title: Managing the risk of circulating vaccine-derived poliovirus during the endgame: oral poliovirus vaccine needs.
abstract: BACKGROUND
  The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) use, beginning with serotype 2-containing OPV (i.e., OPV2 cessation) followed by the remaining two OPV serotypes (i.e., OPV13 cessation). The risk of circulating vaccine-derived poliovirus (cVDPV) outbreaks after OPV cessation of any serotype depends on the serotype-specific population immunity to transmission prior to its cessation.
  
  
  METHODS
  Based on an existing integrated global model of poliovirus risk management policies, we estimate the serotype-specific OPV doses required to manage population immunity for a strategy of intensive supplemental immunization activities (SIAs) shortly before OPV cessation of each serotype. The strategy seeks to prevent any cVDPV outbreaks after OPV cessation, although actual events remain stochastic.
  
  
  RESULTS
  Managing the risks of OPV cessation of any serotype depends on achieving sufficient population immunity to transmission to transmission at OPV cessation. This will require that countries with sub-optimal routine immunization coverage and/or conditions that favor poliovirus transmission conduct SIAs with homotypic OPV shortly before its planned coordinated cessation. The model suggests the need to increase trivalent OPV use in SIAs by approximately 40 % or more during the year before OPV2 cessation and to continue bOPV SIAs between the time of OPV2 cessation and OPV13 cessation.
  
  
  CONCLUSIONS
  Managing the risks of cVDPVs in the polio endgame will require serotype-specific OPV SIAs in some areas prior to OPV cessation and lead to demands for additional doses of the vaccine in the short term that will affect managers and manufacturers.
authors.affiliation: Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA. rdt@kidrisk.org.
authors.forename: Radboud J
authors.initials: RJ
authors.lastname: Duintjer Tebbens
authors.affiliation: Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA. kimt@kidrisk.org.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Thompson
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D008962:Models, Theoretical; D011051:Poliomyelitis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017955:Poliovirus / Q000276:immunology; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D011446:Prospective Studies; D012308:Risk Management; D065288:Serogroup
chemical_list: D011055:Poliovirus Vaccine, Oral