Abstract
Background: The eradication of wild and vaccine-derived poliovirus requires the withdrawal of oral poliovirus vaccine (OPV) and replacement with inactivated poliovirus vaccine (IPV). We aim to produce comparative estimates of humoral and intestinal mucosal immunity associated with alternative immunization schedules. Methods: We performed a random-effect network meta-analysis in a Bayesian framework. We searched MEDLINE for randomised trials published up to 01 November 2018, comparing poliovirus immunisation schedules in primary series. The first endpoint was seroconversion against poliovirus serotypes 1, 2 and 3 and the second endpoint was intestinal immunity against serotype 2, measured by absence of shedding poliovirus after challenge. Findings: We identified 17 studies and eight studies, with 8256 and 4254 infants, eligible for humoral and intestinal immunity outcomes, respectively. The relative risk (RR) of seroconversion to serotype 2 after three doses of bivalent OPV was 0.12 [95% CrI: 0·09, 0·15] compared with three doses of trivalent OPV. The addition of one or two doses of IPV after bOPV increased RR to 0·85 [95% CrI: 0·75, 1·0] and 1·1 [95% CrI: 0·97, 1·4], respectively. However, IPV did not significantly increase intestinal immunity. Interpretation: The immunogenicity of vaccination schedules can be assessed using network meta-analysis. Equitable distribution of one full or two fractional IPV doses should be prioritised, with equivalent immunogenicity between low-cost IPV options (fractional, monovalent type 2, adjuvanted and Sabin-strain). However, addition of IPV will not prevent circulation of type 2 poliovirus in areas with faecal-oral transmission. Funding Statement: UK Medical Research Council studentship Declaration of Interests: The authors declare: no competing interests.
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