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Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan

Author

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  • Dominika A. Kalkowska
  • Radboud J. Duintjer Tebbens
  • Mark A. Pallansch
  • Kimberly M. Thompson

Abstract

Since most poliovirus infections occur with no paralytic symptoms, the possibility of silent circulation complicates the confirmation of the end of poliovirus transmission. Based on empirical field experience and theoretical modeling results, the Global Polio Eradication Initiative identified three years without observing paralytic cases from wild polioviruses with good acute flaccid paralysis surveillance as an indication of sufficient confidence that poliovirus circulation stopped. The complexities of real populations and the imperfect nature of real surveillance systems subsequently demonstrated the importance of specific modeling for areas at high risk of undetected circulation, resulting in varying periods of time required to obtain the same level of confidence about no undetected circulation. Using a poliovirus transmission model that accounts for variability in transmissibility and neurovirulence for different poliovirus serotypes and characterizes country‐specific factors (e.g., vaccination and surveillance activities, demographics) related to wild and vaccine‐derived poliovirus transmission in Pakistan and Afghanistan, we consider the probability of undetected poliovirus circulation for those countries once apparent die‐out occurs (i.e., in the absence of any epidemiological signals). We find that gaps in poliovirus surveillance or reaching elimination with borderline sufficient population immunity could significantly increase the time to reach high confidence about interruption of live poliovirus transmission, such that the path taken to achieve and maintain poliovirus elimination matters. Pakistan and Afghanistan will need to sustain high‐quality surveillance for polioviruses after apparent interruption of transmission and recognize that as efforts to identify cases or circulating live polioviruses decrease, the risks of undetected circulation increase and significantly delay the global polio endgame.

Suggested Citation

  • Dominika A. Kalkowska & Radboud J. Duintjer Tebbens & Mark A. Pallansch & Kimberly M. Thompson, 2019. "Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan," Risk Analysis, John Wiley & Sons, vol. 39(2), pages 402-413, February.
    • Handle: RePEc:wly:riskan:v:39:y:2019:i:2:p:402-413
    DOI: 10.1111/risa.13214
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    References listed on IDEAS

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    1. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Dominika A. Kalkowska & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Characterizing Poliovirus Transmission and Evolution: Insights from Modeling Experiences with Wild and Vaccine‐Related Polioviruses," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 703-749, April.
    2. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Stephen L. Cochi & Derek T. Ehrhardt & Noha H. Farag & Stephen C. Hadler & Lee M. Hampton & Maureen Martinez & Steve G.F. Wassilak & Kimberly M. Thomp, 2018. "Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations," Risk Analysis, John Wiley & Sons, vol. 38(8), pages 1701-1717, August.
    3. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Olen M. Kew & Victor M. Cáceres & Hamid Jafari & Stephen L. Cochi & Roland W. Sutter & R. Bruce Aylward & Kimberly M. Thompson, 2006. "Risks of Paralytic Disease Due to Wild or Vaccine‐Derived Poliovirus After Eradication," Risk Analysis, John Wiley & Sons, vol. 26(6), pages 1471-1505, December.
    4. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Konstantin M. Chumakov & Neal A. Halsey & Tapani Hovi & Philip D. Minor & John F. Modlin & Peter A. Patriarca & Roland W. Sutter & Peter F. Wright & S, 2013. "Review and Assessment of Poliovirus Immunity and Transmission: Synthesis of Knowledge Gaps and Identification of Research Needs," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 606-646, April.
    5. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Konstantin M. Chumakov & Neal A. Halsey & Tapani Hovi & Philip D. Minor & John F. Modlin & Peter A. Patriarca & Roland W. Sutter & Peter F. Wright & S, 2013. "Expert Review on Poliovirus Immunity and Transmission," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 544-605, April.
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    1. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "Reflections on Modeling Poliovirus Transmission and the Polio Eradication Endgame," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 229-247, February.
    2. Dominika A. Kalkowska & Kimberly M. Thompson, 2021. "Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Borno and Yobe in Northeast Nigeria," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 303-311, February.
    3. Dominika A. Kalkowska & Richard Franka & Jeff Higgins & Stephanie D. Kovacs & Joseph C. Forbi & Steven G. F. Wassilak & Mark A. Pallansch & Kimberly M. Thompson, 2021. "Modeling Poliovirus Transmission in Borno and Yobe, Northeast Nigeria," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 289-302, February.
    4. Dominika A. Kalkowska & Mark A. Pallansch & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2021. "Global Transmission of Live Polioviruses: Updated Dynamic Modeling of the Polio Endgame," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 248-265, February.
    5. Kimberly M. Thompson, 2021. "Modeling and Managing Poliovirus Risks: We are Where we are…," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 223-228, February.

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