title: Modeling options to manage type 1 wild poliovirus imported into Israel in 2013.
abstract: BACKGROUND
  After 25 years without poliomyelitis cases caused by circulating wild poliovirus (WPV) in Israel, sewage sampling detected WPV type 1 (WPV1) in April 2013, despite high vaccination coverage with only inactivated poliovirus vaccine (IPV) since 2005.
  
  
  METHODS
  We used a differential equation-based model to simulate the dynamics of poliovirus transmission and population immunity in Israel due to past exposure to WPV and use of oral poliovirus vaccine (OPV) in addition to IPV. We explored the influences of various immunization options to stop imported WPV1 circulation in Israel.
  
  
  RESULTS
  We successfully modeled the potential for WPVs to circulate without detected cases in Israel. Maintaining a sequential IPV/OPV schedule instead of switching to an IPV-only schedule in 2005 would have kept population immunity high enough in Israel to prevent WPV1 circulation. The Israeli response to WPV1 detection prevented paralytic cases; a more rapid response might have interrupted transmission more quickly.
  
  
  CONCLUSIONS
  IPV-based protection alone might not provide sufficient population immunity to prevent poliovirus transmission after an importation. As countries transition to IPV in immunization schedules, they may need to actively manage population immunity and consider continued use of OPV, to avoid the potential circulation of imported live polioviruses before globally coordinated cessation of OPV use.
authors.affiliation: Kid Risk, Inc. Delft University of Technology, The Netherlands.
authors.forename: Dominika A
authors.initials: DA
authors.lastname: Kalkowska
authors.affiliation: Kid Risk, Inc.
authors.forename: Radboud J
authors.initials: RJ
authors.lastname: Duintjer Tebbens
authors.affiliation: Public Health Services Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.affiliation: Public Health Services Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Lester M
authors.initials: LM
authors.lastname: Shulman
authors.affiliation: Division of Epidemiology, Ministry of Health, Jerusalem.
authors.forename: Emilia
authors.initials: E
authors.lastname: Anis
authors.affiliation: Global Immunization Division, Center for Global Health.
authors.forename: Steven G F
authors.initials: SG
authors.lastname: Wassilak
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pallansch
authors.affiliation: Kid Risk, Inc. College of Medicine, University of Central Florida, Orlando.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008954:Models, Biological; D011051:Poliomyelitis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D017955:Poliovirus / Q000276:immunology / Q000302:isolation & purification; D023321:Poliovirus Vaccines / Q000008:administration & dosage / Q000276:immunology; D011157:Population Dynamics; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D023321:Poliovirus Vaccines
keywords: IPV; OPV; eradication; polio; population immunity; vaccine