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Table 3 Impact of outbreak response choices on effective mOPV exportations, new iVDPV excretors, and OPV restarts

From: Characterization of outbreak response strategies and potential vaccine stockpile needs for the polio endgame

Outbreak response choice or assumption Number of affected iterations mOPV exportations (totals from 100 iterations) PID patients infected with OPV used during oSIAs (totals from 100 iterations) OPV restarts Expected paralytic cases 2013–2052 (after OPV cessation)a
Potential expor-tations Effective reintro-ductions (to other blocks) Out-breaks Newly infected long-term excretors Potential iVDPV reintro-ductions Effective iVDPV reintro-ductions Out-breaks No OPV restart OPV restart All
Base case N/A 3,618 312 (14) 0 117 96 22 10 2 340 720,000 15,000
Duration of mOPV use after homotypic OPV cessation (years)  
 - 3 77 3,141 255 (11) 0 84 57 15 7 10b 240 850,000 85,000
 - through Tend 30 4,153 364 (18) 0 136 119 23 19 0 370 - 370
Minimum R0 to trigger block-wide response  
 - 8 45 5,709 479 (23) 0 173 151 34 16 2b 370 610,000 13,000
 - 13 43 1,323 155 (12) 1 64 66 15 7 4 370 1,000,000 40,000
Response delay (days)c
 - Always 30 96 3,521 300 (15) 0 106 99 23 10 2 240 530,000 11,000
 - Always 45 92 3,620 311 (14) 0 117 96 22 10 3 620 1,000,000 29,000
 - Always 60 96 3,936 335 (18) 0 133 106 23 10 6 640 1,100,000 64,000
oSIA vaccine between OPV2 and OPV13 cessation for serotype 2 outbreaks  
 - tOPV 36 3,634 315 (5) 0 117 96 21 10 2 340 720,000 15,000
 - IPV 36 3,586 317 (14) 1 121 96 22 11 3 360 740,000 22,000
Finite mOPV stockpile 27 3,962 347 (19) 0 166 102 24 10 7b 1,300 770,000 55,000
  1. Abbreviations: IPV inactivated poliovirus vaccine, iVDPV immunodeficiency-associated vaccine-derived poliovirus; mOPV, monovalent OPV, OPV oral poliovirus vaccine, OPV## cessation globally-coordinated cessation of OPV containing the serotype(s) indicated by ##, oSIA outbreak response supplemental immunization activity, PID primary immunodeficiency disease, R 0 basic reproduction number, T end end of the analytical time horizon (i.e., December 31, 2052), tOPV trivalent OPV
  2. aDoes not include a total of approximately 1,000 expected WPV, VAPP, and cVDPV cases that occur before OPV cessation of each serotype [2]
  3. bOne additional iteration had ongoing LPV transmission at Tend without having accumulated 50,000 cases since 2016
  4. cAll alternative choices assume non-adaptive surveillance quality (detection threshold) and response delay in the event of a subpopulation-specific response