Planning for globally coordinated cessation of bivalent oral poliovirus vaccine: risks of non-synchronous cessation and unauthorized oral poliovirus vaccine use

Radboud J Duintjer Tebbens,Kimberly M Thompson,Lee M Hampton

doi:10.1186/s12879-018-3074-0

Radboud J Duintjer Tebbens, Kimberly M Thompson + Show 1 more

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https://doi.org/10.1186/s12879-018-3074-0

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Abstract

BackgroundOral polio vaccine (OPV) containing attenuated serotype 2 polioviruses was globally withdrawn in 2016, and bivalent OPV (bOPV) containing attenuated serotype 1 and 3 polioviruses needs to be withdrawn after the certification of eradication of all wild polioviruses to eliminate future risks from vaccine-derived polioviruses (VDPVs). To minimize risks from VDPVs, the planning and implementation of bOPV withdrawal should build on the experience with withdrawing OPV containing serotype 2 polioviruses while taking into account similarities and differences between the three poliovirus serotypes.MethodsWe explored the risks from (i) a failure to synchronize OPV cessation and (ii) unauthorized post-cessation OPV use for serotypes 1 and 3 in the context of globally-coordinated future bOPV cessation and compared the results to similar analyses for serotype 2 OPV cessation.ResultsWhile the risks associated with a failure to synchronize cessation and unauthorized post-cessation OPV use appear to be substantially lower for serotype 3 polioviruses than for serotype 2 polioviruses, the risks for serotype 1 appear similar to those for serotype 2. Increasing population immunity to serotype 1 and 3 poliovirus transmission using pre-cessation bOPV supplemental immunization activities and inactivated poliovirus vaccine in routine immunization reduces the risks of circulating VDPVs associated with non-synchronized cessation or unauthorized OPV use.ConclusionsThe Global Polio Eradication Initiative should synchronize global bOPV cessation during a similar window of time as occurred for the global cessation of OPV containing serotype 2 polioviruses and should rigorously verify the absence of bOPV in immunization systems after its cessation.

Highlights

Oral polio vaccine (OPV) containing attenuated serotype 2 polioviruses was globally withdrawn in 2016, and bivalent OPV containing attenuated serotype 1 and 3 polioviruses needs to be withdrawn after the certification of eradication of all wild polioviruses to eliminate future risks from vaccine-derived polioviruses (VDPVs)
We investigated how different levels of maintenance of supplemental immunization activities (SIAs) using bivalent OPV (bOPV) or intensification of bOPV Supplemental immunization activity (SIA) prior to bOPV cessation affect the risk of creating indigenous circulating VDPVs (cVDPVs) before or after bOPV cessation [23]
To explore the impact of the amount of unauthorized OPV use, we considered different proportions of covered children who receive a full schedule of routine immunization (RI) doses, i.e., birth dose and three non-birth doses, of the stopped OPV vaccine instead of the poliovirus vaccine that remains in the RI schedule, i.e., bOPV and inactivated polio vaccine (IPV) after the trivalent OPV (tOPV)-bOPV switch and IPV after bOPV cessation

Summary

Introduction

Oral polio vaccine (OPV) containing attenuated serotype 2 polioviruses was globally withdrawn in 2016, and bivalent OPV (bOPV) containing attenuated serotype 1 and 3 polioviruses needs to be withdrawn after the certification of eradication of all wild polioviruses to eliminate future risks from vaccine-derived polioviruses (VDPVs). Cessation of the use of oral poliovirus vaccine (OPV) represents an essential part of the global polio eradication endgame strategy [1, 2] because OPV use can, in very rare cases, lead to the development of vaccinederived polioviruses (VDPVs) These VDPVs can cause paralytic poliomyelitis (polio) outbreaks similar to those caused by wild polioviruses (WPVs) [3]. Live, attenuated poliovirus introduced into a population with low immunity to poliovirus transmission could spread and over time evolve into circulating VDPVs (cVDPVs), which in turn could cause polio outbreaks Such introductions could occur if a country continues general use of OPV serotypes that other countries have stopped using or if OPV is used without authorization in an area well after cessation of its general use. The process included an extensive monitoring effort to identify and destroy remaining tOPV to prevent introductions of live, attenuated serotype 2 polioviruses [7, 9, 14,15,16]

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