Dataset Information

The role of older children and adults in wild poliovirus transmission.

ABSTRACT: As polio eradication inches closer, the absence of poliovirus circulation in most of the world and imperfect vaccination coverage are resulting in immunity gaps and polio outbreaks affecting adults. Furthermore, imperfect, waning intestinal immunity among older children and adults permits reinfection and poliovirus shedding, prompting calls to extend the age range of vaccination campaigns even in the absence of cases in these age groups. The success of such a strategy depends on the contribution to poliovirus transmission by older ages, which has not previously been estimated. We fit a mathematical model of poliovirus transmission to time series data from two large outbreaks that affected adults (Tajikistan 2010, Republic of Congo 2010) using maximum-likelihood estimation based on iterated particle-filtering methods. In Tajikistan, the contribution of unvaccinated older children and adults to transmission was minimal despite a significant number of cases in these age groups [reproduction number, R = 0.46 (95% confidence interval, 0.42-0.52) for >5-y-olds compared to 2.18 (2.06-2.45) for 0- to 5-y-olds]. In contrast, in the Republic of Congo, the contribution of older children and adults was significant [R = 1.85 (1.83-4.00)], perhaps reflecting sanitary and socioeconomic variables favoring efficient virus transmission. In neither setting was there evidence for a significant role of imperfect intestinal immunity in the transmission of poliovirus. Bringing the immunization response to the Tajikistan outbreak forward by 2 wk would have prevented an additional 130 cases (21%), highlighting the importance of early outbreak detection and response.

SUBMITTER: Blake IM

PROVIDER: S-EPMC4115498 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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The role of older children and adults in wild poliovirus transmission.

Blake Isobel M IM Martin Rebecca R Goel Ajay A Khetsuriani Nino N Everts Johannes J Wolff Christopher C Wassilak Steven S Aylward R Bruce RB Grassly Nicholas C NC

Proceedings of the National Academy of Sciences of the United States of America 20140707 29

As polio eradication inches closer, the absence of poliovirus circulation in most of the world and imperfect vaccination coverage are resulting in immunity gaps and polio outbreaks affecting adults. Furthermore, imperfect, waning intestinal immunity among older children and adults permits reinfection and poliovirus shedding, prompting calls to extend the age range of vaccination campaigns even in the absence of cases in these age groups. The success of such a strategy depends on the contribution ...[more]

PMID: 25002465

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Project description:ObjectiveTo explore the extent to which undervaccinated subpopulations may influence the confidence about no circulation of wild poliovirus (WPV) after the last detected case.Design and participantsWe used a hypothetical model to examine the extent to which the existence of an undervaccinated subpopulation influences the confidence about no WPV circulation after the last detected case as a function of different characteristics of the subpopulation (eg, size, extent of isolation). We also used the hypothetical population model to inform the bounds on the maximum possible time required to reach high confidence about no circulation in a completely isolated and unvaccinated subpopulation starting either at the endemic equilibrium or with a single infection in an entirely susceptible population.ResultsIt may take over 3 years to reach 95% confidence about no circulation for this hypothetical population despite high surveillance sensitivity and high vaccination coverage in the surrounding general population if: (1) ability to detect cases in the undervaccinated subpopulation remains exceedingly small, (2) the undervaccinated subpopulation remains small and highly isolated from the general population and (3) the coverage in the undervaccinated subpopulation remains very close to the minimum needed to eradicate. Fully-isolated hypothetical populations of 4000 people or less cannot sustain endemic transmission for more than 5 years, with at least 20 000 people required for a 50% chance of at least 5 years of sustained transmission in a population without seasonality that starts at the endemic equilibrium. Notably, however, the population size required for persistent transmission increases significantly for realistic populations that include some vaccination and seasonality and/or that do not begin at the endemic equilibrium.ConclusionsSignificant trade-offs remain inherent in global polio certification decisions, which underscore the need for making and valuing investments to maximise population immunity and surveillance quality in all remaining possible WPV reservoirs.

Project description:BackgroundLife satisfaction is associated with many important health outcomes among older adults and is an indicator of successful ageing. The present study aims to replicate earlier findings regarding relationships between satisfaction with various life domains and life satisfaction in older adults. The study furthermore explores how parental status is associated with satisfaction with different life domains and how two types of intergenerational contact (contact with own children; post-retirement work in childcare) relate to life satisfaction.MethodsParticipants were 1978 older adults, aged 65-75 year (51.7% female), who live in Bremen and took part in the OUTDOOR ACTIVE study. 82.6% of the participants had one or more children. All participants completed a questionnaire, which among others comprised items assessing life satisfaction as well as satisfaction with six different life domains (satisfaction with living situation, financial situation, leisure time, health, family, neighbors and friends).ResultsLS is significantly related to all of the investigated life domains, independent of sex and age. For the participants with children, life satisfaction had the highest association with satisfaction with family (β: 0.202; 95%CI: 0.170-0.235), followed by satisfaction with neighbors and friends (β: 0.151; 95%CI: 0.111-0.191), and health satisfaction (β: 0.148; 95%CI: 0.120-0.176). In comparison to that, participants without children had the highest association between life satisfaction and satisfaction with health (β: 0.193; 95%CI: 0.135-0.252), followed by satisfaction with family (β: 0.175; 95%CI: 0.114-0.236) and satisfaction with neighbors and friends (β: 0.154; 95%CI: 0.077-0.232). In participants with children, there was a non-significant negative association between life satisfaction and work in childcare (β: -0.031; 95%CI: -0.178-0.116), while life satisfaction was statistically significantly positively associated to work in childcare in participants without own children (β: 0.681; 95%CI: 0.075-1.288).ConclusionsThe results suggest that the domain-specific approach to life satisfaction can elucidate differences in the correlates of life satisfaction and well-being between older adults with and without children. They further suggest that the benefits of working with children for life satisfaction may be more pronounced in older adults without children than older adults with children.

Dataset Information

The role of older children and adults in wild poliovirus transmission.

Publications

The role of older children and adults in wild poliovirus transmission.

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