{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T18:25:28Z","timestamp":1783189528272,"version":"3.54.6"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T00:00:00Z","timestamp":1538956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health","award":["5NU2RGH001913-02-00"],"award-info":[{"award-number":["5NU2RGH001913-02-00"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Risk Analysis"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Since most poliovirus infections occur with no paralytic symptoms, the possibility of silent circulation complicates the confirmation of the end of poliovirus transmission. Based on empirical field experience and theoretical modeling results, the Global Polio Eradication Initiative identified three years without observing paralytic cases from wild polioviruses with good acute flaccid paralysis surveillance as an indication of sufficient confidence that poliovirus circulation stopped. The complexities of real populations and the imperfect nature of real surveillance systems subsequently demonstrated the importance of specific modeling for areas at high risk of undetected circulation, resulting in varying periods of time required to obtain the same level of confidence about no undetected circulation. Using a poliovirus transmission model that accounts for variability in transmissibility and neurovirulence for different poliovirus serotypes and characterizes country\u2010specific factors (e.g., vaccination and surveillance activities, demographics) related to wild and vaccine\u2010derived poliovirus transmission in Pakistan and Afghanistan, we consider the probability of undetected poliovirus circulation for those countries once apparent die\u2010out occurs (i.e., in the absence of any epidemiological signals). We find that gaps in poliovirus surveillance or reaching elimination with borderline sufficient population immunity could significantly increase the time to reach high confidence about interruption of live poliovirus transmission, such that the path taken to achieve and maintain poliovirus elimination matters. Pakistan and Afghanistan will need to sustain high\u2010quality surveillance for polioviruses after apparent interruption of transmission and recognize that as efforts to identify cases or circulating live polioviruses decrease, the risks of undetected circulation increase and significantly delay the global polio endgame.<\/jats:p>","DOI":"10.1111\/risa.13214","type":"journal-article","created":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T18:09:39Z","timestamp":1539022179000},"page":"402-413","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan"],"prefix":"10.1111","volume":"39","author":[{"given":"Dominika A.","family":"Kalkowska","sequence":"first","affiliation":[{"name":"Kid Risk, Inc.  Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radboud J.","family":"Duintjer Tebbens","sequence":"additional","affiliation":[{"name":"Kid Risk, Inc.  Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Pallansch","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases Centers for Disease Control and Prevention  Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly M.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Kid Risk, Inc.  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