston Road, London, NW1 2BE, England.
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Resik S, Tejeda A, Sutter RW, Diaz M, Sarmiento L, Alemañi N, Garcia G, Fonseca M, Hung LH, Kahn AL, Burton A, Landaverde JM, Aylward RB. Priming after a fractional dose of inactivated poliovirus vaccine. N Engl J Med 2013; 368:416-24. [PMID: 23363495 DOI: 10.1056/nejmoa1202541] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND To reduce the costs of maintaining a poliovirus immunization base in low-income areas, we assessed the extent of priming immune responses after the administration of inactivated poliovirus vaccine (IPV). METHODS We compared the immunogenicity and reactogenicity of a fractional dose of IPV (one fifth of a full dose) administered intradermally with a full dose administered intramuscularly in Cuban infants at the ages of 4 and 8 months. Blood was collected from infants at the ages of 4 months, 8 months, 8 months 7 days, and 8 months 30 days to assess single-dose seroconversion, single-dose priming of immune responses, and two-dose seroconversion. Specimens were tested with a neutralization assay. RESULTS A total of 320 infants underwent randomization, and 310 infants (96.9%) fulfilled the study requirements. In the group receiving the first fractional dose of IPV, seroconversion to poliovirus types 1, 2, and 3 occurred in 16.6%, 47.1%, and 14.7% of participants, respectively, as compared with 46.6%, 62.8%, and 32.0% in the group receiving the first full dose of IPV (P<0.008 for all comparisons). A priming immune response to poliovirus types 1, 2, and 3 occurred in 90.8%, 94.0%, and 89.6% of participants, respectively, in the group receiving the fractional dose as compared with 97.6%, 98.3%, and 98.1% in the group receiving the full dose (P=0.01 for the comparison with type 3). After the administration of the second dose of IPV in the group receiving fractional doses, cumulative two-dose seroconversion to poliovirus types 1, 2, and 3 occurred in 93.6%, 98.1%, and 93.0% of participants, respectively, as compared with 100.0%, 100.0%, and 99.4% in the group receiving the full dose (P<0.006 for the comparisons of types 1 and 3). The group receiving intradermal injections had the greatest number of adverse events, most of which were minor in intensity and none of which had serious consequences. CONCLUSIONS This evaluation shows that vaccinating infants with a single fractional dose of IPV can induce priming and seroconversion in more than 90% of immunized infants. (Funded by the World Health Organization and the Pan American Health Organization; Australian New Zealand Clinical Trials Registry number, ACTRN12610001046099.).
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Commentary: Immunologic response to oral polio vaccine in human immunodeficiency virus-infected and uninfected Zimbabwean children. Pediatr Infect Dis J 2012; 31:181-3. [PMID: 22252205 DOI: 10.1097/inf.0b013e31824835a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Inactivated polio vaccine development for technology transfer using attenuated Sabin poliovirus strains to shift from Salk-IPV to Sabin-IPV. Vaccine 2011; 29:7188-96. [PMID: 21651934 DOI: 10.1016/j.vaccine.2011.05.079] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Industrial-scale inactivated polio vaccine (IPV) production dates back to the 1960s when at the Rijks Instituut voor de Volksgezondheid (RIV) in Bilthoven a process was developed based on micro-carrier technology and primary monkey kidney cells. This technology was freely shared with several pharmaceutical companies and institutes worldwide. In this contribution, the history of one of the first cell-culture based large-scale biological production processes is summarized. Also, recent developments and the anticipated upcoming shift from regular IPV to Sabin-IPV are presented. Responding to a call by the World Health Organization (WHO) for new polio vaccines, the development of Sabin-IPV was continued, after demonstrating proof of principle in the 1990s, at the Netherlands Vaccine Institute (NVI). Development of Sabin-IPV plays an important role in the WHO polio eradication strategy as biocontainment will be critical in the post-OPV cessation period. The use of attenuated Sabin strains instead of wild-type Salk polio strains will provide additional safety during vaccine production. Initially, the Sabin-IPV production process will be based on the scale-down model of the current, and well-established, Salk-IPV process. In parallel to clinical trial material production, process development, optimization and formulation research is being carried out to further optimize the process and reduce cost per dose. Also, results will be shown from large-scale (to prepare for future technology transfer) generation of Master- and Working virus seedlots, and clinical trial material (for phase I studies) production. Finally, the planned technology transfer to vaccine manufacturers in low and middle-income countries is discussed.
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Breman JG, de Quadros CA, Dowdle WR, Foege WH, Henderson DA, John TJ, Levine MM. The role of research in viral disease eradication and elimination programs: lessons for malaria eradication. PLoS Med 2011; 8:e1000405. [PMID: 21311582 PMCID: PMC3026693 DOI: 10.1371/journal.pmed.1000405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
By examining the role research has played in eradication or regional elimination initiatives for three viral diseases--smallpox, poliomyelitis, and measles--we derive nine cross-cutting lessons applicable to malaria eradication. In these initiatives, some types of research commenced as the programs began and proceeded in parallel. Basic laboratory, clinical, and field research all contributed notably to progress made in the viral programs. For each program, vaccine was the lynchpin intervention, but as the programs progressed, research was required to improve vaccine formulations, delivery methods, and immunization schedules. Surveillance was fundamental to all three programs, whilst polio eradication also required improved diagnostic methods to identify asymptomatic infections. Molecular characterization of pathogen isolates strengthened surveillance and allowed insights into the geographic source of infections and their spread. Anthropologic, sociologic, and behavioural research were needed to address cultural and religious beliefs to expand community acceptance. The last phases of elimination and eradication became increasingly difficult, as a nil incidence was approached. Any eradication initiative for malaria must incorporate flexible research agendas that can adapt to changing epidemiologic contingencies and allow planning for posteradication scenarios.
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Affiliation(s)
- Joel G. Breman
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Walter R. Dowdle
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - William H. Foege
- The Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Donald A. Henderson
- Center for Biosecurity, University of Pittsburgh Medical Center, Baltimore, Maryland, United States of America
| | | | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Economic analysis of the global polio eradication initiative. Vaccine 2010; 29:334-43. [DOI: 10.1016/j.vaccine.2010.10.026] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/28/2010] [Accepted: 10/08/2010] [Indexed: 11/22/2022]
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Development of an individual-based model for polioviruses: implications of the selection of network type and outcome metrics. Epidemiol Infect 2010; 139:836-48. [DOI: 10.1017/s0950268810001676] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYWe developed an individual-based (IB) model to explore the stochastic attributes of state transitions, the heterogeneity of the individual interactions, and the impact of different network structure choices on the poliovirus transmission process in the context of understanding the dynamics of outbreaks. We used a previously published differential equation-based model to develop the IB model and inputs. To explore the impact of different types of networks, we implemented a total of 26 variations of six different network structures in the IB model. We found that the choice of network structure plays a critical role in the model estimates of cases and the dynamics of outbreaks. This study provides insights about the potential use of an IB model to support policy analyses related to managing the risks of polioviruses and shows the importance of assumptions about network structure.
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Thomassen YE, van Sprang EN, van der Pol LA, Bakker WA. Multivariate data analysis on historical IPV production data for better process understanding and future improvements. Biotechnol Bioeng 2010; 107:96-104. [DOI: 10.1002/bit.22788] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Thompson KM, Tebbens RJD, Pallansch MA, Kew OM, Sutter RW, Aylward RB, Watkins M, Gary HE, Alexander J, Jafari H, Cochi SL. The risks, costs, and benefits of possible future global policies for managing polioviruses. Am J Public Health 2008; 98:1322-30. [PMID: 18511720 DOI: 10.2105/ajph.2007.122192] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses. METHODS We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations. RESULTS For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue. CONCLUSIONS Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of posteradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.
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Affiliation(s)
- Kimberly M Thompson
- Kids Risk Project, Harvard School of Public Health, 677 Huntington Ave, Third Floor, Boston, MA 02115, USA.
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Abstract
BACKGROUND Worldwide eradication of wild polioviruses is likely to yield substantial health and financial benefits, provided we finish the job. Challenges in the four endemic areas combined with continuing demands for financial resources for eradication have led some to question the goal of eradication and to suggest switching to a policy of control. METHODS We developed a dynamic model, based on modelling of the currently endemic areas in India, to show the importance of maintaining and increasing the immunisation intensity to complete eradication and to illustrate how policies based on perception about high short-term costs or cost-effectiveness ratios without consideration of long-term benefits could undermine any eradication effort. An extended model assesses the economic implications and disease burden of a change in policy from eradication to control. FINDINGS Our results suggest that the intensity of immunisation must be increased to achieve eradication, and that even small decreases in intensity could lead to large outbreaks. This finding implies the need to pay even higher short-run costs than are currently being spent, which will further exacerbate concerns about continued investment in interventions with high perceived cost-effectiveness ratios. We show that a wavering commitment leads to a failure to eradicate, greater cumulative costs, and a much larger number of cases. We further show that as long as it is technically achievable, eradication offers both lower cumulative costs and cases than control, even with the costs of achieving eradication exceeding several billion dollars more. A low-cost control policy that relies only on routine immunisation for 20 years with discounted costs of more than $3500 million could lead to roughly 200 000 expected paralytic poliomyelitis cases every year in low-income countries, whereas a low-case control policy that keeps the number of cases at about 1500 per year could cost around $10 000 million discounted over the 20 years. INTERPRETATION Focusing on the large costs for poliomyelitis eradication, without assessing the even larger potential benefits of eradication and the enormous long-term costs of effective control, might inappropriately affect commitments to the goal of eradication, and thus debate should include careful consideration of the options.
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Affiliation(s)
- Kimberly M Thompson
- Kids Risk Project, Harvard School of Public Health, Boston, MA, USA; Massachusetts Institute of Technology, Sloan School of Management, Cambridge, MA, USA.
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Grassly NC, Wenger J, Durrani S, Bahl S, Deshpande JM, Sutter RW, Heymann DL, Aylward RB. Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study. Lancet 2007; 369:1356-1362. [PMID: 17448821 DOI: 10.1016/s0140-6736(07)60531-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A high-potency monovalent oral type 1 poliovirus vaccine (mOPV1) was developed in 2005 to tackle persistent poliovirus transmission in the last remaining infected countries. Our aim was to assess the efficacy of this vaccine in India. METHODS We estimated the efficacy of mOPV1 used in supplementary immunisation activities from 2076 matched case-control pairs of confirmed cases of poliomyelitis caused by type 1 wild poliovirus and cases of non-polio acute flaccid paralysis in India. The effect of the introduction of mOPV1 on population immunity was calculated on the basis of estimates of vaccination coverage from data for non-polio acute flaccid paralysis. FINDINGS In areas of persistent poliovirus transmission in Uttar Pradesh, the protective efficacy of mOPV1 was estimated to be 30% (95% CI 19-41) per dose against type 1 paralytic disease, compared with 11% (7-14) for the trivalent oral vaccine. 76-82% of children aged 0-23 months were estimated to be protected by vaccination against type 1 poliovirus at the end of 2006, compared with 59% at the end of 2004, before the introduction of mOPV1. INTERPRETATION Under conditions where the efficacy of live-attenuated oral poliovirus vaccines is compromised by a high prevalence of diarrhoea and other infections, a dose of high-potency mOPV1 is almost three times more effective against type 1 poliomyelitis disease than is trivalent vaccine. Achieving high coverage with this new vaccine in areas of persistent poliovirus transmission should substantially improve the probability of rapidly eliminating transmission of the disease.
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Affiliation(s)
- Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Jay Wenger
- National Polio Surveillance Project, WHO, New Delhi, India
| | - Sunita Durrani
- National Polio Surveillance Project, WHO, New Delhi, India
| | - Sunil Bahl
- National Polio Surveillance Project, WHO, New Delhi, India
| | | | - Roland W Sutter
- Global Polio Eradication, Initiative, WHO, Geneva, Switzerland
| | - David L Heymann
- Global Polio Eradication, Initiative, WHO, Geneva, Switzerland
| | - R Bruce Aylward
- Global Polio Eradication, Initiative, WHO, Geneva, Switzerland
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Thompson KM. Poliomyelitis and the role of risk analysis in global infectious disease policy and management. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2006; 26:1419-21. [PMID: 17184389 DOI: 10.1111/j.1539-6924.2006.00853.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Kimberly M Thompson
- Massachusetts Institute of Technology, Sloan School of Management, System Dynamics Group, Cambridge, MA 02142, USA.
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