Evaluating cessation of the type 2 oral polio vaccine by modeling pre- and post-cessation detection rates
The globally synchronized removal of the attenuated Sabin type 2 strain from the oral polio vaccine (OPV) in April 2016 marked a major change in polio vaccination policy. This change will provide a significant reduction in the burden of vaccine-associated paralytic polio (VAPP), but may increase the risk of circulating vaccine-derived poliovirus (cVDPV2) outbreaks during the transition period. This risk can be monitored by tracking the disappearance of Sabin-like type 2 (SL2) using data from the polio surveillance system. We studied SL2 prevalence in 17 countries in Africa and Asia, from 2010 to 2016 using acute flaccid paralysis surveillance data. We modeled the peak and decay of SL2 prevalence following mass vaccination events using a beta-binomial model for the detection rate, and a Ricker function for the temporal dependence. We found type 2 circulated the longest of all serotypes after a vaccination campaign, but that SL2 prevalence returned to baseline levels in approximately 50 days. Post-cessation model predictions identified 19 anomalous SL2 detections outside of model predictions in Afghanistan, India, Nigeria, Pakistan, and western Africa. Our models established benchmarks for the duration of SL2 detection after OPV2 cessation. As predicted, SL2 detection rates have plummeted, except in Nigeria where OPV2 use continued for some time in response to recent cVDPV2 detections. However, the anomalous SL2 detections suggest specific areas that merit enhanced monitoring for signs of cVDPV2 outbreaks.
Daily prevalence of SL1-3 over time in Bihar province, India. The proportion of NP-AFP children positive for SL1 (A), 2 (B), and 3 (C) are shown by day of stool collection (solid lines). Triangles at the bottom of the panels show when SIAs were done, with the colors indicating vaccine used (tOPV containing OPV1, 2, and 3 in black, and bOPV containing OPV1 and 3 in green). OPV detection rates pulse very rapidly and briefly after SIAs. Between campaigns, detection rates are sporadic and of low prevalence, compatible with detecting SL from routine immunization that is continually being administered to children less then 1 year of age. NP-AFP = non-polio acute flaccid paralysis. OPV = oral poliovirus vaccine. SIA = supplementary immunization activity. SL = Sabin-like poliovirus.