#Projection of #costs of #polio #eradication compared to permanent control (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Projection of costs of polio eradication compared to permanent control

Marita Zimmermann, MPH, PhD, Brittany Hagedorn, MBA, Hil Lyons, MS, PhD

The Journal of Infectious Diseases, jiz488, https://doi.org/10.1093/infdis/jiz488

Published: 30 September 2019

 

Abstract

Despite increased efforts and spending toward polio eradication, it has yet to be eliminated worldwide. We aimed to project economic costs of polio eradication compared to permanent control. We used historical Financial Resource Requirements from the Global Polio Eradication Initiative, as well as vaccination and population data from publicly available sources to project costs for routine immunization, immunization campaigns, surveillance and lab, technical assistance, social mobilization, treatment, and overhead. We found that cumulative spending for a control strategy would exceed that for an eradication strategy in 2032 (range 2027-2051). Eradication of polio would likely be cost-saving compared to permanent control.

Polio, Eradication, Costs, Permanent Control, Budget

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: Poliomyelitis; Worldwide; Global Health.

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Surviving #polio with #disabilities (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

MEDIA WATCH|BOOK|ONLINE FIRST

Surviving polio with disabilities

Sanjeet Bagcchi

Published: January 18, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30014-3

 

Summary

In 1988—the year when a global drive for eradication of polio began thanks to the initiatives taken up by the World Health Assembly—350 000 children a year worldwide were paralysed for life by polio. According to WHO, one in 200 cases of polio resulted in irreversible paralysis, and, among paralysed patients, 5–10% died as a result of progressive immobilisation of their respiratory muscles. At that time, polio was endemic in 125 countries, and many children who ultimately survived the infection despite paralysis subsequently had substantial, lifelong disabilities, mostly affecting their legs.

Keywords: Poliomyelitis; Society.

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#Immunogenicity of Different #Routine #Poliovirus #Vaccination #Schedules: a Randomized Controlled Trial, #Karachi, Pakistan (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Immunogenicity of Different Routine Poliovirus Vaccination Schedules: a Randomized Controlled Trial, Karachi, Pakistan

Ali F Saleem, Ondrej Mach, Mohammad T Yousafzai, Asia Khan, William C Weldon, M Steven Oberste, Syed S Zaidi, Muhammad M Alam, Farheen Quadri, Roland W Sutter, Anita KM Zaidi

The Journal of Infectious Diseases, jix577, https://doi.org/10.1093/infdis/jix577

Published:  06 November 2017

 

Abstract

Background

We assessed immunity against polioviruses induced with new Pakistani immunization schedule and compared it with alternative immunization schedules.

Methods

Newborns were randomized to receive one of the following vaccination schedules, administered at birth, 6, 10, and 14 weeks of age. Arm A: 4x IPV; Arm B: 4x bOPV; Arm C and D: bOPV, bOPV, bOPV, bOPV+ inactivated poliovirus vaccine (IPV); Arm E: 4x trivalent oral poliovirus vaccine (tOPV). At 22 weeks of age, children received one challenge dose of tOPV, and children in arm D received one additional IPV dose. Sera were analyzed for presence of polio neutralizing antibodies at birth, 14, and 22 weeks of age.

Results

Study arms A-E, the seroconversion for PV1 at 22 weeks of age was 80%, 97%, 94%, 96%, 94% respectively; for PV2: 84%, 19%, 53%, 49%, 93%; and for PV3: 93%, 94%, 98%, 94%, 85%.

Interpretation

Current immunization schedule in Pakistan induced high seroconversion rates for PV1 and PV3; however, it induced PV2 seroconversion in only half of study subjects. There is a growing cohort of young children in Pakistan who are unprotected against PV2; and this creates an increasing risk of a large-scale outbreak of poliomyelitis caused by circulating vaccine-derived PV2.

Issue Section:  Major Article

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Keywords: Poliovirus; Poliomyelitis; Vaccines; Pakistan.

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Acute segmental #poliomyelitis-like flaccid #paralysis in an #adult in the #UK, associated with #EVD68 (Pract Neurol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pract Neurol. 2017 Jun 16. pii: practneurol-2017-001609. doi: 10.1136/practneurol-2017-001609. [Epub ahead of print]

Acute segmental poliomyelitis-like flaccid paralysis in an adult in the UK, associated with enterovirus D68.

Stacpoole SRL1,2, Molyneux A2, Bäumer D1,2.

Author information: 1 Department of Neurology, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK. 2 Department of Neurology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

 

Abstract

Enterovirus D68 has been associated with a poliomyelitis-like illness, notably during an outbreak in 2014, and particularly affecting children in the USA. We report a case of acute segmental flaccid paralysis with respiratory involvement in an adult in the UK, with enterovirus D68 detected in a sputum sample. MR imaging of cervical spinal cord showed a longitudinally extensive T2 hyperintensity in the anterior cord. Cerebrospinal fluid showed an elevated white cell count, predominantly lymphocytic, with otherwise normal constituents and negative viral PCRs. His respiratory function improved after intravenous immunoglobulin, suggesting that this may be useful in such cases. Clinicians should consider enterovirus D68 infection in the differential diagnosis of Guillain-Barré syndrome, particularly the pharyngeal-cervical-brachial variant.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

KEYWORDS: CLINICAL NEUROLOGY; GUILLAIN-BARRE SYNDROME; INFECTIOUS DISEASES; MYELOPATHY; NEUROVIROLOGY

PMID: 28626021 DOI: 10.1136/practneurol-2017-001609

Keywords: EV-D68; Enterovirs; Acute Flaccid Paralysis; Poliomyelitis.

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#Immunogenicity and #safety of 3 aluminium hydroxide adjuvanted #vaccines with reduced doses of inactivated #polio vaccine (IPV-Al)… in young infants in Dominican Republic:… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Immunogenicity and safety of three aluminium hydroxide adjuvanted vaccines with reduced doses of inactivated polio vaccine (IPV-Al) compared with standard IPV in young infants in the Dominican Republic: a phase 2, non-inferiority, observer-blinded, randomised, and controlled dose investigation trial

Prof Luis Rivera, MD, Rasmus S Pedersen, PhD, Lourdes Peña, MD, Klaus J Olsen, PhD, Lars V Andreasen, PhD, Ingrid Kromann, BSc, Pernille I Nielsen, MSc, Charlotte Sørensen, MSc, Jes Dietrich, PhD, Ananda S Bandyopadhyay, MBBS, Birgit Thierry-Carstensen, MSc

Published: 25 April 2017 / Open Access / Article has an altmetric score of 1 / DOI: http://dx.doi.org/10.1016/S1473-3099(17)30177-9

Open access funded by Bill & Melinda Gates Foundation

© 2017 The Author(s). Published by Elsevier Ltd.

 

Summary

Background

Cost and supply constraints are key challenges in the use of inactivated polio vaccine (IPV). Dose reduction through adsorption to aluminium hydroxide (Al) is a promising option, and establishing its effectiveness in the target population is a crucial milestone in developing IPV-Al. The aim of this clinical trial was to show the non-inferiority of three IPV-Al vaccines to standard IPV.

Methods

In this phase 2, non-inferiority, observer-blinded, randomised, controlled, single-centre trial in the Dominican Republic, healthy infants aged 6 weeks, not previously polio vaccinated, were allocated after computer-generated randomisation by block-size of four, to receive one of four IPV formulations (three-times reduced dose [1/3 IPV-Al], five-times reduced dose [1/5 IPV-Al], ten-times reduced dose [1/10 IPV-Al], or IPV) intramuscularly in the thigh at 6, 10, and 14 weeks of age. The primary outcome was seroconversion for poliovirus types 1, 2, and 3 with titres more than or equal to four-fold higher than the estimated maternal antibody titre and more than or equal to 8 after three vaccinations. Non-inferiority was concluded if the lower two-sided 90% CI of the seroconversion rate difference between IPV-Al and IPV was greater than −10%. The safety analyses were based on the safety analysis set (randomly assigned participants who received at least one trial vaccination) and the immunogenicity analyses were based on the per-protocol population. This study is registered with ClinicalTrials.gov registration, number NCT02347423.

Findings

Between Feb 2, 2015, and Sept 26, 2015, we recruited 824 infants. The per-protocol population included 820 infants; 205 were randomly assigned to receive 1/3 IPV-Al, 205 to receive 1/5 IPV-Al, 204 to receive 1/10 IPV-Al, and 206 to receive IPV. The proportion of individuals meeting the primary endpoint of seroconversion for poliovirus types 1, 2, and 3 was already high for the three IPV-Al vaccines after two vaccinations, but was higher after three vaccinations (ie, after completion of the expanded programme of immunisation schedule): 1/3 IPV-Al 98·5% (n=202, type 1), 97·6% (n=200; type 2), and 99·5% (n=204, type 3); 1/5 IPV-Al: 99·5% (n=204, type 1), 96·1% (n=197, type 2), and 98·5% (n=202, type 3); and 1/10 IPV-Al: 98·5% (n=201, type 1), 94·6% (n=193, type 2), and 99·5% (n=203, type 3). All three IPV-Al were non-inferior to IPV, with absolute differences in percentage seroconversion for each poliovirus type being greater than −10% (1/3 IPV-Al type 1, −1·46 [–3·60 to 0·10], type 2, −0·98 [–3·62 to 1·49], and type 3, −0·49 [–2·16 to 0·86]; 1/5 IPV-Al type 1, −0·49 [–2·16 to 0·86], type 2, −2·45 [–5·47 to 0·27], and type 3, −1·46 [–3·60 to 0·10]; and 1/10 IPV-Al type 1, −1·47 [–3·62 to 0·10], type 2, −3·94 [–7·28 to −0·97], and type 3, −0·49 [–2·17 to 0·86]). Three serious adverse events occurred that were unrelated to the vaccine.

Interpretation

The lowest dose (1/10 IPV-Al) of the vaccine performed well both after two and three doses. Based on these results, this new vaccine is under investigation in phase 3 trials.

Funding

Bill & Melinda Gates Foundation.

Keywords: Vaccines; Poliovirus; Poliomyelitis.

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#Humoral and #intestinal #immunity induced by new schedules of bivalent oral #poliovirus #vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial (The Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Articles

Humoral and intestinal immunity induced by new schedules of bivalent oral poliovirus vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial

Prof Edwin J Asturias, MD, Ananda S Bandyopadhyay, MBBS, Steve Self, PhD, Luis Rivera, MD, Xavier Saez-Llorens, MD, Eduardo Lopez, MD, Mario Melgar, MD, James T Gaensbauer, MD, William C Weldon, PhD, M Steven Oberste, PhD, Bhavesh R Borate, MBBS, Chris Gast, PhD, Ralf Clemens, MD, Walter Orenstein, MD, Miguel O’Ryan G, MD, José Jimeno, MD, Sue Ann Costa Clemens, MD, Joel Ward, MD, Ricardo Rüttimann, MD the Latin American IPV001BMG Study Group†

†Study group listed at end of Article

Published Online: 19 May 2016 / Article has an altmetric score of 6 / DOI: http://dx.doi.org/10.1016/S0140-6736(16)00703-0

© 2016 Elsevier Ltd. All rights reserved.

 

Summary

Background

Replacement of the trivalent oral poliovirus vaccine (tOPV) with bivalent types 1 and 3 oral poliovirus vaccine (bOPV) and global introduction of inactivated poliovirus vaccine (IPV) are major steps in the polio endgame strategy. In this study, we assessed humoral and intestinal immunity in Latin American infants after three doses of bOPV combined with zero, one, or two doses of IPV.

Methods

This open-label randomised controlled multicentre trial was part of a larger study. 6-week-old full-term infants due for their first polio vaccinations, who were healthy on physical examination, with no obvious medical conditions and no known chronic medical disorders, were enrolled from four investigational sites in Colombia, Dominican Republic, Guatemala, and Panama. The infants were randomly assigned by permuted block randomisation (through the use of a computer-generated list, block size 36) to nine groups, of which five will be discussed in this report. These five groups were randomly assigned 1:1:1:1 to four permutations of schedule: groups 1 and 2 (control groups) received bOPV at 6, 10, and 14 weeks; group 3 (also a control group, which did not count as a permutation) received tOPV at 6, 10, and 14 weeks; group 4 received bOPV plus one dose of IPV at 14 weeks; and group 5 received bOPV plus two doses of IPV at 14 and 36 weeks. Infants in all groups were challenged with monovalent type 2 vaccine (mOPV2) at 18 weeks (groups 1, 3, and 4) or 40 weeks (groups 2 and 5). The primary objective was to assess the superiority of bOPV–IPV schedules over bOPV alone, as assessed by the primary endpoints of humoral immunity (neutralising antibodies—ie, seroconversion) to all three serotypes and intestinal immunity (faecal viral shedding post-challenge) to serotype 2, analysed in the per-protocol population. Serious and medically important adverse events were monitored for up to 6 months after the study vaccination. This study is registered with ClinicalTrials.gov, number NCT01831050, and has been completed.

Findings

Between May 20, 2013, and Aug 15, 2013, 940 eligible infants were enrolled and randomly assigned to the five treatment groups (210 to group 1, 210 to group 2, 100 to group 3, 210 to group 4, and 210 to group 5). One infant in group 1 was not vaccinated because their parents withdrew consent after enrolment and randomisation, so 939 infants actually received the vaccinations. Three doses of bOPV or tOPV elicited type 1 and 3 seroconversion rates of at least 97·7%. Type 2 seroconversion occurred in 19 of 198 infants (9·6%, 95% CI 6·2–14·5) in the bOPV-only groups, 86 of 88 (97·7%, 92·1–99·4) in the tOPV-only group (p<0·0001 vs bOPV-only), and 156 of 194 (80·4%, 74·3–85·4) infants in the bOPV–one dose of IPV group (p<0·0001 vs bOPV-only). A further 20 of 193 (10%) infants in the latter group seroconverted 1 week after mOPV2 challenge, resulting in around 98% of infants being seropositive against type 2. After a bOPV–two IPV schedule, all 193 infants (100%, 98·0–100; p<0·0001 vs bOPV-only) seroconverted to type 2. IPV induced small but significant decreases in a composite serotype 2 viral shedding index after mOPV2 challenge. 21 serious adverse events were reported in 20 patients during the study, including two that were judged to be possibly related to the vaccines. Most of the serious adverse events (18 [86%] of 21) and 24 (80%) of the 30 important medical events reported were infections and infestations. No deaths occurred during the study.

Interpretation

bOPV provided humoral protection similar to tOPV against polio serotypes 1 and 3. After one or two IPV doses in addition to bOPV, 80% and 100% of infants seroconverted, respectively, and the vaccination induced a degree of intestinal immunity against type 2 poliovirus.

Funding

Bill & Melinda Gates Foundation.

Keywords: Research; Abstractss; Poliomyelitis; Vaccines.

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A #cluster of paralytic #poliomyelitis cases due to #transmission of slightly diverged #Sabin-2 #vaccine #virus (J Virol., abstract)

[Source: Journal of Virology, full page: (LINK). Abstract, edited.]

A cluster of paralytic poliomyelitis cases due to transmission of slightly diverged Sabin-2 vaccine virus

Ekaterina A. Korotkova a,b, Anatoly P. Gmyl b, Maria L. Yakovenko a,b, Olga E. Ivanova b, Tatyana P. Eremeeva b, Liubov I. Kozlovskaya b, Armen K. Shakaryan b, Galina Y. Lipskaya a, Irina L. Parshina c, Nataliya V. Loginovskikh d, Nadezhda S. Morozova e and Vadim I. Agol a,b#

Author Affiliations: aA. N. Belozersky Institute of Physical-Chemical Biology, M. V. Lomonosov Moscow State University, Moscow 119899, Russia; bM. P. Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow 142782, Russia; cCenter for Hygiene and Epidemiology in the Altai Region, Barnaul 656049, Russia; dCenter for Hygiene and Epidemiology in the Omsk Region, Omsk 644116, Russia; eFederal Center of Hygiene and Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow 117105, Russia

 

ABSTRACT

Four cases of acute flaccid paralysis caused by slightly evolved (Sabin-like) vaccine polioviruses of serotype 2 were registered in July-August, 2010 in an orphanage of Biysk (Altai Region, Russia). The Biysk cluster of vaccine-associated paralytic poliomyelitis (VAPP) had several uncommon, if not unique, features (1). Until this outbreak, Sabin-like viruses (in distinction with more markedly evolved vaccine-derived polioviruses, VDPV) were reported to cause only sporadic cases of VAPP. Consequently, VAPP were not considered to require outbreak-type responses. However, the Biysk outbreak completely blurred the borderline between Sabin-like viruses and VDPV in epidemiological terms (2). The outbreak demonstrated a very high disease/infection ratio, apparently exceeding even that reported for wild polioviruses. The viral genome structures did not provide any substantial hints as to the underlying reason(s) for such pathogenicity (3). The replacement of intestinal poliovirus lineages by other Sabin-like lineages during short intervals after the disease onsets was observed in two patients. Again, the sequences of the respective genomes provided no clues to explain these events (4). The polioviruses isolated from the patients and their contacts demonstrated a striking heterogeneity as well as rapid and uneven evolution of the whole genomes and their parts, apparently due to extensive interpersonal contacts in a relatively small closed community, multiple bottlenecking and recombination. Altogether, the results demonstrate several new aspects of pathogenicity, epidemiology, and evolution of vaccine-related polioviruses and underscore several serious gaps in understanding these problems.

 

IMPORTANCE.

The oral poliovirus vaccine largely contributed to the nearly complete disappearance of poliovirus-caused poliomyelitis. Being generally safe, it can, in some cases, result in a paralytic disease. Two types of such outcomes are distinguished: caused by slightly diverged (Sabin-like) viruses, on the one hand, and by significantly diverged VDPVs, on the other. This classification is based on the number of mutations in the viral genome region encoding a viral structural protein. Until now, only sporadic poliomyelitis cases due to Sabin-like polioviruses were described, and, in distinction with the VDPV-triggered outbreaks, they did not require broad-scale epidemiological responses. Here, an unusual outbreak of poliomyelitis caused by a Sabin-like virus is reported, which had an exceptionally high disease/infection ratio. This outbreak blurred the borderline between Sabin-like polioviruses and VDPV both in pathogenicity and kind of responses required as well as underscores important gaps in understanding pathogenicity, epidemiology, and evolution of vaccine-derived polioviruses.

 

FOOTNOTES

#To whom inquiries regarding the paper should be addressed: M. P. Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow 142782, Russia; agol@belozersky.msu.ru.

Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Keywords: Research; Abstracts; Poliomyelitis; Vaccines.

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