Background:Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response. Methods:We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts. Results:Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term. Conclusions:Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.

译文

背景:最近在尼日利亚北部(博尔诺州和索科托州)和巴基斯坦(巴洛克希斯坦省)检测到循环的血清型2疫苗源性脊髓灰质炎病毒,在巴基斯坦,阿富汗和尼日利亚(博尔诺)发现了血清型1型野生脊髓灰质炎病毒,这代表了需要紧急响应的公共卫生紧急情况。
方法:我们使用现有的动态脊髓灰质炎病毒传播和口服脊髓灰质炎病毒疫苗进化模型证明了接种不足的亚群的重要性。我们回顾了在小儿麻痹症终末期中学到的有关亚群在维持传播中的作用的经验教训,并探讨了亚群对其他疫苗可预防的疾病消除工作的影响。
结果:相对分离的亚群受益于周围人群对传播的高度免疫力,只要他们没有获得较高的疫苗接种覆盖率,它们就会维持传播。未能以较高的覆盖率到达此类亚群是根除脊髓灰质炎根除延误的根本原因。要实现和保持根除工作,必须解决最薄弱的环节,其中包括对不安全地区和/或卫生系统受到破坏或运行不佳的人群进行免疫接种,以及管理具有主要免疫缺陷的人的风险,这些人可以长期排出疫苗衍生的脊髓灰质炎病毒。
结论:根除疫苗可预防疾病的努力需要为各国创造绩效期望,以使所有居住在其境内的人们获得免疫,并通过适当的干预措施保持较高的覆盖率。脊髓灰质炎;消灭;传播;异质性。

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