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Updated Characterization of Post-OPV Cessation Risks: Lessons from 2019 Serotype 2 Outbreaks and Implications for the Probability of OPV Restart

机译：OPV后停止风险的更新表征：2019年血清型的课程2爆发和对OPV概率的爆发和影响

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摘要

After the globally coordinated cessation of any serotype of oral poliovirus vaccine (OPV), some risks remain from undetected, existing homotypic OPV-related transmission and/or restarting transmission due to several possible reintroduction risks. The Global Polio Eradication Initiative (GPEI) coordinated global cessation of serotype 2-containing OPV (OPV2) in 2016. Following OPV2 cessation, the GPEI and countries implemented activities to withdraw all the remaining trivalent OPV, which contains all three poliovirus serotypes (i.e., 1, 2, and 3), from the supply chain and replace it with bivalent OPV (containing only serotypes 1 and 3). However, as of early 2020, monovalent OPV2 use for outbreak response continues in many countries. In addition, outbreaks observed in 2019 demonstrated evidence of different types of risks than previously modeled. We briefly review the 2019 epidemiological experience with serotype 2 live poliovirus outbreaks and propose a new risk for unexpected OPV introduction for inclusion in global modeling of OPV cessation. Using an updated model of global poliovirus transmission and OPV evolution with and without consideration of this new risk, we explore the implications of the current global situation with respect to the likely need to restart preventive use of OPV2 in OPV-using countries. Simulation results without this new risk suggest OPV2 restart will likely need to occur (81% of 100 iterations) to manage the polio endgame based on the GPEI performance to date with existing vaccine tools, and with the new risk of unexpected OPV introduction the expected OPV2 restart probability increases to 89%. Contingency planning requires new OPV2 bulk production, including genetically stabilized OPV2 strains.
机译：在全球协调的口服鼠疫疫苗（OPV）的任何血清型停止后，由于几种可能的重新引入风险，一些风险仍然来自未检测到的现有型OPV相关的传播和/或重启传输。全球脊髓灰质炎根除倡议（GPEI）于2016年协调全球溃现2次申察OPV（OPV2）。在OPV2停止之后，GPEI和各国实施了撤回所有剩余三价OPV的活动，其中包含所有三个脊髓灰质血症血清型（即，来自供应链的1,2和3）并用二价OPV替换它（仅含有血清型1和3）。然而，截至2020年初，在许多国家继续进行单价OPV2用于爆发反应的使用。此外，2019年观察到的爆发展示了不同类型风险的证据，而不是先前建模。我们简要介绍了血清型爆发的2019年流行病学经验，并提出了意外OPV介绍的新风险，以纳入OPV戒烟的全球建模。使用更新的全球Poliovirus传输和OPV演变模型，不考虑这种新风险，我们探讨了当前全球局势对最可能需要重新启动OPV2在OPV使用国家的可能性情况的可能性。没有这种新风险的仿真结果表明OPV2重启可能会发生（100个迭代的81％）来管理基于GPEI性能的Polio Endame与现有的疫苗工具，并具有意外OPV的新风险引入预期的OPV2重启概率增加到89％。应急计划需要新的OPV2散装生产，包括遗传稳定的OPV2菌株。

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