Polio Eradication Initiative in Afghanistan, 1997–2013

Simpson, Diane M.; Sadr-Azodi, Nahad; Mashal, Taufiq; Sabawoon, Wrishmeen; Pardis, Ajmal; Quddus, Arshad; Garrigós, Carmen; Guirguis, Sherine; Zaidi, Syed Sohail Zahoor; Shaukat, Shahzad; Sharif, Salman; Asghar, Humayun; Hadler, Stephen C.

doi:10.1093/infdis/jiu022

Cited by 14 publications

(30 citation statements)

References 1 publication

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“…An estimated 190 million and 33 million people lived in Pakistan and Afghanistan, respectively, in 2015 . RI with tOPV started in 1978 in both countries, although coverage with the third dose remained below 10% until 1983 . Pakistan began tOPV SIAs in 1994 and acute flaccid paralysis (AFP) surveillance in 1995 while Afghanistan started AFP surveillance and national tOPV SIAs in 1997 .…”

Section: Methodsmentioning

confidence: 99%

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

Tebbens¹,

Pallansch

Cochi

et al. 2018

Risk Analysis

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Due to security, access, and programmatic challenges in areas of Pakistan and Afghanistan, both countries continue to sustain indigenous wild poliovirus (WPV) transmission and threaten the success of global polio eradication and oral poliovirus vaccine (OPV) cessation. We fitted an existing differential-equation-based poliovirus transmission and OPV evolution model to Pakistan and Afghanistan using four subpopulations to characterize the well-vaccinated and undervaccinated subpopulations in each country. We explored retrospective and prospective scenarios for using inactivated poliovirus vaccine (IPV) in routine immunization or supplemental immunization activities (SIAs). The undervaccinated subpopulations sustain the circulation of serotype 1 WPV and serotype 2 circulating vaccine-derived poliovirus. We find a moderate impact of past IPV use on polio incidence and population immunity to transmission mainly due to (1) the boosting effect of IPV for individuals with preexisting immunity from a live poliovirus infection and (2) the effect of IPV-only on oropharyngeal transmission for individuals without preexisting immunity from a live poliovirus infection. Future IPV use may similarly yield moderate benefits, particularly if access to undervaccinated subpopulations dramatically improves. However, OPV provides a much greater impact on transmission and the incremental benefit of IPV in addition to OPV remains limited. This study suggests that despite the moderate effect of using IPV in SIAs, using OPV in SIAs remains the most effective means to stop transmission, while limited IPV resources should prioritize IPV use in routine immunization.

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Section: Methodsmentioning

confidence: 99%

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

Tebbens¹,

Pallansch

Cochi

et al. 2018

Risk Analysis

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“…Mirroring attacks on vaccinators in Nigeria in 2013, threats and killings of vaccinators have also occurred in both Pakistan and Afghanistan. [22]…”

Section: Recent Outbreaksmentioning

confidence: 99%

“…[23] In Afghanistan, the first case of disease caused by cVDPV was reported in 2009–2010, and 11 cases were reported in 2012. These cases had a median age of 18 months, and vaccination history of 2 OPV doses, suggesting inadequate vaccination may propagate the risk of spreading WPV from OPV [22] Better adherence to vaccination schedules and increased vaccination campaigns with complete penetration into at risk populations are crucial. Strategies to decrease poliomyelitis in Afghanistan include identifying high-risk areas, and focusing special efforts on these areas.…”

Section: Recent Outbreaksmentioning

confidence: 99%

“…Strategies to decrease poliomyelitis in Afghanistan include identifying high-risk areas, and focusing special efforts on these areas. [22] Transit vaccination teams at border crossings into Pakistan and Iran have been successful in vaccinating >1 million children per year. [22] These efforts may be bearing fruit, as no cases of paralysis caused by cVDPV have been reported in Afghanistan or Pakistan between January and October of 2015.…”

Section: Recent Outbreaksmentioning

confidence: 99%

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Enteroviruses in the early 21st century

Lugo¹,

Krogstad

2016

Current Opinion in Pediatrics

127

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Purpose of review Enteroviruses cause a wide variety of diseases with neurologic, respiratory, skin, and gastrointestinal findings. The purpose of this review is to clarify changes in the classification of enteroviruses, provide information about recent disease outbreaks, and to summarize progress toward treatment and prevention of these infections. Recent findings Enteroviruses are now classified into 4 distinct species. New variants of Coxsackievirus B1, Enterovirus-A71, and Enterovirus-D68 (EV-D68) have emerged as causes of recent outbreaks in the United States and other countries, including more severe disease manifestations than previously described. EV-D68 now commonly circulates in the United States, and has been linked to severe respiratory disease and associated with acute flaccid myelitis. Overcoming enormous political and logistical challenges, fewer than 100 cases of polio have been reported in 2015, and the initiation of “endgame” strategies appears imminent. Unfortunately treatment for enterovirus infections remains supportive, although the recently completed pleconaril trial in newborns suggests that antiviral therapy may reduce mortality in neonatal disease. Summary Clinicians should be aware of the respiratory and neurological manifestations associated with EV-D68 and the potential for severe disease seen with other recently described enterovirus variants. Healthcare professionals should recognize the utility of rapid diagnostic methods and progress toward prevention and treatment of enterovirus infections.

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“…As we approach WPV eradication and manage OPV cessation, the vaccination of subpopulations emerges as critical for success. Undervaccinated subpopulations can sustain transmission and pose challenges because of a confluence of factors [11,12] related to political circumstances (including poor program performance, low vaccination coverage, poor surveillance, and/ or poor data quality), conditions that favor intense fecal-oral poliovirus transmission and correlate with low socioeconomic status (including poor sanitary and hygienic conditions, high birth rates and crowding, poor nutrition, poverty, and high exposure to pathogens that interfere with vaccine response), and/or limited access (including immigrants, displaced populations, and populations in violent, insecure, or remote areas) [13][14][15][16][17][18][19][20][21]. However, other subpopulations also emerge as important, including those in countries with sufficient access to vaccine who refuse immunization [22][23][24][25][26].…”

mentioning

confidence: 99%

Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in Maintaining Transmission

Thompson

Tebbens²

2017

The Journal of Infectious Diseases

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Background.Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response.Methods.We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts.Results.Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term.Conclusions.Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.

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Polio Eradication Initiative in Afghanistan, 1997–2013

Cited by 14 publications

References 1 publication

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

Enteroviruses in the early 21st century

Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in Maintaining Transmission

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