Kid Risk, Inc., P.O. Box 590129, Newton, MA, USA.
Risk Anal. 2013 Apr;33(4):544-605. doi: 10.1111/j.1539-6924.2012.01864.x. Epub 2012 Jul 15.
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.
成功管理风险以实现野生脊灰病毒（WPV）根除，并应对停用口服脊灰病毒疫苗（OPV）以停止所有麻痹性脊髓灰质炎病例的复杂性，这强烈依赖于我们对脊灰病毒免疫和传播的集体理解。随着越来越多的人从 OPV 转向灭活脊灰病毒疫苗（IPV），许多风险管理选择促使我们需要了解权衡和不确定性，并开发模型以帮助做出决策。美国疾病控制与预防中心于 2010 年 4 月召集了一次国际专家会议，以审查与脊灰病毒免疫和传播相关的现有文献。本次专家审查评估了 66 项 OPV 挑战研究和其他证据，以支持开发脊灰病毒传播和潜在暴发的定量模型。本综述重点介绍了暴露史对易感性、排泄持续时间和排泄病毒浓度的免疫特征。我们还讨论了宿主对脊灰病毒传播的免疫力减弱的证据、排泄的脊灰病毒浓度与传染性之间的关系、不同传播途径的重要性以及 OPV 和 WPV 之间的传播差异。我们讨论了在脊灰风险模型中使用现有证据的局限性，并得出结论，尽管有大量关于免疫的研究，但非常有限的数据直接支持与传播相关的模型输入的量化。鉴于证据的局限性，我们确定需要专家的投入，以便从现有数据中推导出定量模型输入。
