US National Library of Medicine
National Institutes of Health – 2008
Wringe A, Fine PE, Sutter RW, Kew OM.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England. email@example.com
Eight outbreaks of paralytic polio attributable to circulating vaccine-derived poliovirus (cVDPV) have highlighted the risks associated with oral poliovirus vaccine (OPV) use in areas of low vaccination coverage and poor hygiene. As the Polio Eradication Initiative enters its final stages, it is important to consider the extent to which these viruses spread under different conditions, so that appropriate strategies can be devised to prevent or respond to future cVDPV outbreaks.
METHODS AND FINDINGS:
This paper examines epidemiological (temporal, geographic, age, vaccine history, social group, ascertainment), and virological (type, genetic diversity, virulence) parameters in order to infer the numbers of individuals likely to have been infected in each of these cVDPV outbreaks, and in association with single acute flaccid paralysis (AFP) cases attributable to VDPVs. Although only 114 virologically-confirmed paralytic cases were identified in the eight cVDPV outbreaks, it is likely that a minimum of hundreds of thousands, and more likely several million individuals were infected during these events, and that many thousands more have been infected by VDPV lineages within outbreaks which have escaped detection.
Our estimates of the extent of cVDPV circulation suggest widespread transmission in some countries, as might be expected from endemic wild poliovirus transmission in these same settings. These methods for inferring extent of infection will be useful in the context of identifying future surveillance needs, planning for OPV cessation and preparing outbreak response plans.
US National Library of Medicine
National Institutes of Health – Mar 2017
Berchenko Y – 1, Manor Y – 2, Freedman LS – 3, Kaliner E – 4, Grotto I – 4,5, Mendelson E – 2,6, Huppert A – 3,6.
1 Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P. O. 653, Beer-Sheva 84105, Israel. firstname.lastname@example.org.
2 Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
3 Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer 52621, Israel.
4 Public Health Services, Ministry of Health, Jerusalem 9101002, Israel.
5 Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
6 School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P. O. 39040, Tel Aviv 6997801, Israel.
A major obstacle to eradicating polio is that poliovirus from endemic countries can be reintroduced to polio-free countries. Environmental surveillance (ES) can detect poliovirus from sewage or wastewaters samples, even in the absence of patients with paralysis. ES is underused, in part because its sensitivity is unknown. We used two unique data sets collected during a natural experiment provided by the 2013 polio outbreak in Israel: ES data from different locations and records of supplemental immunization with the live vaccine. Data from the intersecting population between the two data sets (covering more than 63,000 people) yielded a dose-dependent relationship between the number of poliovirus shedders and the amount of poliovirus in sewage. Using a mixed-effects linear regression analysis of these data, we developed several quantitative tools, such as (i) ascertainment of the number of infected individuals from ES data for application during future epidemics elsewhere, (ii) evaluation of the sensitivity of ES, and (iii) determination of the confidence level of the termination of poliovirus circulation after an outbreak. These results will be valuable in monitoring future outbreaks with ES, and this approach could be used to certify poliovirus elimination or to validate the need for more containment efforts.
US National Library of Medicine
National Institutes of Health – May 2012
Sasaki A, Haraguchi Y, Yoshida H.
Department of Evolutionary Studies of Biosystems, The Graduate University for Advanced Studies Hayama, Kanagawa, Japan.
Live vaccination against polio has effectively prevented outbreaks in most developed countries for more than 40 years, and there remain only a few countries where outbreaks of poliomyelitis by the wild strain still threaten the community. It is expected that worldwide eradication will be eventually achieved through careful surveillance and a well-managed immunization program. The present paper argues, however, that based on a simple stochastic model the risk of outbreak by a vaccine-derived strain after the cessation of vaccination is quite high, even if many years have passed since the last confirmed case. As vaccinated hosts are natural reservoirs for virulent poliovirus, the source of the risk is the vaccination itself, employed to prevent the outbreaks. The crisis after stopping vaccination will emerge when the following two conditions are met: the susceptible host density exceeds the threshold for epidemics and the vaccinated host density remains large enough to ensure the occurrence of virulent mutants in the population. Our estimates for transmission, recovery, and mutation rates, show that the probability of an outbreak of vaccine-derived virulent viruses easily exceeds 90%. Moreover, if a small fraction of hosts have a longer infectious period, as observed in individuals with innate immunodeficiency, the risk of an outbreak rises significantly. Under such conditions, successful global eradication of polio is restricted to a certain range of parameters even if inactivated polio vaccine (IPV) is extensively used after the termination of live vaccination.
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Testimony by Phil Robertson from Duck Dynasty
1 Moreover, brethren, I declare unto you the gospel which I preached unto you, which also ye have received, and wherein ye stand;
2 by which also ye are saved, if ye keep in memory what I preached unto you, unless ye have believed in vain.
3 For I delivered unto you first of all that which I also received, how that Christ died for our sins according to the scriptures;
4 and that he was buried, and that he rose again the third day according to the scriptures:
1 Therefore leaving the principles of the doctrine of Christ, let us go on unto perfection; not laying again the foundation of repentance from dead works, and of faith toward God,
2 of the doctrine of baptisms, and of laying on of hands, and of resurrection of the dead, and of eternal judgment.
3 And this will we do, if God permit.
4 For it is impossible for those who were once enlightened, and have tasted of the heavenly gift, and were made partakers of the Holy Ghost,
5 and have tasted the good word of God, and the powers of the world to come,
6 if they shall fall away, to renew them again unto repentance; seeing they crucify to themselves the Son of God afresh, and put him to an open shame.
7 For the earth which drinketh in the rain that cometh oft upon it, and bringeth forth herbs meet for them by whom it is dressed, receiveth blessing from God:
8 but that which beareth thorns and briers is rejected, and is nigh unto cursing; whose end is to be burned.
1 Who hath believed our report? and to whom is the arm of the Lord revealed?
2 For he shall grow up before him as a tender plant,and as a root out of a dry ground:he hath no form nor comeliness;and when we shall see him,there is no beauty that we should desire him.
3 He is despised and rejected of men;a man of sorrows, and acquainted with grief:and we hid as it were our faces from him;he was despised, and we esteemed him not.
4 Surely he hath borne our griefs,and carried our sorrows:yet we did esteem him stricken,smitten of God, and afflicted.
5 But he was wounded for our transgressions,he was bruised for our iniquities:the chastisement of our peace was upon him;and with his stripes we are healed.
6 All we like sheep have gone astray;we have turned every one to his own way;and the Lord hath laid on him the iniquity of us all.
7 He was oppressed, and he was afflicted,yet he opened not his mouth:he is brought as a lamb to the slaughter,and as a sheep before her shearers is dumb,so he openeth not his mouth.
8 He was taken from prison and from judgment:and who shall declare his generation? for he was cut off out of the land of the living:for the transgression of my people was he stricken.
9 And he made his grave with the wicked,and with the rich in his death;because he had done no violence,neither was any deceit in his mouth.
10 Yet it pleased the Lord to bruise him;he hath put him to grief:when thou shalt make his soul an offering for sin,he shall see his seed, he shall prolong his days,and the pleasure of the Lord shall prosper in his hand.
11 He shall see of the travail of his soul, and shall be satisfied:by his knowledge shall my righteous servant justify many;for he shall bear their iniquities.
12 Therefore will I divide him a portion with the great,and he shall divide the spoil with the strong;because he hath poured out his soul unto death:and he was numbered with the transgressors;and he bare the sin of many,and made intercession for the transgressors.
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