{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:50:45Z","timestamp":1792180245732,"version":"4.4.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"9","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["5NU2RGH001913-05-00"],"award-info":[{"award-number":["5NU2RGH001913-05-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pakistan and Afghanistan remain the only reservoirs of wild poliovirus transmission. Prior modeling suggested that before the coronavirus disease 2019 (COVID-19) pandemic, plans to stop the transmission of serotype 1 wild poliovirus (WPV1) and persistent serotype 2 circulating vaccine-derived poliovirus (cVDPV2) did not appear on track to succeed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We updated an existing poliovirus transmission and Sabin-strain oral poliovirus vaccine (OPV) evolution model for Pakistan and Afghanistan to characterize the impacts of immunization disruptions and restrictions on human interactions (ie, population mixing) due to the COVID-19 pandemic. We also consider different options for responding to outbreaks and for preventive supplementary immunization activities (SIAs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The modeling suggests that with some resumption of activities in the fall of 2020 to respond to cVDPV2 outbreaks and full resumption on 1 January 2021 of all polio immunization activities to pre\u2013COVID-19 levels, Pakistan and Afghanistan would remain off-track for stopping all transmission through 2023 without improvements in quality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Using trivalent OPV (tOPV) for SIAs instead of serotype 2 monovalent OPV offers substantial benefits for ending the transmission of both WPV1 and cVDPV2, because tOPV increases population immunity for both serotypes 1 and 2 while requiring fewer SIA rounds, when effectively delivered in transmission areas.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiab160","type":"journal-article","created":{"date-parts":[[2021,3,20]],"date-time":"2021-03-20T04:17:12Z","timestamp":1616213832000},"page":"1529-1538","source":"Crossref","is-referenced-by-count":14,"title":["Updated Characterization of Poliovirus Transmission in Pakistan and Afghanistan and the Impacts of Different Outbreak Response Vaccine Options"],"prefix":"10.1093","volume":"224","author":[{"given":"Dominika A","family":"Kalkowska","sequence":"first","affiliation":[{"name":"Kid Risk, Inc, Orlando, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A","family":"Pallansch","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L","family":"Cochi","sequence":"additional","affiliation":[{"name":"Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0849-9147","authenticated-orcid":false,"given":"Kimberly M","family":"Thompson","sequence":"additional","affiliation":[{"name":"Kid Risk, Inc, Orlando, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"key":"2021111805071487600_CIT0001","author":"World Health Organization"},{"key":"2021111805071487600_CIT0002","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.15585\/mmwr.mm6946a5","article-title":"Progress toward poliomyelitis eradication\u2014Pakistan, January 2019-September 2020","volume":"69","author":"Hsu","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021111805071487600_CIT0003","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.15585\/mmwr.mm6940a3","article-title":"Progress toward poliomyelitis eradication\u2014Afghanistan, January 2019-July 2020","volume":"69","author":"Martinez","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021111805071487600_CIT0004","author":"World Health Organization"},{"key":"2021111805071487600_CIT0005","author":"World Health Organization Global Polio Eradication Initiative"},{"key":"2021111805071487600_CIT0006","author":"World Health Organization Global Polio Eradication Initiative"},{"key":"2021111805071487600_CIT0007","author":"World Health Organization Global Polio Eradication Initiative"},{"key":"2021111805071487600_CIT0008","author":"World Health Organization Global Polio Eradication 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analysis","volume":"14","author":"Molodecky","year":"2017","journal-title":"PLoS Med"},{"key":"2021111805071487600_CIT0015","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1111\/risa.12962","article-title":"Modeling poliovirus transmission in Pakistan and Afghanistan to inform vaccination strategies in undervaccinated subpopulations","volume":"38","author":"Duintjer Tebbens","year":"2018","journal-title":"Risk Anal"},{"key":"2021111805071487600_CIT0016","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/risa.13194","article-title":"Evaluation of proactive and reactive strategies for polio eradication activities in Pakistan and Afghanistan","volume":"39","author":"Duintjer Tebbens","year":"2019","journal-title":"Risk Anal"},{"key":"2021111805071487600_CIT0017","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/risa.13214","article-title":"Modeling undetected live poliovirus circulation after apparent interruption of transmission: Pakistan and Afghanistan","volume":"39","author":"Kalkowska","year":"2019","journal-title":"Risk Anal"},{"key":"2021111805071487600_CIT0018","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/risa.13193","article-title":"Environmental surveillance system characteristics and impacts on confidence about no undetected serotype 1 wild poliovirus circulation","volume":"39","author":"Kalkowska","year":"2019","journal-title":"Risk Anal"},{"key":"2021111805071487600_CIT0019","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/risa.13580","article-title":"Disease surveillance investments and administration: limits to information value in Pakistan polio eradication","volume":"41","author":"Scott","year":"2021","journal-title":"Risk Anal"},{"key":"2021111805071487600_CIT0020","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12879-018-3070-4","article-title":"Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study","volume":"18","author":"O\u2019Reilly","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2021111805071487600_CIT0021","doi-asserted-by":"crossref","first-page":"e0208336","DOI":"10.1371\/journal.pone.0208336","article-title":"Assessing the sensitivity of the polio environmental surveillance system","volume":"13","author":"Kroiss","year":"2018","journal-title":"PLoS One"},{"key":"2021111805071487600_CIT0022","doi-asserted-by":"crossref","first-page":"e0180608","DOI":"10.1371\/journal.pone.0180608","article-title":"The role of supplementary environmental surveillance to complement acute flaccid paralysis surveillance for wild poliovirus in Pakistan\u20142011\u20132013","volume":"12","author":"Cowger","year":"2017","journal-title":"PLoS One"},{"key":"2021111805071487600_CIT0023","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/risa.13447","article-title":"Global transmission of live polioviruses: updated dynamic modeling of the polio 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