title: Modeling strategies to increase population immunity and prevent poliovirus transmission in 2 high-risk areas in northern India.
abstract: BACKGROUND
  India presented many challenges to the global effort to eliminate the transmission of wild polioviruses (WPVs) and poliomyelitis, with the last case of WPV type 2 in the world reported in northern India in 1999 and WPV types 1 and 3 circulating until early 2011.
  
  
  METHODS
  We used a differential equation-based model to characterize the dynamics of poliovirus transmission and various opportunities to increase and maintain high population immunity to poliovirus transmission for 2 high-risk areas in northern India. We explored options that India probably considered before 2011, to demonstrate the impact of strategies to accelerate WPV elimination and sustain high population immunity. We also characterized the impact of current and potential future vaccination strategies and explored the potential trade-offs associated with the various strategies.
  
  
  RESULTS
  National immunization policy choices impact population immunity, which leads to different numbers of expected paralytic cases and risks of circulating vaccine-derived poliovirus outbreaks. Assuming that India maintains high vaccination intensity everywhere, we do not anticipate issues with outbreaks of circulating vaccine-derived poliovirus type 2 infection following globally coordinated cessation of type 2-containting oral poliovirus vaccine use. We find a relatively modest potential role for inactivated poliovirus vaccine.
  
  
  CONCLUSIONS
  National policy makers should consider the impacts of their vaccine choices on population immunity to poliovirus transmission.
authors.affiliation: Kid Risk, Inc., Orlando, Florida Delft University of Technology, Delft, The Netherlands; and.
authors.forename: Dominika A
authors.initials: DA
authors.lastname: Kalkowska
authors.affiliation: Kid Risk, Inc., Orlando, Florida.
authors.forename: Radboud J
authors.initials: RJ
authors.lastname: Duintjer Tebbens
authors.affiliation: Kid Risk, Inc., Orlando, Florida College of Medicine, University of Central Florida, Orlando.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011051:Poliomyelitis / Q000517:prevention & control* / Q000635:transmission*; D017955:Poliovirus / Q000276:immunology*; D023321:Poliovirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D055815:Young Adult
chemical_list: D023321:Poliovirus Vaccines
keywords: IPV; OPV; eradication; polio; population immunity