Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832, USA.
Risk Anal. 2013 Apr;33(4):647-63. doi: 10.1111/j.1539-6924.2012.01891.x. Epub 2012 Sep 17.
Eradication of wild poliovirus (WPV) types 1 and 3, prevention and cessation of circulating vaccine-derived polioviruses, and achievement and maintenance of a world free of paralytic polio cases requires active risk management by focusing on population immunity and coordinated cessation of oral poliovirus vaccine (OPV). We suggest the need for a complementary and different conceptual approach to achieve eradication compared to the current case-based approach using surveillance for acute flaccid paralysis (AFP) to identify symptomatic poliovirus infections. Specifically, we describe a modeling approach to characterize overall population immunity to poliovirus transmission. The approach deals with the realities that exposure to live polioviruses (e.g., WPV, OPV) and/or vaccination with inactivated poliovirus vaccine provides protection from paralytic polio (i.e., disease), but does not eliminate the potential for reinfection or asymptomatic participation in poliovirus transmission, which may increase with time because of waning immunity. The AFP surveillance system provides evidence of symptomatic poliovirus infections detected, which indicate immunity gaps after outbreaks occur, and this system represents an appropriate focus for controlling disease outbreaks. We describe a conceptual dynamic model to characterize population immunity to poliovirus transmission that helps identify risks created by immunity gaps before outbreaks occur, which provides an opportunity for national and global policymakers to manage the risk of poliovirus and prevent outbreaks before they occur. We suggest that dynamically modeling risk represents an essential tool as the number of cases approaches zero.
消灭野生脊灰病毒（WPV）1 型和 3 型、预防和阻断循环疫苗衍生脊灰病毒、实现并维持无麻痹性脊灰病例的世界，需要通过关注人群免疫力和协调停止口服脊灰疫苗（OPV）来积极进行风险管理。我们建议，与目前使用急性弛缓性麻痹（AFP）监测来发现有症状脊灰病毒感染的基于病例的方法相比，需要采用补充的、不同的概念方法来实现消灭脊灰病毒。具体而言，我们描述了一种建模方法来描述人群对脊灰病毒传播的总体免疫力。该方法应对以下现实情况：接触活脊灰病毒（例如 WPV、OPV）和/或接种脊灰灭活疫苗可提供对麻痹性脊灰（即疾病）的保护，但不能消除再次感染或无症状参与脊灰病毒传播的可能性，而这种可能性会随着时间的推移因为免疫力下降而增加。AFP 监测系统提供了已检测到的有症状脊灰病毒感染的证据，这些感染表明在暴发发生后存在免疫空白，该系统代表了控制疾病暴发的适当重点。我们描述了一种概念性动态模型，用于描述人群对脊灰病毒传播的免疫力，有助于在暴发发生之前识别由免疫空白造成的风险，为国家和全球政策制定者提供了管理脊灰病毒风险和预防暴发的机会。我们建议，随着病例数量接近零，动态建模风险是一项重要工具。
