Kisjes Kasper H, Duintjer Tebbens Radboud J, Wallace Gregory S, Pallansch Mark A, Cochi Stephen L, Wassilak Steven G F, Thompson Kimberly M
Kid Risk, Inc. Delft University of Technology, Delft, The Netherlands.
Kid Risk, Inc.
J Infect Dis. 2014 Nov 1;210 Suppl 1(Suppl 1):S424-33. doi: 10.1093/infdis/jit843.
Pockets of undervaccinated individuals continue to raise concerns about their potential to sustain epidemic transmission of vaccine-preventable diseases. Prior importations of live polioviruses (LPVs) into Amish communities in North America led to their recognition as a potential and identifiable linked network of undervaccinated individuals.
We developed an individual-based model to explore the potential transmission of a LPV throughout the North American Amish population.
Our model demonstrates the expected limited impact associated with the historical importations, which occurred in isolated communities during the low season for poliovirus transmission. We show that some conditions could potentially lead to wider circulation of LPVs and cases of paralytic polio in Amish communities if an importation occurred during or after 2013. The impact will depend on the uncertain historical immunity to poliovirus infection among members of the community.
Heterogeneity in immunization coverage represents a risk factor for potential outbreaks of polio if introduction of a LPV occurs, although overall high population immunity in North America suggests that transmission would remain relatively limited. Efforts to prevent spread between Amish church districts with any feasible measures may offer the best opportunity to contain an outbreak and limit its size.
未充分接种疫苗人群的存在持续引发人们对其维持疫苗可预防疾病流行传播可能性的担忧。此前北美阿米什社区曾有活脊髓灰质炎病毒（LPV）输入，这使得他们被认定为未充分接种疫苗个体的一个潜在且可识别的关联网络。
我们开发了一个基于个体的模型，以探究LPV在北美阿米什人群中的潜在传播情况。
我们的模型展示了与历史输入事件相关的预期有限影响，这些输入事件发生在脊髓灰质炎病毒传播的低季节，且是在孤立社区中。我们表明，如果在2013年期间或之后发生输入事件，某些条件可能会导致LPV在阿米什社区更广泛地传播以及出现麻痹性脊髓灰质炎病例。影响将取决于该社区成员对脊髓灰质炎病毒感染不确定的历史免疫力。
免疫接种覆盖率的异质性是LPV引入时脊髓灰质炎潜在暴发的一个风险因素，尽管北美总体人群免疫力较高表明传播仍将相对有限。采取任何可行措施防止在阿米什教区之间传播，可能是控制疫情暴发并限制其规模的最佳机会。
