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Decision Analysis in Planning for a Polio Outbreak in the United States.

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Title: Decision Analysis in Planning for a Polio Outbreak in the United States.
Authors: Jenkins, Pamela C., Modlin, John F.
Source: Pediatrics. Aug2006, Vol. 118 Issue 2, p611-618. 8p. 1 Diagram, 1 Chart, 3 Graphs.
Subjects: Polio prevention, Central nervous system diseases, Vaccination, Preventive medicine, Disease outbreaks
Geographic Terms: United States
Abstract: OBJECTIVE. Global eradication of poliomyelitis may soon be achieved, but circulating polioviruses could reemerge years after eradication by reversion of live attenuated oral vaccine virus to a virulent form, laboratory stock mishandling, or bioterrorism. If a poliomyelitis outbreak occurs in the United States, access to a vaccine stockpile to interrupt viral spread will be necessary. Options for the stockpile include the inactivated polio vaccine and the live-attenuated trivalent and monovalent oral poliovirus vaccines. With differences in immunogenicity, adverse effects, availability, and other issues, the optimal vaccine choice for the stockpile is not clear. We sought to compare vaccine interventions for poliomyelitis outbreak control. DESIGN. We applied decision analysis to 8 strategies for outbreak control: no intervention, 1 or 2 inactivated polio vaccine doses, 1 or 2 trivalent oral poliovirus vaccine doses, 1 or 2 monovalent oral poliovirus vaccine doses, and sequential inactivated polio vaccine-monovalent oral poliovirus vaccine. Historical data from outbreaks in developed countries were used to estimate the risk of paralytic disease after a hypothetical reintroduction of circulating polioviruses. The outcome measure was cases of paralytic poliomyelitis. RESULTS. Monovalent oral poliovirus vaccine provided optimal outbreak control in most scenarios because of high seroconversion rates with 1 dose. Control provided by trivalent oral poliovirus vaccine and inactivated polio vaccine was equivalent at high vaccine coverage rates. At low intervention rates, trivalent oral poliovirus vaccine produced fewer paralytic cases than inactivated polio vaccine in highly immune populations but more cases than inactivated polio vaccine in poorly immunized groups because of secondary transmission of oral poliovirus vaccine virus and vaccine-derived viruses. CONCLUSIONS. This model suggests that monovalent oral poliovirus vaccine would be the most advantageous vaccine for outbreak control. If a monovalent oral poliovirus vaccine stockpile is impractical the optimal vaccine choice depends on the previous immunity and the anticipated intervention rates. [ABSTRACT FROM AUTHOR]
Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Decision Analysis in Planning for a Polio Outbreak in the United States.
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  Data: <searchLink fieldCode="AR" term="%22Jenkins%2C+Pamela+C%2E%22">Jenkins, Pamela C.</searchLink><br /><searchLink fieldCode="AR" term="%22Modlin%2C+John+F%2E%22">Modlin, John F.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Pediatrics%22">Pediatrics</searchLink>. Aug2006, Vol. 118 Issue 2, p611-618. 8p. 1 Diagram, 1 Chart, 3 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Polio+prevention%22">Polio prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Central+nervous+system+diseases%22">Central nervous system diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Vaccination%22">Vaccination</searchLink><br /><searchLink fieldCode="DE" term="%22Preventive+medicine%22">Preventive medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+outbreaks%22">Disease outbreaks</searchLink>
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  Data: OBJECTIVE. Global eradication of poliomyelitis may soon be achieved, but circulating polioviruses could reemerge years after eradication by reversion of live attenuated oral vaccine virus to a virulent form, laboratory stock mishandling, or bioterrorism. If a poliomyelitis outbreak occurs in the United States, access to a vaccine stockpile to interrupt viral spread will be necessary. Options for the stockpile include the inactivated polio vaccine and the live-attenuated trivalent and monovalent oral poliovirus vaccines. With differences in immunogenicity, adverse effects, availability, and other issues, the optimal vaccine choice for the stockpile is not clear. We sought to compare vaccine interventions for poliomyelitis outbreak control. DESIGN. We applied decision analysis to 8 strategies for outbreak control: no intervention, 1 or 2 inactivated polio vaccine doses, 1 or 2 trivalent oral poliovirus vaccine doses, 1 or 2 monovalent oral poliovirus vaccine doses, and sequential inactivated polio vaccine-monovalent oral poliovirus vaccine. Historical data from outbreaks in developed countries were used to estimate the risk of paralytic disease after a hypothetical reintroduction of circulating polioviruses. The outcome measure was cases of paralytic poliomyelitis. RESULTS. Monovalent oral poliovirus vaccine provided optimal outbreak control in most scenarios because of high seroconversion rates with 1 dose. Control provided by trivalent oral poliovirus vaccine and inactivated polio vaccine was equivalent at high vaccine coverage rates. At low intervention rates, trivalent oral poliovirus vaccine produced fewer paralytic cases than inactivated polio vaccine in highly immune populations but more cases than inactivated polio vaccine in poorly immunized groups because of secondary transmission of oral poliovirus vaccine virus and vaccine-derived viruses. CONCLUSIONS. This model suggests that monovalent oral poliovirus vaccine would be the most advantageous vaccine for outbreak control. If a monovalent oral poliovirus vaccine stockpile is impractical the optimal vaccine choice depends on the previous immunity and the anticipated intervention rates. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=22893447
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        Value: 10.1542/peds.2005-2358
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        Text: English
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      – SubjectFull: Polio prevention
        Type: general
      – SubjectFull: Central nervous system diseases
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      – SubjectFull: Vaccination
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      – SubjectFull: United States
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              Text: Aug2006
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