Abstract
BackgroundPakistan is one of only three countries where poliovirus circulation remains endemic. For the Pakistan Polio Eradication Program, identifying high risk districts is essential to target interventions and allocate limited resources.MethodsUsing a hierarchical Bayesian framework we developed a spatial Poisson hurdle model to jointly model the probability of one or more paralytic polio cases, and the number of cases that would be detected in the event of an outbreak. Rates of underimmunization, routine immunization, and population immunity, as well as seasonality and a history of cases were used to project future risk of cases.ResultsThe expected number of cases in each district in a 6-month period was predicted using indicators from the previous 6-months and the estimated coefficients from the model. The model achieves an average of 90% predictive accuracy as measured by area under the receiver operating characteristic (ROC) curve, for the past 3 years of cases.ConclusionsThe risk of poliovirus has decreased dramatically in many of the key reservoir areas in Pakistan. The results of this model have been used to prioritize sub-national areas in Pakistan to receive additional immunization activities, additional monitoring, or other special interventions.
Highlights
Pakistan is one of only three countries where poliovirus circulation remains endemic
To aid in the prioritization of sub-national areas for programmatic interventions, we developed a spatial model to estimate the risk of future wild poliovirus serotype 1 (WPV1) cases for the 155 districts of Pakistan
Space–time smoothing models fit to the non-polio AFP (NPAFP) vaccination dose history data indicated that zero dose routine immunization (RI) and underimmunized rates are highly heterogeneous across Pakistan (Figs. 1 and 2)
Summary
Pakistan is one of only three countries where poliovirus circulation remains endemic. For the Pakistan Polio Eradication Program, identifying high risk districts is essential to target interventions and allocate limited resources. At the time of this writing, only Pakistan, Afghanistan, and Nigeria remain endemic for polio with only 37 cases of wild poliovirus serotype 1 (WPV1) recorded in 2016. In the Eastern Mediterranean Region of the World Health Organization (WHO) key strategies of the of GPEI included (1) achieving high coverage of at least three doses of oral polio vaccine (OPV), (2) implementation of supplementary immunization activities (SIAs), and (3) the development of sensitive epidemiological and laboratory surveillance using standard WHO definitions [2]. Eradication efforts began in Pakistan in 1994, when the first SIA was conducted, and in 1995, when
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