title: New strategies for the elimination of polio from India.
abstract: The feasibility of global polio eradication is being questioned as a result of continued transmission in a few localities that act as sources for outbreaks elsewhere. Perhaps the greatest challenge is in India, where transmission has persisted in Uttar Pradesh and Bihar despite high coverage with multiple doses of vaccine. We estimate key parameters governing the seasonal epidemics in these areas and show that high population density and poor sanitation cause persistence by not only facilitating transmission of poliovirus but also severely compromising the efficacy of the trivalent vaccine. We analyze strategies to counteract this and show that switching to monovalent vaccine may finally interrupt virus transmission.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, UK. n.grassly@imperial.ac.uk
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Grassly
authors.forename: Christophe
authors.initials: C
authors.lastname: Fraser
authors.forename: Jay
authors.initials: J
authors.lastname: Wenger
authors.forename: Jagadish M
authors.initials: JM
authors.lastname: Deshpande
authors.forename: Roland W
authors.initials: RW
authors.lastname: Sutter
authors.forename: David L
authors.initials: DL
authors.lastname: Heymann
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Aylward
mesh_terms: D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control*; D004306:Dose-Response Relationship, Immunologic; D006801:Humans; D017589:Immunization Programs; D007194:India / Q000453:epidemiology; D011051:Poliomyelitis / Q000453:epidemiology / Q000517:prevention & control*; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage* / Q000737:chemistry; D011156:Population Density; D012499:Sanitation
chemical_list: D011055:Poliovirus Vaccine, Oral