Expert review on poliovirus immunity and transmission.
Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.
Kid Risk, Inc., P.O. Box 590129, Newton, MA, USA. rdt@kidrisk.org
Radboud J
RJ
Duintjer Tebbens
Mark A
MA
Pallansch
Konstantin M
KM
Chumakov
Neal A
NA
Halsey
Tapani
T
Hovi
Philip D
PD
Minor
John F
JF
Modlin
Peter A
PA
Patriarca
Roland W
RW
Sutter
Peter F
PF
Wright
Steven G F
SG
Wassilak
Stephen L
SL
Cochi
Jong-Hoon
JH
Kim
Kimberly M
KM
Thompson
D002487:Centers for Disease Control and Prevention, U.S.; D006801:Humans; D011051:Poliomyelitis / Q000276:immunology* / Q000517:prevention & control / Q000635:transmission*; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D014481:United States
D011055:Poliovirus Vaccine, Oral