Quantifying the Impact of Expanded Age Group Campaigns for Polio Eradication

December 1, 2014


A priority of the Global Polio Eradication Initiative (GPEI) 2013–2018 strategic plan is to evaluate the potential impact on polio eradication resulting from expanding one or more Supplementary Immunization Activities (SIAs) to children beyond age five-years in polio endemic countries. It has been hypothesized that such expanded age group (EAG) campaigns could accelerate polio eradication by eliminating immunity gaps in older children that may have resulted from past periods of low vaccination coverage.

The distribution of mucosal immunity in 5–14 year-olds in EAG campaigns compared with standard campaigns targeting 0–4 year-olds. Average mucosal immunity waning time was varied between 6 months and 10 years (half-life 0.34–7 years), and SIA coverage between 10%–60% per round.

We reported the results in fractions of mucosal antibody titer >8, assuming a fixed fraction of acquired viral dose.
We note that other values yield similar results: (A) no wild poliovirus circulation, baseline; (B) no wild poliovirus circulation, expanded age group campaigns; (C) with wild poliovirus circulation, baseline scenario; and (D) with wild poliovirus circulation, expanded age group campaigns. doi:10.1371/journal.pone.0113538.g006

Conclusion: We found that EAG campaigns would not significantly improve prospects for polio eradication; the probability of elimination increased by 8% (from 24% at baseline to 32%) when expanding three annual SIAs to 5–14 year old children and by 18% when expanding all six annual SIAs. In contrast, expanding only two of the annual SIAs to target hard-to-reach populations at modest vaccination coverage—representing less than one tenth of additional vaccinations required for the six SIA EAG scenario—increased the probability of elimination by 55%. Implementation of EAG campaigns in polio endemic regions would not improve prospects for eradication. In endemic areas, vaccination campaigns which do not target missed populations will not benefit polio eradication efforts.