Kid Risk, Inc.
Kid Risk, Inc, College of Medicine, University of Central Florida, Orlando.
J Infect Dis. 2014 Nov 1;210 Suppl 1:S485-97. doi: 10.1093/infdis/jit838.
The Global Polio Eradication Initiative plans to stop all oral poliovirus vaccine (OPV) after wild poliovirus eradication, starting with serotype 2. Stakeholders continue to discuss the role of using inactivated poliovirus vaccine (IPV) to manage the risks of circulating vaccine-derived polioviruses (cVDPVs) during the end game.
We use a poliovirus transmission and OPV evolution model to explore the impact of various routine immunization policies involving IPV on population immunity dynamics and the probability and magnitude of cVDPV emergences following OPV cessation.
Adding a single IPV dose to an OPV-only routine immunization schedule at or just before OPV cessation produces very limited impact on the probability of cVDPV emergences and the number of expected polio cases in settings in which we expect cVDPVs in the absence of IPV use. The highest-cost option of switching to a 3-dose IPV schedule only marginally decreases cVDPV risks. Discontinuing supplemental immunization activities while introducing IPV prior to OPV cessation leads to an increase in cVDPV risks.
Introducing a dose of IPV in countries currently using OPV only for routine immunization offers protection from paralysis to successfully vaccinated recipients, but it does little to protect high-risk populations from cVDPV risks.
全球根除脊髓灰质炎行动计划在野生脊灰病毒根除后停止使用所有口服脊髓灰质炎疫苗（OPV），首先停止使用血清型 2 型 OPV。利益相关者继续讨论在消灭脊灰行动后期使用灭活脊髓灰质炎疫苗（IPV）来管理循环疫苗衍生脊灰病毒（cVDPV）风险的作用。
我们使用脊灰病毒传播和 OPV 进化模型来探讨各种涉及 IPV 的常规免疫接种政策对人群免疫动态以及 OPV 停止后 cVDPV 出现的概率和程度的影响。
在 OPV 停止时或之前，在仅使用 OPV 的常规免疫接种计划中添加一剂 IPV，对在没有使用 IPV 的情况下我们预计会出现 cVDPV 的情况下，cVDPV 出现的概率和预期脊灰病例数的影响非常有限。仅转换为 3 剂 IPV 方案的最高成本选择略微降低了 cVDPV 风险。在停止补充免疫活动的同时在 OPV 停止之前引入 IPV 会增加 cVDPV 的风险。
在目前仅使用 OPV 进行常规免疫接种的国家中引入一剂 IPV 可为成功接种疫苗的受种者提供预防瘫痪的保护，但对保护高危人群免受 cVDPV 风险的作用不大。
