Characterization of Household and Community Shedding and Transmission of Oral Polio Vaccine in Mexican Communities With Varying Vaccination Coverage
Por:
Altamirano J., Purington N., Behl R., Sarnquist C., Holubar M., García-García L., Ferreyra-Reyes L., Montero-Campos R., Cruz-Hervert L.P., Boyle S., Modlin J., van Hoorebeke C., Leary S., Huang C., Sommer M., Ferreira-Guerrero E., Delgado-Sanchez G., Canizales-Quintero S., Díaz Ortega J.L., Desai M., Maldonado Y.A.
Publicada:
15 nov 2018
Resumen:
Background. The World Health Assembly 2012 Polio Eradication and Endgame
Strategic Plan calls for the eventual cessation of all oral polio
vaccines (OPVs), to be replaced with inactivated polio vaccine (IPV);
however, IPV induces less robust mucosal immunity than OPV. This study
characterized household and community OPV shedding and transmission
after OPV vaccination within primarily IPV-vaccinated communities.
Methods. Households in 3 IPV-vaccinated Mexican communities were
randomized to receive 3 levels of OPV vaccination coverage (70%, 30%,
or 10%). Ten stool samples were collected from all household members
over 71 days. Analysis compared vaccinated subjects, household contacts
of vaccinated subjects, and subjects in unvaccinated households.
Logistic and Cox regression models were fitted to characterize
transmission of OPV by coverage and household vaccination status.
Results. Among 148 vaccinated children, 380 household contacts, and 1124
unvaccinated community contacts, 78%, 18%, and 7%, respectively, shed
OPV. Community and household contacts showed no differences in
transmission (odds ratio [OR], 0.67; 95% confidence interval [CI],
.37-1.20), in shedding trajectory (OR, 0.61; 95% CI, .35-1.07), or in
time to shedding (hazard ratio, 0.68; 95% CI, .39-1.19). Transmission
began as quickly as 1 day after vaccination and persisted as long as 71
days after vaccination. Transmission within unvaccinated households
differed significantly across vaccination coverage communities, with the
70% community experiencing the most transmissions (15%), and the 10%
community experiencing the least (4%). These trends persisted over time
and in the time to first shedding analyses.
Conclusions. Transmission did not differ between household contacts of
vaccinees and unvaccinated households. Understanding poliovirus
transmission dynamics is important for postcertification control.
Filiaciones:
Altamirano J.:
Stanford University School of MedicineCA, United States
Purington N.:
Stanford University School of MedicineCA, United States
Behl R.:
Stanford University School of MedicineCA, United States
Sarnquist C.:
Stanford University School of MedicineCA, United States
Holubar M.:
Stanford University School of MedicineCA, United States
García-García L.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Ferreyra-Reyes L.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Montero-Campos R.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Cruz-Hervert L.P.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
Boyle S.:
Bill & Melinda Gates Foundation, Seattle, WA, United States
Modlin J.:
Bill & Melinda Gates Foundation, Seattle, WA, United States
van Hoorebeke C.:
Stanford University School of MedicineCA, United States
Leary S.:
Stanford University School of MedicineCA, United States
Huang C.:
Stanford University School of MedicineCA, United States
Sommer M.:
Stanford University School of MedicineCA, United States
Ferreira-Guerrero E.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Delgado-Sanchez G.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Canizales-Quintero S.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Díaz Ortega J.L.:
Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Desai M.:
Stanford University School of MedicineCA, United States
Maldonado Y.A.:
Stanford University School of MedicineCA, United States
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